Paramedic Practical Skills Manual - Great Lakes...

GLEMSA/DU Skill Sheet Name ______________________

Introduction This is the Great Lakes EMS Academy / Davenport University Consortium Paramedic ALS Psychomotor Skills

Manual. This manual is part of the student’s permanent record. The student will have possession of this book

throughout the Paramedic course. The student should try to bring this to class every day and also with them to their

various clinical experiences.

In 2016, the Great Lakes EMS Academy has changed some of the methods in training, evaluation and

documentation of skills training. These changes have occurred to make sure that we are in compliance with the

NREMT Paramedic Psychomotor Competencies Portfolio (PPCP). This new portfolio structure will necessitate

very involved documentation by the student.

Psychomotor skills are an important component of safe and effective out-of-hospital care. Delivery of care, at its

most fundamental level, is when and where the importance of EMS is demonstrated to the public. Compassionate

care using the complete affective skill set can result in a positive image of EMS and lead to medical and public

support for the profession. Psychomotor Skills include the skills lab and scenario lab components. Psychomotor

education begins in the skills lab component, where psychomotor learning takes place. The skills lab component is

the setting for educational imprinting, cognitive integration, frequent drilling and autonomic development of

psychomotor skills. The scenario lab component provides students a contextual opportunity to demonstrate what

they have learned in a simulated environment based upon the psychomotor skills established in the skills lab. Once

students have demonstrated skill competence in the simulated environment, they progress to assessing and treating

real patients in the clinical phase with adequate supervision.

The clinical phase in a student’s education includes “planned, scheduled, educational student experience with patient

contact activities in settings, such as hospitals, clinics, free-standing emergency centers, and the ambulance.”

Generally speaking, we try to teach skills within the first days of class. We follow short discussion on skills with

demonstration and then practice…practice…practice. During practice time the students are expected to participate

in learner-lead skills practice. Following practice, the student will go through skills evaluation. During evaluation a

passing score is determined by how many points the student receives from the skill sheet. The minimal score for

successful completion is found on the bottom of each of the skill sheets. Next, we will put the student into

scenario-based training at the earliest time possible. Only after the completion of scenario-based training may a

student practice that skill in the clinical environment. So, for example, students will learn how to start an IV in the

second week of class. They will be practicing the skill on a manikin arm, which is setting on a table. The next week

will already be “testing” for that skill. Scenario-based training will be the next step. The student will then be

“signed off” in their clinical manual. At that time, the student will be able to start IVs in the clinical environment.

Paramedic students are required to successfully test out several times for each of the skills. The opportunity to test

will begin within the first few weeks of class. As adult learners we all need to be challenged and see progress. As

we are taught and then practice skills, our abilities and confidence increases with experience.

Students who fail skills testing will have an opportunity to retest. Students may need to complete remedial training

outside of the regularly scheduled time frames for class.

At the end of each module, the faculty will be reviewing the student’s practical skill sheets to assure that the student

has passed all of the required skills testing. If there is a problem with the student’s documentation for skills

evaluation, the student will be required to show competency in that skill (pass a skill station).

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To be Successful To pass each practical skill, the student must obtain a score that is at least as high as the minimum score designated

at the bottom of the skill sheet and must not violate any of the critical criteria (auto fail).

The student must physically go through all of the steps on each practical skill in order to sufficiently learn

it. Simply repeating what is printed on the practical skill sheet is not sufficient, and the student will fail the

examination if he or she does that. The student must demonstrate that he or she is capable of physically performing

the practical skill, not simply repeating printed lines of text.

Each skill must be practiced several times in order to sufficiently learn it. Simply watching an instructor

demonstrate the skill or watching other students practice the skill is not sufficient. The student must physically

practice the skill themselves several times in order to sufficiently learn it.

“Standard Precautions” is the first step on each practical skill, and failure to take appropriate standard precautions is

a critical failure on many practical skills. Therefore, the student should form the habit of always taking standard

precautions before every practical skill.

Many steps must be performed in a specific manner in order to obtain the corresponding point or to avoid violating

critical criteria. Alternatively, many steps can be successfully completed in a variety of manners, and instructors

practice different styles of demonstrating these steps. Students are responsible for understanding what constitutes

critical criteria and which procedures are open to personal variation in style.

Some steps must be performed at specific points during the practical skills while others can be performed at points

other than the ones printed on the practical skill sheets. Students are responsible for knowing which procedures

must be performed at specific points in the practical skills.

The most common reason that the student fails a practical skill is because of anxiety. Stay calm and go through the

practical skill at a comfortable pace. If the student forgets what to do next, he or she should remain calm and

mentally repeat the steps that he or she has already completed. If the student wishes, he or she is also allowed to

physically repeat any steps that he or she has already completed.

A huge part of skills training at the Academy is the documentation of that skills training. Pretty much, everything

you do during the practical aspect of class needs to be documented on paper and on FISDAP. People do not fail

paramedic class because they are not able to start an IV or intubate a manikin. They fail because they are not able to

document their performance in the Lab and clinical environment.

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Skill Sheets This manual is full of skill sheets that we will be using throughout the time that we are training together. We will

often use these skill sheets throughout the module and then at the end switch to a NREMT skill sheet. It is important

for students to learn the skill sheets. However, when it comes to doing the skill in the field in a dynamic setting with

extra pressure, students need to know why they are doing things and be comfortable with the procedure as a whole.

Routinely we teach the student a skill then we practice that skill for a week. The following week, we try to test that

skill. Then later we incorporate the skill into scenarios and we use an abridge version of the skill sheet to “test”

students while they are doing the skill during a scenario. Students should always try to perform skills as though they

are being tested at the NREMT.

Preparatory Module We include all of the skill sheets that we will start with during the Preparatory module. During this module we will

be teaching you several ALS SKILLS:

1. Intravenous (IV) therapy,

2. Establishing an intraosseous (IO) line

3. IM and SQ injections

4. IV Drug Administration

5. Use of A nebulizer for medication administration

6. Use of Nasal Mucosal Atomizer Device (MAD) for Medication administration

7. Use of a glucometer

8. Supraglottic Airways

We have several SCENARIO skill sheets that we use during this module. They consist of:

1. Cardiac Chest Pain

2. Shortness of Breath

3. Stroke

4. Altered Mental Status (AMS)

5. Acute Abdomen

6. Normal Childbirth

7. Abnormal Childbirth

8. General Medical Complaint

9. Hemorrhage control and shock Management

10. Splinting

11. Trauma Patient Management

At the end of this module, students are TESTED on the following skills using the NREMT Skill Sheets:



3. IM and SQ injections


5. Supraglottic Airways

6. Pediatric Airway Compromise

7. Medical Emergency Scenario

8. Traumatic Emergency Scenario

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Cardiology Module During the second module (Cardiology), we will give the students several more SKILL SHEETS. They include:

1. Adult Oral-tracheal Intubation

2. Pediatric Oral-tracheal Intubation

3. Task analysis for defibrillation

4. Task analysis for cardioversion

5. Task analysis for pacing

6. 12-Lead ECG

7. IV Drip Skill Sheet

8. NREMT Dynamic Cardiology

9. NREMT Static Cardiology

We have several SCENARIO skill sheets that we use during this module. They consist of:



3. ACLS – Bradycardia

4. ACLS – Tachycardia

5. ACLS – Cardiac Arrest – VF/VT


1. Ventilatory Management – Adult

2. Ventilatory Management - Pediatrics



Medical Emergencies I

During the third module (MEI), we will give the students more SKILL SHEETS. They include:

1. Comprehensive History

2. Comprehensive Physical Exam

We have several SCENARIO skill sheets that we use during this module. At this time, we will continue to do many

advanced cardiac life support (ACLS) scenarios. The medical scenarios will include:



3. Stroke

4. AMS

5. Anaphylaxis

6. Acute Abdomen





4. IV start and Medication Administration

5. Medical Emergencies Scenario

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Medical Emergencies II

During the fourth module (ME II), the students does not receive any new SKILL SHEETS.

We have several SCENARIO skill sheets that we use during this module. At this time, we will continue to do many

advanced cardiac life support (ACLS) scenarios. The medical scenarios will include:

1. Normal Childbirth

2. Abnormal Childbirth

3. General Medical Complaint

4. Comprehensive Pediatric Physical Exam

5. Toxicology (poisons)

6. Toxicology (medications)

7. Toxicology (illegal drugs)

8. Acute Abdomen

9. Psychiatric Emergencies

10. General Medical




3. Ventilatory Management – Pediatric

4. IO start and Medication Administration

5. Medical Emergencies Scenario

Trauma Module

During trauma the students will receive the following SKILL SHEETS again (we will use these in Preparatory).

1. Bleeding and shock

2. KED AND Backboarding

3. Orthopedic Injuries (Splinting and Traction Splinting)

4. Trauma Management

5. Surgical and Needle Cricothyrotomy

6. Needle Decompression

We have several SCENARIO skill sheets that we use during this module. The trauma scenarios will include:

1. Blunt Trauma

2. Penetrating trauma

3. Burns

4. Hemorrhagic Shock


1. IO start and Fluid Administration

2. Traumatic Patient Management

3. Random Basic Skill (KED, Splinting, Bleeding control)

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Operations and Review

During Operations and Review the student will be tested one final time on the skills listed below:







7. Ventilatory Management - Pediatrics

8. Oral Station

9. Out-of-Hospital Patient Management (medical scenario)

FISDAP and Skills Documentation As you can imagine the community would really like you, as a Paramedic student, to have some experience with

advanced life support (ALS) skills before you start practicing those skills on them.

Generally speaking, we will discuss (lecture) a skill in class before we practice that skill on a manikin. Regarding

ALS skills, we should have several successful practice attempts on a skill before we try that skill on a human.

We need to be able to show Preceptors that we are ready to perform skills. We have two methods to assure that we

are communicating our skill and knowledge level to preceptors. First, we have a Clinical Progress Table our

Paramedic Clinical Manual. We need to bring the Clinical Manual in during practical sessions and have the staff

sign off on various skills when we are ready to perform those skills in the field.

We also have FISDAP. FISDAP is the website that we use to schedule and track our clinical experience. We also

need to document our skills practice and scenarios in FISDAP. Students will need to document their skills practice

every week. This will involve uploading the documents that we used to “test” the skill.

FISDAP Support: http://www.fisdap.net/support?r=student

Getting Started with FISDAP How do I create a new FISDSAP account?

1. Once you have a FIISDAP activation code, creating an account is easy.

2. Go to the FISDASP home page, www.fisdap.net.

3. Click Create an Account.

4. Type or paste in your activation code (you get that from Melissa) and click Continue.

5. You will need to enter your billing information, then click Place Order. On the receipt page, click Create

Your Account.

6. Enter your profile information, and choose a FISDAP username and password, then click Save & Continue.

7. Read and accept the User Agreement and click Continue.

8. You’re all done! Click Continue to My FISDAP to log in and access your new account.

http://www.fisdap.net/support?r=student

http://www.fisdap.net/

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Scoring Skill Sheets While participating in skills training at the Academy we will usually be using standard GLEMSA / DU skills sheets

or the NREMT skill sheets. When using these skill sheets the participant will earn a score on 0, 1 or 2 for each line

item. The explanation of how to score the line item can be found below:

0 = Unsuccessful; required critical or excessive prompting; inconsistent; not yet competent. This would be when

the student completely skips a step in the skill. For some items there is no way to gently prompt the student.

At other times, the instructor may give clues to help the students obtain a “1”.

1 = Not yet competent, marginal or inconsistent, this includes partial attempts. A “1” is given when the student

needed a little help in remembering the step. When a student performs the step, but there is a problem with

that performance, the student would score a “1”

2 = Successful; competent; no prompting necessary. To score a “2”, there is not much room for improvement.

The student has “mastered” that aspect of the skill.

Auto-Fail - When there is an “AF” included at the end of the line item the student has to score a 1 or a 2 for that line

item. These auto-fails are sometime regraded as critical criteria. Failing to complete that step can have a major

impact on the patient or the success of the skill.

Critical Criteria – Towards the bottom of the skill sheets you may find a list of critical criteria. These are easily

noticed by the presence of a small check box located in the scoring column. If the student obtains a check here, it is

the same as an auto-fail. The skill attempt is recognized as a fail.

Level of Competence When we evaluate students as they complete skill, instructors will not only give the student a Pass / Fail mark. We

will also describe the competency level while performing that skill. The expectation is that the student will progress

from manipulation to naturalization. To graduate from the Academy, student need only be at the precision level.

Manipulation (M) = Student completed the skills evaluation with some problems or hesitations during the

procedure. The instructor had to give hints or noted flaws in the performance of the skill.

Precision (P) = Instructor was quiet during the skills evaluation and simply allowed the student to go through the

skills with no interruptions. The student completed skill with no mistakes.

Articulation (A) = Student completed the task with no mistakes. The instructor asked questions about the

procedure, like: “why are we doing this”, “tell me about capnography for monitoring placement”, “what would you

do if….”

Naturalization (N) = Student completed the task with no mistakes. The instructor distracts the learner with

conversation about something not related to the skill or has students prepping the patient/working a scenario. The

student would be able to troubleshoot problems and have confidence while completing the skill.

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Skills Tested at the NREMT Psychomotor Evaluation

1. Patient Assessment-Trauma You will be required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a

simulated patient for a given scenario, including: Scene Size-Up

Initial Assessment/Resuscitation

Focused History and Physical Examination - Rapid Trauma Assessment

Detailed Physical Examination

2. Patient Assessment-Medical You will be required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a

simulated patient for a given scenario, including:

Scene Size-Up

Initial Assessment/Resuscitation

Focused History and Physical Examination - Rapid Trauma Assessment

On-Going Assessment

3. Apneic Adult (supraglottic airway) Given a scenario of having just found an apneic adult patient with a palpable carotid pulse, you must

demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-

mask device, and supplemental oxygen. You will then complete the adult presentation by placing a supraglottic

airway device.

4. Pediatric Respiratory Compromise You will be given a scenario of having just found an infant in respiratory distress and must demonstrate

immediate management of the patient using simple airway maneuvers, adjuncts, and supplemental oxygen. You

will then be required to demonstrate bag-valve-mask ventilation as the patient progresses from respiratory

distress to respiratory failure.

5. Cardiac Arrest Management/AED You will be evaluated on your ability to manage a cardiac arrest situation, including 1-rescuer CPR and usage

of the AED given a cardiac arrest scenario where no bystanders are present.

6. IV and Medication Skills

Intravenous Therapy - You will be required to establish a patent IV in a mannequin arm in accordance

with a given scenario.

Intravenous Bolus Medications - after establishing a patient IV line, you will be required to administer

an IV bolus of medication in accordance with a given scenario.

8. Pediatric Intraosseous Infusion Skills You will be required to establish an intraosseous line in a pediatric IO mannequin. Either manual insertion using

Jamshidi® needles or electric, drill-type devices are permitted to establish intraosseous access.

9. Spinal Immobilization (Supine Patient) You will be required to immobilize an adult patient who is found supine with a suspected unstable spine using a

long spine immobilization device. An EMT Assistant will be provided and you are also responsible for the

direction and subsequent actions of the EMT Assistant.

10. Random EMT Skills You will be evaluated over one (1) of the following EMT skills tested at random. All instruments for these

skills will adhere to the National Registry EMT Users Guide material: Spinal Immobilization (Seated Patient)

Long Bone Immobilization

Joint Immobilization

Bleeding Control/Shock Management


Supraglottic Airway – King LTd Date Date

1. “Scene is safe and standard precautions” and checks ABCs (AF)

2. Uses a manual airway and BVM to ventilate patient within 30 seconds (AF)

3. Ventilates at a rate of 10 /min. Squeeze BVM for 1 second. (AF)

4. Attaches BVM to O2 and has O2 set at 12 to 15 liters/minute (AF)

5. Checks no gag reflex and properly inserts basic airway

6. Check lungs sounds and place patient on pulse oximetry

Ventilate the patient for 30 to 60 seconds at a proper rate and tidal volume. “Lung sounds are clear and equal. Pulse oximetry is at 88%. It is time to place an supraglottic airway.”

7. Student should direct the evaluator or helper to ventilate patient

8. Checks/prepares the airway device (chooses correct size)

9. Lubricates the distal tip of the device (AF)

10. Positions the head (sniffing position)

11. Performs a tongue-jaw lift and inserts device to the appropriate depth

12. Inflates the balloon(s) appropriately and removes the syringe(s) (AF)

13. Attaches BVM appropriately and ventilates patient

14. Confirms placement /ventilation observing chest rise, and auscultating over the

epigastrium and bilaterally over each lung

15. Adjusts airway to allow for maximum ventilation (possibly pull back)

16. Uses secondary device/method to monitor the placement of the tube:

capnography, ETCO2 detector, watch patient color and SaO2

17. Secures device or confirms that the device remains properly secured

Did not take, or verbalize, body substance isolation precautions

Did not ventilate properly (rate, tidal volume, no interruptions)

Did not pre-oxygenate the patient prior to placement

Did not confirm placement properly/timely

Inserted any adjunct in a manner that was dangerous to the patient

29 points needed to pass skill evaluation Points: __/34 __/ 34

Pass / Fail

Competency Level (If this was learner-led, mark “S”)

1. Instructor:__________ 2. Instructor: _____________ Initials:


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Supraglottic Airway-Combitube Date Date

1. “Scene is safe and standard precautions” and ABCs

2. Uses a manual airway maneuver and BVM to ventilate patient

3. Ventilates at a rate of 10 /min. Squeeze BVM for 1 second.

4. Attaches BVM to O2 and has O2 set at 12 to 15 liters/minute

5. Checks no gag reflex and properly inserts basic airway

6. Check lungs sounds and place patient on pulse oximetry

Ventilate the patient for 30 to 60 seconds at a proper rate and tidal volume. “Lung sounds are clear and equal. Pulse oximetry is at 88%. It is time to place an supraglottic airway.”

1. Student should direct the evaluator or helper to ventilate patient

2. Checks/prepares the airway device (chooses correct size)

3. Lubricates the distal tip of the device

4. Positions the head (neutral position)

5. Performs a tongue-jaw lift and inserts device to the appropriate depth

6. (front teeth between black lines)

7. Inflates the balloon(s) appropriately and removes the syringe(s)

8. Attaches BVM appropriately and ventilates patient

9. Confirms placement /ventilation observing chest rise, and auscultating over the

epigastrium and bilaterally over each lung

10. Adjusts ventilation as necessary (if no lung sounds move to tube #2)

11. Uses secondary device/method to monitor the placement of the tube:

capnography, colorametric ETCO2 watch patient color and SaO2

12. Secures device or confirms that the device remains properly secured


Did not ventilate properly (rate, tidal volume, no interruptions)

Did not pre-oxygenate the patient prior to placement

Did not confirm placement properly/timely

Inserted any adjunct in a manner that was dangerous to the patient


Pass / Fail




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Intravenous (I.V.) Cannulation Date Date

Start Time:

1. Takes/verbalizes “Standard Precautions.” (AF)

2. Checks selected IV fluid for: (student needs all 3 to get credit)

Expiration date, proper fluid, clarity. (AF)

3. Selects appropriate catheter 1) medical=20 or 18, 2) trauma=18 or 16)

4. Prepares administration set (makes sure the line is flushed). (AF)

5. Explains the procedure to patient and offers empathy statement

6. Cuts or tears tape at any time before venipuncture. (AF)

7. Applies constricting band and checks distal pulse and palpates suitable vein.

8. Cleanses site appropriately. Betadine scrub then alcohol swipe.

9. States “open sharp” when appropriate. (AF)

10. Uses non-dominant hand to secure vein near insertion site

11. Advises patient of “poke” and inserts catheter at proper angle.

12. Notes or verbalizes flashback and advances needle and catheter 2-3 mm in vein

13. Does not touch/contaminate catheter during cannulation. (AF)

14. Releases tourniquet and then places gauze under hub of the catheter.

15. Occludes vein proximal to catheter to minimize blood loss from the hub.

16. Removes needle and connects IV tubing to catheter NO MESS (AF)

17. Disposes of needle in proper container. (AF)

18. Runs IV for a brief period to assure patent line.

19. Properly Secures catheter and IV line. (AF)

20. Checks IV site for edema, redness, and pain. Adjusts flow rate as appropriate.

End Time:

Failure to establish a patent IV within 6-minute time limit.

Improper technique resulting in potential harm


Pass / Fail




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Intraosseous Infusion (Jamshidi) Date Date

Start Time:

1. Takes/verbalizes “Standard Precautions.” (AF)

2. Checks selected IV fluid for: (student needs all 3 to get credit) (AF)

Expiration date. Proper fluid. Clarity.

3. Prepares administration set and extension tubing.

4. Prepares syringe and ext. tubing. At this time the student will use the stop-cock

on the extension tubing to draw up fluid into the syringe from the IV bag. (AF)

5. Cuts or tears tape and identifies proper anatomical site for I.O. puncture.

6. Cleanses site appropriately. Verbalizes Betadine® scrub

7. Performs IO puncture: Verbalizes: “Open sharp”

8. Stabilizes tibia –cups extremity under the puncture site

9. Inserts needle at proper 90o angle.

10. Advances needle with twisting motion until “pop” is felt.

11. Unscrews cap and removes stylette from needle.

12. Verbalizes open sharps again and disposes of needle in proper container.

13. Attaches extension set to IO needle and pushes approximately 3-5 cc of saline

then aspirates to look for return of blood

14. Slowly injects saline to assure proper placement of needle.

15. Knows how to check for placement (needle is firmly placed, look for edema).

16. Adjusts the stop-cock on extension tubing to allow the primary administration set

to flow and adjusts flow rate as appropriate.

17. Secures needle with bulky dressing and tape similar to impaled object

18. Knows amount to administer for fluid bolus (20 mL/kg).

19. Knows IV bag will possibly need pressure infuser for proper flow.

End Time:

Failure to establish an IO line within the 6-minute time limit.

Failure to avoid unnecessarily uses open needles or recaps a needle.

Any improper technique resulting in the potential for air embolism.


Pass / Fail




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The administration of the medication may involve using a pre-load or drawing up a medication from a vial.

This station has a 3-minute time limit. Give student a scenario that would require the administration of a

typical ALS medication.

Intravenous Medication Administration Date Date

1. Continuing to take /verbalizes “Standard Precautions.” (AF)

2. Assures IV is running with no signs of infiltration.

3. Asks patient about allergies and medications. (AF)

4. Checks selected medication: (student needs all 3 to get credit)

proper medication Expiration date concentration (AF)

5. Calculates the correct amount of volume to be administered

6. Uses the correct syringe (smallest one that will hold the volume)

7. Verbalizes a second check of medication (has someone else check) (AF)


9. Assures aseptic technique when drawing up medication.

10. Prepares syringe with the appropriate amount of the medication. (AF)

11. Uses a safe practice while drawing up medication

12. Assures the air is dispelled from syringe. And correct dose is drawn (AF)

13. Verbalizes a third check of medication (AF)

14. Assures aseptic technique when placing medication into IV line. (AF)

15. The student should use a needleless system/technique if possible

(stop-cock with extension tubing)

16. Stops IV flow (pinching the tube or using stop-cock).

17. Administers medication at appropriate push rate.

18. Disposes of syringe and needle in proper container. (AF)

19. Flushes tubing (runs IV at wide open for short period of time). Adjusts flow rate to TKO.

20. Verbalizes that the patent should be observed for the effect of the med.

21. Documents who, what, when, how, how much, and any changes.

Failure to administer the medication within 3-minute time limit.

Improper drug or dose is an autofail.

Failure to dispose/verbalize disposal of needle in proper container.


Pass / Fail




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The administration of the medication may involve drawing up a medication from a vial. This station has a 3-

minute time limit. Give student a scenario that would require the administration of the one of the following

medications: Epi, Glucagon, Narcan

IM and SQ Injection Date Date

1. Takes PPE precautions. AF

2. Explains procedure to patient and offers empathy statement and ask patient allergies

and current medications. AF

3. Selects correct medication and checks for correct name, concentration, expiration.

Inspects medication for discoloration and particles.

4. Selects proper needle and syringe

23 – 25 gauge, 5/8” long needle for SQ

19 – 23 gauge, 1”-1 ½” long needle for IM

5. Prepares correct amount of medication. AF

6. Second check of label for correct name, concentration, expiration date. AF

7. Student knows:

The maximum volume for SQ injection is 2.0 mL for adult 1.0 mL for child

The maximum volume for IM injection is 5.0 mL (2.0 mL for Deltoid)

8. States: “open sharps” whenever needle is uncapped.

9. Chooses and cleanses injection site appropriately.

SQ: upper arms, thighs, and abdomen

IM: Deltoid, Dorsal Gluteal and Vastus Lateralis

10. Third check for correct drug and dose. AF

11. Pinches skin at injection site for SQ

Stretches the skin taut over injection site for IM

12. Inserts needle at 45o angle, bevel up for SQ injection.

Inserts needle at 90o angle for IM injection.

13. Aspirates for blood return. AF

14. If no blood return, injects medication at appropriate rate.

15. Removes needle “open sharp” and disposes of it in proper container.

16. Applies pressure/massages to injection site.

17. Monitors patient for effects of medication.

Failure to administer medication within 5-minute time limit

Performs any improper technique resulting in the potential harm to patient

Failure to dispose/verbalize disposal of needle in proper container


Pass / Fail


1. Instructor:____________ 2. Instructor: ______________ Initials:


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This skill will be practiced/tested as a scenario. The patient should present with decreased level of

consciousness and slow and shallow respiration with circumoral cyanosis. Blood pressure should be normal

and the patient will not respond to verbal commands. There is an obvious suspicion of drug use.

Intra-Nasal Medication Administration - Mucosal Atomizer Device (MAD) Date

1. Don appropriate standard precautions Assure the scene is safe!

2. Form a general Impression

3. Primary and secondary survey, especially vital signs, oxygen saturation and pupil size

4. The patient have proper airway and ventilatory care [manual airway, NPA (possible), BVM] (AF)

5. Knows indications for Narcan:

Obvious narcotics use (paraphernalia, empty pill bottles, witnesses, history of OD)

Slow and shallow respirations

Pinpoint pupils

Blood sugar >60 mg/dL

Prepare the Equipment

6. Checks medication:

Right medication, expiration date, concentration and clarity (AF)

7. Prepares syringe with correct amount of medication and attaches mucosal atomizer device

(MAD). Possible dosing regiments (AF)

0.4 mg or 1.0 mg

8. Verbalizes the consideration of immobilizing the patient prior to administration.

9. Inserts MAD device into nare and quickly pushes the medication.

10. Watches patient for improvement and knows that a second dose may be required (opposite

nare).

11. Possible side effects:

Patients have a predictable period of combative behavior with Narcan

Nausea and vomiting

Hypotension and hypertension

Tremors, irritability, sweating and narcotics withdrawals

Seizures

12. Knows that all patients who were given Narcan are required to go to emergency room

13. Knows Contraindications: Allergy or hypersensitivity to Narcan

22 points needed to pass skill evaluation Points: __/26

Pass / Fail




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This skill will be practiced/tested as a scenario. The patient should present with SOB and wheezing with

a history of asthma. Blood pressure should be normal and the patient should be able to follow commands.

Nebulized Medication Administration – Albuterol Date

1. Don appropriate standard precautions

2. Place patient in position that will optimize ease of ventilation (high fowler, tripod, etc.)

3. Primary and secondary survey, especially lung sounds, oxygen saturation and vital signs

4. Explain procedure to patient


5. Selects appropriate device to administer albuterol.

6. Prepares equipment

7. Checks medication for name, expiration date, dosage and clarity and places drug in nebulizer

8. Knows the adult dose of Albuterol (25 mg in 3 mL) Pediatric dose is 1.25 mg (1/2 the adult)

9. Has oxygen connected and running at 6-8 liters/minute

10. Gives device (mouth-piece) to patient with instructions or applies device to patient’s face (mask)

11. Reassess patient for desired effects

Decrease in level of ventilatory distress/anxiety

Oxygen saturation >94%

Decreased adventitious lung sounds (wheezing)

Absence of adverse reactions (chest pain, palpitations, pulmonary edema)

12. Knows the onset of relief takes 5 minutes and the drug will have peak effects is 30-60 minutes

13. Knows Indication:

A patient experiencing shortness of breath with signs of bronchoconstriction, is able to follow

commands, and has oxygen saturations < 95%.

14. Knows Contraindications:

Patients with a known hypersensitivity to Albuterol, cardiac chest pain, apnea or unconsciousness.

Tachycardia may be an issue.

23 points needed to pass skill evaluation Points: __/28

Pass / Fail




18

This skill will be practiced/tested as a scenario. The patient should present with an altered mental status.

Glucometer Date

1. Verbalizes scene safety and standard precautions

2. Talks with patient even if the seem unresponsive

3. Assembles equipment

Glucometer

Teststrip

Lancet

Gauze

Bandaid or tape

Sharps container

4. Places test strip into glucometer

5. Finds proper site for poke and cleans site with alcohol or substitute

6. Empathy statement for Poke and then warning for Poke

7. Uses proper lancet technique to “poke” patient and properly disposes of the sharp

8. Correct specimen placement on test strip

9. Reads glucometer and record results

10. Applies pressure to fingertip. Uses band-aid. Records/documents appropriately

11. Knows indications for blood sugar checks

12. Knows normal blood sugar levels

13. Knows proper treatment for low/high blood sugar levels

22 points needed to pass skill evaluation Points:

____/26

Pass / Fail




19

This skill will be practiced/tested as a scenario. The patient should present with SOB and pulmonary edema.

Blood pressure should be normal and the patient should be able to follow commands

Continuous Positive Airway Pressure (CPAP) Date

1. Don appropriate standard precautions

2. Form a general Impression

3. Place patient in position that will optimize ease of ventilation (high fowler, tripod, etc.)

4. Primary and secondary survey, especially lung sounds, oxygen saturation and vital signs

5. Explain procedure to patient


6. Connect CPAP device to oxygen source

Some use 50 psi oxygen source. Do not use oxygen regulator/flow meter

Some use regulator/flow meter at 15 l/min

7. Assemble mask and tubing according to manufacturer instructions

8. Insert the CPAP valve into the mask (5 cm, 7.5 cm, or 10 cm H2O pressure valve)

9. Have patient hold mask to his own face or apply head straps and ensure proper mask seal

10. Coach patient to breathe normally and adjust to air pressure

11. Reassess patient for desired effects

Decrease in level of ventilatory distress/anxiety

Oxygen saturation >92%

Decreased adventitious lung sounds

Absence of adverse reactions (barotrauma and pneumothorax)

12. Knows Indication:

A patient experiencing respiratory insufficiency or failure, including pulmonary edema or

bronchoconstrictive disease, is able to follow commands, and has oxygen saturations < 90%.

13. Knows Contraindications:

Patients with pneumothorax, apnea, unconsciousness, and full cardiac arrest. Relative

contraindications include trauma with suspicion of elevated intracranial pressure, abdominal

distention with risk for vomiting, and hypotension. Patients who have emphysema should be

monitored closely with CPAP, as they are at increased risk for barotrauma and pneumothorax.

22 points needed to pass skill evaluation Points:

____/26

Pass / Fail



Comments:


20


21

Shortness of Breath Leader

Team

First 60 seconds

1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) (AF)

2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) (AF)

3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) (AF)

4. Good Introduction

Basic History

5. History Allergies, Medical Hx, Medications (AF)

6. Onset: “what were you doing when it started?”

7. Provocation/palliation: “does anything make it better or worse?”

8. Time: “When did it start and has it been constant?”

9. Follow up questions: “What do you think it is?” “Been short of breath like this before?”

Differential Diagnosis

10. Organized and thorough assessment and integrated findings to expand the assessment

Chest pain?

Nausea or have you vomited?

Trauma to the chest?

Productive cough?

Risk factors for P.E.

Have you been sick lately? Running a fever?

Smoker? COPD?

Anxiety problems? [This area is worth a total of 5 pts]

Alcohol or illicit drugs?”?”

“Any history of surgeries?”

Physical Exam

11. Lung sounds. (AF)

12. Palpate abdomen.

13. Distal extremities for edema and JVD.

14. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF)

Management

15. Position, Oxygen and IV(AF)

16. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

standard questioning / assessment needs to occur prior to administration(AF)

17. Moved patient appropriately

18. Provided effective radio report to hospital(AF)

Affective

19. Uses proper non-verbal communication(AF)

20. Uses patient’s name and gives Empathy statements(AF)

21. Communicated thoughts/rationale of clinical impression and treatment plan to patient

22. Looks confident, makes the patient feel at ease. (AF)

Total needed to pass: 38 Total ____ / 44

Instructors name (printed) Pass / Fail

Initials

Comments:


22

Chest pain Leader Team

First 60 seconds

1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves)

2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position)

3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs)


Basic History

5. History Allergies, Medical Hx, Medications



8. Quality: “Can you describe the pain?”

9. Region/radiation: “Can you point to the pain and does it go anywhere?”

10. Severity: “can you put it on a scale from 1 – 10?”


12. Follow up questions: “What do you think it is?” “Have you ever had pain like this before?”



Short of breath?”

Nausea / Vomiting

Trauma to the chest?”

Risk factors for cardiac

History of GERD or GI problems

Sick lately? Running a fever?

Have you had any problems with your bowel/Stools?”

Any history of surgeries

Changes in your diet [This area is worth a total of 5 pts]

Risk factors for P.E

Physical Exam

14. Lung sounds.



17. Compare pulses in both radials to assess for thoracic aneurysm.

18. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate.

Management

19. Position, Oxygen and IV

20. Aspirin, confirms no problem with aspirin and that there is no risk for internal bleeding

21. Nitroglycerine, confirms no ED meds and advises patient how the SL route works

22. Morphine, “sells” the medication to the patient.

23. Provided effective radio report to hospital

Affective

24. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements



50Instructors name (printed) Pass / Fail

Initials

Comments:


23

Stroke Leader Team

First 60 seconds





Basic History

History Allergies, Medical Hx, Medications


6. Time: “When were they last seen normal?”

7. Follow up questions: “What do you think it is?” “Has this happened before?”

Cincinnati Stroke Scale

8. Speech: “you can’t teach….”, Facial Droop, Arm Drift (eyes closed)

MENDS Exam

9. Visual Fields (checks all four quadrants)

10. Horizontal Gaze (moves eyes back and forth)

11. Sensory feels touch in each extremity (eyes closed)

12. Coordination (finger to nose and heel to shin)



Been sick lately?

Risk factors for cerebral embolism

Risk factors for aneurysm (HTN)

Hx of seizures?

Any complaint of a headache or stiff neck

Running a fever? Feeling run down / tired?

Nausea or have you vomited

Trauma to the head? [This area is worth a total of 5 pts]

Medication, alcohol or illicit drugs

Physical Exam

14. Check blood sugar


16. Repeat Cincinnati Stroke Scale

Management


18. Proper IV fluid and/or drug administration

19. Moved Patient appropriately


Affective





Initials

Comment


24

Altered Mental Status Leader Team

First 60 seconds




4. Rapids Medical Assessment (quick head to toe looking for life threats) Pupils, JVD, Lung Sounds,

Palpate Abdomen, Any Signs of Trauma (with a Good Introduction)

Basic History






Been sick lately?



Trauma?

Hx of seizures?

Problems with bowel or bladder?






Depression or Psychiatric Hx

Physical Exam

9. Lung sounds

10. Inspect and Palpate Abdomen



Management

13. Position, Manage ABCs

14. Oxygen and IV




Affective





Initials

Comment


25

Abdominal Pain Leader Team

First 60 seconds





Basic History











Short of breath?”

Nausea / Vomiting

Trauma to the Abdomen?”




Have you had any problems with your Bowel/Stools?”



Risk of pregnancy and the menstrual cycle

Physical Exam

14. Lung sounds.

15. Inspect and Palpate abdomen.


17. Compare pulses in both Feet to assess for aortic aneurysm.


Management


20. Proper fluid and/or drug administration



Affective





Initials

Comments:


26

Childbirth - Normal Leader Team

First 60 seconds





5. Tell me more about your complaint why you called 911

Questions Regarding the Urgency of Childbirth

6. How far along are you?

7. Water Broke? Or mucous plug? Any bleeding? If they saw the amniotic fluid was it clear

8. Tell me about the contractions

9. Do you feel the need to push or have a B. M.

10. Questions for Para Gravida

Questions Regarding Possible Complications

11. Previous complications with child birth

12. Have you been seeing your doctor? Who is your doctor? And have you been taking meds?

13. Use of drugs or ETOH during Pregnancy?

14. Hx of Gestational Diabetes? Twins? C-section? Placenta previa


Management

16. Position and Oxygen possible IV if time / # of people permit

17. Check for crowning and prolapsed cord

18. Check to see if amniotic sac in the way and fix it if it is intact. If amniotic fluid is present is it clear

(looking for meconium)

19. Place hand against baby’s head and allow for gentle delivery

20. Suction Mouth and then Nose

21. Check for nuchal cord and fix it if there is a problem

22. Pull the anterior shoulder downward to clear the mother's symphysis pubis (as needed)

23. Deliver baby and suction again and begin drying off the baby

24. Tie/clamp the umbilical cord in two places and cut the cord when appropriate

25. Dry, warm, position, and suction as needed

26. Continue with appropriate neonatal resuscitation (as needed)

27. 1 minute and 5 minute APGAR

28. Note time of birth

29. Package mom up and assess for delivery of the placenta (lengthening of the cord)

30. Assess for excessive post-partum bleeding and treat appropriately




Initials

Comments:


27

Childbirth - Abnormal Leader Team

First 60 seconds


















Management



18. Check to see if amniotic sac in the way and fix it if it is intact. If amniotic fluid is present is it

clear (looking for meconium)

Abnormal Delivery This area is worth 5 points

Breech Prolapsed Cord Multiple births

Continues with delivery

Provides airway for neonate if birth

is prolonged

Checks for pulsation of the cord

Pushes baby’s head up/off cord

Immediate transport

Proper positioning

Knows that cord should still be cut

Second delivery may be breech



Initials


28

General Medical Complaint Leader

Team

First 60 seconds





Basic History









Recent Trauma?

Sickness? Fever? Productive cough?


Bowels/ Stool been normal?

Bladder/ Urine been normal?

Running a fever?

Smoker?

Anxiety/psychiatric problems?

Alcohol or illicit drugs?

Any history of surgeries?

Physical Exam



13. Blood sugar check

14. Temperature



Management






Affective





Total needed to pass: 40 Total ___ / 48


Initials

Comments:


29

Orthopedic Injuries Date

Date

Date

Joint or Long bone fracture (J=Joint and L= Long bone)

Upper or Lower extremity (U=Upper and L=Lower)

Traction Splint (T)

1. “Scene is safe and standard precautions”

2. Asks about general impression of patient (anxiety, position, age, LOC etc)

3. Completes Initial assessment (ABCs and mental status)

4. Asks questions regarding M.O.I.

5. Directs application of manual stabilization of the joint / extremity

6. Removes all clothes from around injury (verbalized when appropriate)

7. Assess PMS (actually checks not verbalized)

Examiner: “PMS is normal.”

8. Selects proper splinting material

9. Immobilizes the bone above and below the injury

10. Reassess PMS (actually checks not verbalized)

Examiner: “PMS is still normal.”

11. Talks to the patient throughout the scenario

12. Gains a SAMPLE history

13. Gives the patient on statement of empathy regarding situation

QUESTIONS

14. Name 6 of the principles of splinting.

15. What would you do to care for an open fracture

16. Later, patient complains of numbness and tingling. What do you do?

CRITICAL CRITERIA

Did not support the joint during immobilization

Did not properly immobilize the joint

Did not check PMS before or after the skill

Total needed to Pass 26 Points: ___/32 ___/32 ___/32

Pass / Fail:

1. Instructor: ______________ 2. Instructor: ________________

3. Instructor _______________

Initials:


30

Bleeding Control and Shock Management Date: Date:

Start: Time

1. Takes, or verbalizes, body substance isolation precautions (AF)

2. Initial Assessment (General Impression and ABCs)

3. Asks about MOI as approaching patient (AF)

4. Has someone hold C-spine (if the MOI suggests c-spine injury)

5. Applies direct pressure to the wound with gloved hand (no delay) (AF)

“The wound continues to bleed”.

6. Applies tourniquet

7. Dresses and bandages wound

“The patient is now showing signs and symptoms of Shock”.

8. States the need for rapid transport to hospital

9. Properly positions the patient (trendelenberg)

10. Administers high concentration oxygen (AF)

11. Initiates steps to prevent heat loss from the patient (AF)

12. Completes secondary survey (head-to-toe)

13. Talks to patient (SAMPLE and empathy statement)

14. Takes vital signs

15. Initiates transport and establishes 1 or 2 IV during transport

16. Knows proper fluid bolus for controlled and uncontrolled bleeding (AF)

End Time


Did not apply high concentration oxygen

Did not control hemorrhage using correct procedures in a timely manner

Did not indicate a need for immediate transportation

Total needed to pass: 18 Points:

AF= Auto Fail or Critical Criteria Pass / Fail: ____/32 ____/32

Initials:


31

Patient Management-Trauma Date Date

1. Scene safety and standard precautions (AF)

2. Asks specific questions about mechanism of injury (MOI) (height, weapons, speed, etc)

3. Determines the # of patients, and requests additional help if necessary

4. Considers stabilization of spine (AF)

Initial Assessment / Primary Survey

1. Verbalizes general impression of the patient (major bleeding, position, acuity, age & sex etc)

2. Determines responsiveness/level of consciousness

3. If patient is awake, ask about chief complaint and MOI (“what happened?”)

4. A

Spontaneous Breathing

Any noises with respiration (AF)

Impending airway problem (facial trauma or epistaxis)

5. B

Breathing rate and tidal volume (AF)

Sign of adequate breathing (AF)

If there is any MOI or signs of difficult breathing – check neck and chest (AF)

6. C

Pulse check Skin color and capillary refill (AF)

Ensure control of any major bleeding (AF)

Checks for major internal bleeding (quick check of abdomen, pelvis and femurs) (AF)

7. Initiates appropriate oxygen / ventilatory therapy (AF)

8. Identifies priority patients/makes transport decision (AF)

Detailed Physical Examination / Secondary Survey

9. Head Assesses the head / face (eyes, ears, nose, mouth)

10. Neck Posterior sweep

Anterior JVD Trachea midline obvious trauma

11. Chest Expose Inspect Palpates checks Lung Sounds

Have patient take a breath while holding rib cage

12. Abdomen Expose Inspect Palpate

13. Back Checks back immediately when necessary (MOI suggests injury)

14. Pelvis DCAP BTLS TIC Genital sweep (priapism, wetness, blood)

15. Femurs DCAP BTLS TIC

16. Extremities Legs – DCAP, BTLS, TIC, Check PMS)

Arms – DCAP, BTLS, TIC, Check PMS)

17. Vital signs: Pulse Blood Pressure Resp.

18. A.M.P.L.E. Allergies Medications History Last meal

Management

19. Manages primary and secondary njuries appropriately (AF)

20. Radio Report: MOI Assessment Treatment Clear and Concise

35 points needed to pass skill evaluation Points: ____/40 ____/40

AF= Auto Fail or Critical Criteria Pass / Fail:

Initials:


32

Preparatory Module Testing (NREMT)


33



34



35



36



37



38



39



40



41



42



43

Preparatory Module Affective Evaluation

Demographics

Name Class Date

Evaluation Statements

1. Professionalism in the classroom Competent Not yet competent

Showing consideration to fellow students and the instructor by being quiet and participating in discussion at the

appropriate times. Responding appropriately to questions. Does not have a problem turning pagers or phones off prior

to class. Seems eager to learn.

Comments:

2. Self-Motivation Competent Not yet competent Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following

through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving

for excellence; accepting constructive feedback in a positive manner; taking advantage of learning opportunities

Comments:

3. Appearance and Personal Hygiene Competent Not yet competent Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.

Comments:

4. Self-Confidence and Communication Competent Not yet competent Able to communicate thoughts, feelings, and rationale when questioned by the instructor or other students. Uses proper

tone and volume of speech when discussing material. Speaks clearly; writing legibly; listening actively; adjusting

communication strategies to various situations

Comments:

5. Time Management Competent Not yet competent Consistent punctuality; completing tasks and assignments on time. Absenteeism and Tardiness

Comments:

6. Respect Competent Not yet competent Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the

profession.

Comments:

Student’s Comments

Signature of Student

Date

Signature of Primary Instructor Date


44

Cardiology Module Skills and Scenarios


45

Laryngoscopic Intubation – Adult Date Date

1. Takes Standard Precautions (AF) (gloves and face shield or goggles)

2. Begins with Manual airway and BVM ventilations (AF)

3. Appropriately places adjunct airway maneuvers. (AF)

4. Ventilates with 100% oxygen. (AF)

5. Assembles and checks equipment.

Light should be bright white and tight (AF)

6. Places patient’s head in the sniffing position

(look over the fence, then drop the head back) (AF)

7. Blade is inserted slowly /carefully on the right side of the patient’s mouth and then

the tongue is swept to the left. (AF)

8. Student verbalizes care to stay off teeth and be careful not to pinch tongue. Student

pays close attention to insertion of blade. (AF)

9. Lifts laryngoscope forward to displace jaw without putting pressure on teeth. (do not

touch the teeth or pinch the tongue) (AF)

10. Suctions the hypopharynx as necessary (most likely verbalized)

11. Lifts jaw at 45o angle to the ground, exposing glottis.

(lift up and away without using teeth as a fulcrum) (AF)

12. Directly visualizes vocal cords, passes ETT through the glottic opening until distal

cuff disappears beyond vocal cords.

13. Inflates distal cuff with 5-10 ml of air (until pilot balloon is firms)

14. Immediately used EDD

15. Attaches BVM with ETCO2 detector to ETT.

16. Checks for proper tube placement; equal bilateral breath sounds, symmetrical rise and

fall of chest. (--) Epigastric sounds (AF)

17. Secures ETT with tape or commercial device. Does not let go of the tube until the

tube is secured


Pass / Fail


1. Instructor: __________ 2. Instructor: _____________ Initials:


46

Ventilatory Management – Adult Date Date

1. Takes or verbalizes “Standard Precautions” AF

2. Opens the airway manually. Ventilates the patient within 30 seconds. AF

3. Ventilates patient at a rate of 8-12/minute with appropriate volumes

4. Attaches oxygen to bag-valve-mask device and connects to high flow oxygen

5. Asks about 1) compliance, 2) lung sounds, 3) SaO2 and 4) patient responsiveness

“No gag reflex is present and patient accepts adjunct.”

6. Properly measures and inserts basic airway adjunct and continues to ventilate.

“Compliance is normal, pulse @ 100 bpm, L.S. are clear and equal and that SpO2 is 85%....It is time to intubate the patient.”

7. Directs assistant to pre-oxygenate patient and selects proper equipment for intubation

8. Checks equipment for: Stylet positioned properly. Cuff does not leak (leaves syringe on

bulb), laryngoscope operational with bulb tight (white, bright & tight)

9. Have evaluator remove OPA, prepare the ETCO2, and count out loud to 30

Remove OPA and move out of the way when candidate is prepared to intubate

10. Positions head properly (sniffing position or hyperextension) AF

11. Inserts blade carefully 1) avoids pinching the lip, 2) slow approach to the proper position

12. Elevates mandible with proper technique.

13. Introduces ET tube and advances to proper depth, verbalizes: “The ETT is passing

through the vocal cords.” Inflates cuff to proper pressure and disconnects syringe. AF

14. Acknowledges depth of the ETT at the teeth and then again after tube is secured. AF

15. Ventilates (or directs ventilation of) patient within 30 seconds. AF

16. Confirms placement- listens bilaterally over each lung and over epigastrium.

17. Does not let go of the ETT until it is secured.

18. Knows alternate methods for checking placement (ETCO2, pulse oximetry, esophageal

detector, misting)

“You see secretions in the tube and hear gurgling”

19. Pre-oxygenates patient. AF

20. Inserts catheter down ETT with no suction. Insert catheter until resistance is met and

withdraws. Applies suction while withdrawing the catheter. No longer then 5 seconds

21. Directs ventilation of the patient while suctioning water to flush catheter. Repeat as

necessary. Knows this procedure is supposed to be sterile

Critical Criteria

Failure to ventilate properly (depth, rate, O2) more than a 30 second delay at any time.

Uses laryngoscope as a fulcrum during intubation attempt or applies pressure to teeth.

Unable to state two additional methods of confirming/monitoring tube placement

Verbalizes (or through body language) lack of skill practice or confidence in the procedure.


Pass / Fail




47

Ventilatory Management-Pediatric Date Date

1. Takes or verbalizes “Standard Precautions” AF

2. Opens the airway and places pad under torso for proper sniffing position. AF

3. Begins ventilations at the proper rate and depth (12 to 20 breaths/min)

4. Elevates tongue, inserts simple adjunct (oropharyngeal).

5. Verbalizes suction should be available and to suction first if there is gurgling.

“No gag reflex is present and patient accepts adjunct.”

6. Ventilates patient immediately with bag-valve-mask device (May add O2).

7. Candidate should ask about 1) chest rise w/ ventilation, 2) lung sounds, and 3) SpO2

“Ventilation is being performed without difficulty and that pulse oximetry indicates the patient ’s blood oxygen saturation is 88%”

8. Attaches oxygen to bag-valve-mask device and connects to high flow oxygen.

After 30 seconds, “Breath sounds are present, equal bilaterally and it is time to intubate the patient.”

9. Directs assistant to pre-oxygenate patient and selects proper equipment for intubation.

10. Checks equipment for: stylette positioned properly, cuff is checked if the tube has a cuff.

laryngoscope operational with bulb tight (white, bright & tight).

11. Asks the evaluator to remove OPA, Prepare the ETCO2 detector, and count out loud to 30

Remove OPA and move out of the way when candidate is prepared to intubate

12. Positions head properly (sniffing position or hyperextension). AF

13. Inserts blade carefully 1) avoids pinching the lip, 2) slow approach to the proper position.

14. Elevates mandible with proper technique. Any amount of pressure on teeth or fulcruming

motion with Laryngoscope is an auto fail. AF

15. Introduces ET tube and advances to proper depth, “The ETT is passing through the vocal

cords.” Inflates cuff to proper pressure (if there is a cuff) and disconnects syringe.

16. Ventilates (or directs ventilation of) patient within 30 seconds. AF

17. Acknowledges depth of the ETT at the teeth and then again after tube is secured AF

18. Confirms placement listens bilaterally over each lung and over epigastrium.

“What would you expect to hear?”

19. Knows answers to above question.

20. Secures Tube. Does not let go of the tube until it is secured.

“Please demonstrate an additional method of verifying tube placement.”

21. Knows alternate methods for checking placement. (ETCO2, pulse oximetry, misting)

Critical Criteria

Failure to ventilate for a period of 30 seconds (including the beginning)

Failure ventilate properly [depth (chest rise), rate (12-20 bpm), O2 at the appropriate time].

Failure to provide good basic airway with towel roll under shoulders.

Uses teeth as a fulcrum during intubation attempt.

Verbalizes (or through body language) lack of skill practice or confidence in the procedure.

Poor technique that could result in trauma or missed intubations.


Pass / Fail




48

During this task assessment the student will be given a scenario where the patient is dead when

they arrive or the patient is alive and goes into arrest soon after arrival.

Defibrillation Date

Date

Date

1. Confirms that the patient does not have “signs of life”

2. Assures adequate CPR if appropriate

3. Appropriately applies defibrillation pads

4. Charges defibrillator to appropriate level (verbalize level and sets

monitor to a level between 2 ad 10 joules)

5. I am clear…you are clear…everyone is clear….

6. Pushes shock button while watching over patient

7. Immediately starts CPR without trying to interpret rhythm

8. Knows the only rhythms that we always defibrillate

Passing score is = 13 Total ____ /16 ____ /16 ____ /16

Pass / Fail

Skill Level (If this was learner-led, mark “S” for student)

Initials of Evaluator


49

During this task assessment the student will be given a scenario where the patient is in an

unstable wide complex (V.T.) or unstable narrow complex (SVT).

Cardioversion Date

Date

Date

1. Confirms that the patient is unstable by the presence of one of the

following: Low B/P, AMS, significant CP or SOB with Pulm.

edema

2. Places defib/pacer pads on patient appropriately

3. Knows that if time permits an IV can be started and consider sedation

(2.5 of versed and 5 mg of M.S.)

4. Explains procedure to patient

5. Pushes synch and observes monitor for proper synch

6. Charges defibrillator to appropriate level (verbalize level and sets

monitor to a level between 2 ad 10 joules)

7. Knows that the AHA calls for the following Joules:

SVT: 50 joules

Ventricular Tachycardia: as low as 100 joules

Atrial Fibrillation .: 120 joules biphasic

8. I am clear…you are clear…everyone is clear….

9. Pushes shock button while watching over patient (holds button)

10. Immediately evaluates rhythm for 3 seconds of asystole

11. Knows: a short period of asystole = cardioversion was successful.

12. Knows that if the shock was not successful the joules should be

“increased in a step wise fashion”

13. Checks for a pulse

14. Knows that when the patient is in a narrow complex rhythm the

medication after cardioversion would be a Ca++ Channel blocker

15. Knows that when the patient is in a wide complex rhythm the

medication after would be a procainamide, amiodarone, or lidocaine.

Passing score is = 25 Total ____ /30 ____ /30 ____ /30

Pass / Fail




50

During this task assessment the student will be given a scenario where the patient is in a

symptomatic and unstable bradycardia (sinus, junctional, or a block).

Transcutaneous Pacing Date

Date

Date

1. Confirms that the patient is in a symptomatic bradycardia by the

presence of one of a Low B/P or AMS

2. Knows that if time permits an IV can be started and consider sedation

(2.5 of versed and 5 mg of M.S.)


4. Pushes “Pacer” button

5. Observes the PPM screen comes up and assures that the rate is 70 or 80

6. Increases the milliamps slowly

7. Talks to patient about the uncomfortable nature of pacing

8. Observes for electrical capture

9. When there is electrical capture checks for mechanical capture (pulse)

10. Knows that if the B/P is still low (below 90 systolic) that the patient

should get a fluid bolus followed by a dopamine drip

Passing score is = 13 Total ___ /20 ___ /20 ___ /20

Pass / Fail




51

Dynamic Cardiology Points Date Date Date

Start Time:

Takes or verbalizes standard precautions * 1

Asks about a general impression of the patient (from doorway) 1

Checks level of responsiveness 1

Checks ABCs (or CAB if patient appears to have no signs of life) 1

Attaches ECG monitor and/or applies pacer/defibrillation pads 1

Correctly interprets initial rhythm 2

Appropriately manages initial rhythm 2

Notes change in rhythm 1

Checks patient condition to include pulse and, if appropriate, BP 2

Correctly interprets second rhythm 2

Appropriately manages second rhythm 2



Correctly interprets third rhythm 2

Appropriately manages third rhythm 2



Correctly interprets fourth rhythm 2

Appropriately manages fourth rhythm 2

End Time: 29

1. Failure to deliver shock in a timely and safe manner.

2. Failure to order start or resume of CPR when appropriate.

3. Failure to order correct management of airway and oxygenation

4. Orders administration of an inappropriate drug or dosage.

5. Inappropriate use of pacing, cardioversion or defibrillation.

6. Misinterpretation of the any one of the rhythms.

7. Does not appear confident or hesitates too often.

_____

_____

_____

_____

Student need 25 points to pass Points: 29 ___/29 ___/29 ___/29

Pass/Fail:

Initials:


52

Static Cardiology 1. Date

2. Date

3. Date

4. Date

Start Time:

Interpretation:

1. _________________________ 3. _______________________

2. _________________________ 4. _______________________

1 1 1 1

Patient Care Plan:

1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

4. ____________________________________________________

2 2 2 2

Interpretation:

1. _________________________ 3. _______________________

2. _________________________ 4. _______________________

1 1 1 1

Patient Care Plan:

1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

4. ____________________________________________________

2 2 2 2

Interpretation:

1. _________________________ 3. _______________________

2. _________________________ 4. _______________________

1 1 1 1

Patient Care Plan:

1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

4. ____________________________________________________

2 2 2 2

Interpretation:

1. _________________________ 3. _______________________

2. _________________________ 4. _______________________

1 1 1 1

Patient Care Plan:

1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

4. ____________________________________________________

2 2 2 2

End Time:

1. Failure to interpret one of the rhythm.

2. Orders inappropriate/wrong drug or drug dosage.

3. Does not follow current ACLS guidelines.


_____

_____

_____

_____

Student needs 10 points to pass Points: ____/12 ____/12 ____/12 ____/12

Pass/Fail:

Initials:


53

In this station the student is presented with an IV that has already been initiated with a scenario that will require an IV Drip

Medication. The administration of the medication will involve drawing up a medication from a vial/ampule and adding it to an

IV bag. Then administering the IV drip medication. The station has a four (4) minute time limit.

Intravenous Drip Medications Date Date Date Date

1. Continuing to take /verbalizes “Standard Precautions.” (AF)

2. Assures IV is running with no signs of infiltration.

3. Asks patient about allergies and medications.

4. Checks selected medication: (student needs all 3 to get credit)

5. proper medication Expiration date concentration. (AF)

6. Checks selected IV bag: (student needs all 3 to get credit)

proper medication Expiration date concentration. (AF)

7. Calculates the volume of the medication to be injected into the bag. (AF)

8. Uses the correct syringe.

9. Verbalizes a second check of medication and IV fluid (all 3) (AF)

proper med. Expiration date concentration


11. Assures aseptic technique when drawing up medication.

12. Prepares syringe with the appropriate amount of the medication.

13. Uses a safe practice while drawing up medication (no recapping needles)

14. Assures aseptic technique when placing medication into IV bag. Mixes

IV bag and spike the bag with minidrip (60) administration set

15. Documents the concentration of the drug in the IV bag on the IV bag

16. Verbalizes a third check of medication and IV fluid (all 3)

proper medication Expiration date concentration

17. Hooks up the medication administration set to the mainline

18. The student should use a needleless system/technique if possible

19. Stops mainline IV flow (roller clamp).

20. Administers medication at appropriate IV drip rate.

21. Secures medication line to mainline near insertion site (one piece of tape).

22. Disposes of all material in proper container(s). (AF)

23. Verbalizes that the patent should be observed for the effect of the med.

24. Labels medication line near the main line with piece of tape.

25. Documents who, what, when, how, how much, and any changes.

Failure to establish an IV drip within 4-minute time limit.

Contaminates equipment without correcting situation.

The student does not complete three (3) checks

Failure to dispose/verbalize disposal of needle in proper container.

Student needs 43 points to pass Points: ___/50 ___/50 ___/50 ___/50

AF= Auto Fail or Critical Criteria Pass/Fail:

Initials:


54

ACLS - Bradycardia Date Date

Ba

sic

Ca

re

1. Takes or verbalizes Standard Precautions *

2. Asks about a General Impression of the patient (from doorway)

3. Checks Level of Responsiveness

4. Checks /Maintains ABCs (or CAB if patient appears to have no signs of life)

5. Good Introduction if appropriate and Positions patient

6. Attaches ECG Monitor and/or applies pacer/defibrillation pads

7. Obtains Vital Signs and appropriate Physical Exam and monitoring devices

8. Correctly Interprets Initial rhythm

9. Patient History (SAMPLE and possibly OPQRST)

10. Oxygen via appropriate administration (N.C, NRB, BVM)

11. Starts an IV / IO and gives appropriate fluid bolus

AC

LS

Ca

re

12. Atropine .5 mg q 5minutes

13. Dopamine @2-10 mcg/kg/min or Epinephrine @ 2-10 mg/kg/min

14. Transcutaneous Pacing patient as appropriate

15. Reassessment and continual Monitoring


17. Provides proper analgesia and sedation if required/appropriate

18. Knows that if there is capture with pacing and the patent continues to have low

B/P dopamine is indicated.


20. Uses proper non-verbal communication. Uses patient’s name and gives

Empathy statements






6. Misinterpretation of the rhythm.


_____

_____

Student need 34 points to pass Points: ___/40 ___/40

Pass/Fail:

Initials:


55

ACLS - Tachycardia Date Date

Ba

sic

Ca

re





5. Good Introduction if appropriate and Positions patient


7. Obtains Vital Signs and appropriate Physical Exam and monitoring devices

8. Correctly Interprets Initial rhythm

9. Patient History (SAMPLE and possibly OPQRST)

10. Oxygen via appropriate administration (N.C, NRB, BVM)


AC

LS

Ca

re

12. Vagal Maneuvers

13. Adenosine 6 mg fast IV push, followed by 12 mg

14. Ca++ Channel blocker - SVT Cardizem .25mg/kg IV push

Verapamil 2.5 – 5.0 mg followed by 5.0 – 10 mg

15. Ventricular antidysrhythmic

Lidocaine 1.0 – 1.5 mf/kg followed by ½ dose and lidocaine drip

Pracainamide 20 -50 mg/min followed by procainamide drip

Amiodarone 150 mg over 10 minutes. Repeat if needed

16. Synchronized Cardioversion at appropriate level

50-100 joules - SVT

100 Joules – Monomorphic VT

120 Joules – Atrial Fibrillation

Defibrillation (asynchronized) for Torsades de Pointes

17. Reassessment and continual Monitoring Moved patient appropriately

18. Provides proper analgesia and sedation if required/appropriate

19. Knows that if there is capture with pacing and the patent continues to have low

B/P dopamine is indicated.









_____

_____


Pass/Fail:

Initials:


56

ACLS – Cardiac Arrest Date Date

Ba

sic

Ca

re





5. If witnessed arrest – prioritizes defibrillation

If unwitnessed arrest – prioritizes compressions

6. Starts CPR in reasonable amount of time


8. Provides Basic Airway that evolves to an adjunct and Advanced Airway


10. Patient History from bystanders/family. What happened and down time.

Possibly SAMPLE

AC

LS

Ca

re

11. Defibrillation appropriate level every 2 minutes (if appropriate)

12. Epinephrine 1.0 mg every 3-5 minutes IVP (if appropriate)

13. Ventricular antidysrhythmic (if appropriate)

Amiodarone 300 mg. followed by 150 mg

Lidocaine 1.0 – 1.5 mf/kg followed by ½ dose

Procainamide 100 mg every 5 minutes

14. Considers H’s and T’s

15. Switches out person doing compressions every 2-4 minutes

16. Used capnography to maintain ALS airway and look for ROSC

17. Provides proper post arrest care (IV fluids, ventilation, possible drugs)









_____

_____


Pass/Fail:

Initials:


57

12-Lead ECG Date

Date

Date


2. Prepares the patient (shaving and cleansing as needed)

3. Places limb leads on the limbs

4. Places precordial leads at their appropriate locations:

5. Ensures the patient is sitting or lying still, breathing normally and not

talking

6. Obtains 12-lead ECG recording

7. Examines tracing for acceptable quality

8. Interprets 12-lead ECG to local standard and reports findings as needed

9. Voices repeating 12-lead ECG every 5 – 10 minutes in high risk patients

and post- treatment

10. Addresses modesty/privacy of the patient by keeping them covered

where appropriate

Passing score is = 13 Total ___ /20 ___ /20 ___ /20

Pass / Fail




58


Team

First 60 seconds





Basic History








Chest pain?



Productive cough?



Smoker? COPD?




Physical Exam





Management






Affective







Initials

Comments:


59


First 60 seconds





Basic History











Short of breath?”

Nausea / Vomiting









Physical Exam

14. Lung sounds.





Management






Affective





Initials

Comments:


60

Cardiology Module Testing (NREMT)


61



62



63



64

Cardiology Module Affective Evaluation

Demographics

Name Class Date






Comments:




Comments:


Comments:




Comments:


Comments:


profession.

Comments:



Date



65

Medical Emergencies I Skills and Scenarios


66

During this exercise the student should visualize the scene as a clinic or for a home health care setting. The student

will be completing a thorough patient physical exam in order to relay that information to a provider. Completing a

thorough patient physical exam such as this should take 15 to 20 minutes. The patient will most likely have a

general illness of some sort and not require immediate intervention/ transportation. Track the time!

Comprehensive Adult Physical Exam Date Date Date

Initial General Impression

Appearance

1. Speaks when approached

2. Facial expression / Anxiety

3. Skin color

4. Eye contact

5. Weight-estimated/translated to kg

6. Work of breathing

7. Posture, ease of movement

Level of Consciousness/Mental Status

8. Person Place and Time

Speech

9. Rate and Volume

10. Articulation and Fluency

Memory

11. Short term (give the patient 3-4 objects to remember)

12. Long term (ask about something in the past)

Vital signs

13. Blood pressure, Pulse, Respirations, Temperature, and Pulse Oximetry

Secondary physical examination

Skin / Integumentary

14. Colors-flushed, jaundiced, pallor, cyanotic

15. Moisture-dryness, sweating, oiliness

16. Temperature-hot or cool to touch -Take a temperature

17. Skin Turgor

18. Lesions-types, location, arrangement

19. Nails-condition, cleanliness, growth (discoloration , clubbing)

Head and neck

20. Hair (falling out, greasy, dirty)

21. Scalp (flaking, dandruff, dirty)

22. Skull (intact)

23. Face (bones intact, acne, symmetry)

24. Have patient clinch teeth together and assess /palpate TMJ to check for symmetry

(CN V)


67

25. Test the sensory aspect of CN V by having patient close their eyes and see if they can tell

the difference between a paperclip and Q-tip when placed on forehead, cheek and mandible

(the three branches of the trigeminal nerve)

26. Have the patient smile big, showing their front teeth. Then have them raise their eyebrows

and puff out their cheeks Have them close both eyes tightly so you cannot open them.

(checking symmetry) (CN VII)

Eyes

27. Acuity-vision is clear and free of disturbance (CN II)

28. Symmetry (looking for drooping on one side (CN VII)

29. Appearance-color, iris clear

30. Pupils-size, reaction to light

31. Extraocular movements-up, down, both sides (CN III, IV, VI)

Ears

32. External ear

33. Ear canal (otoscope looking at tympanic membrane)

34. Hearing-present/absent (CN VIII)

Nose

35. Deformity

36. Air movement

37. Ability to smell (C.N. I)

Mouth

38. Opens willingly Jaw tension

39. Mucosal color and Moisture Under the tongue

40. Teeth intact

41. Open wide and say: “AHH” Check uvula and malampati score (CN IX, X)

Neck

42. Trachea-midline

43. Jugular veins-appearance with patient position

Chest

44. Chest wall movement-expansion

45. Skin color-closed wounds

46. Open wounds

47. Presence/absence of pain

48. Auscultation-anterior and posterior

49. Heart Sounds

Abdomen

50. Color, closed wounds, Scars

51. Open wounds

52. Size, symmetry, shape, Distention

53. Auscultation

54. Palpation-quadrants, masses, tenderness, rigidity


68

Back

55. Color, closed wounds, Scars

56. Open wounds

57. Size, symmetry, shape

58. Palpation- tenderness along spine

Pelvis

59. Stability

60. Male genitalia - Wounds, rashes, external lesions, Drainage

61. Female genitalia - Wounds, rashes, external lesions, Drainage, Bleeding

Legs and Feet

62. Symmetry and Deformity

63. Range of motion

64. Skin color, Closed wounds, Open wounds

65. Pulses movement, strength and sensation

Arms and Hands

66. Symmetry and Deformity

67. Range of motion

68. Skin color, Closed wounds, Open wounds

69. Pulses movement, strength and sensation

Affective

70. Accepts evaluation and criticism professionally

71. Shows willingness to learn

72. Interacts with simulated patient and other personnel in professional manner,

i.e. uses appropriate name, explains procedures, maintains modesty

You need to get 122 points /144 /144 /144

1. Evaluator _______________________ Student instructor 2. Evaluator _______________________ Student instructor 3. Evaluator _______ ________________ Student instructor

Time:

Pass / Fail:

Initials

Comments

1.

2.

3.


69

Comprehensive Patient History Date Date Date

1. Good introduction and positioning

2. Age, Weight, Sex

3. Reliability (do you trust the person providing the history)

4. Why did you call us?

5. Onset: “What were you doing when this started?” “Was it gradual or sudden?”

6. Provocation: “What brought this on?” “Does anything make it better or worse?”

7. Quality: “Please describe the pain” “has this changed since it began?”

8. Region and Radiation: “Point to where the pain is.” “Does the pain radiate?”

9. Severity: “Scale from 1-10”

10. Timing: “When did this begin?”

11. Setting Is there anything unique to place or events with this episode?

12. Treatments “Have you taken anything to treat this problem?”

13. Pertinent negatives Notes any signs or symptoms not present Does the provider

consider a differential diagnosis and ask question to rule out illness/injuries

14. Converges Moves history from broad to focused to field impression. Does the

provider as the associated symptoms questions to help confirm the diagnosis?

Past Medical History

15. What does the patient say about his/her health?

16. Patient nutritional status. “How have you been eating?”

17. How has you bowel and bladder (bathroom habits been)?

18. Have you been sleeping well?

19. Female: “Tell me about your menstrual cycle” Award points for males

20. Female: “Is there any chance that you are pregnant?” Award points for males

21. “Do you have any habitual activities, such as drugs, alcohol or tobacco use?”

Current Medications

22. “What prescribed medications do you currently take?”

23. “What over-the-counter medication or home remedies do you currently take?”

24. “When did you take your last does of medications?”

25. “Do you take all your medications as directed?”

Adult Illnesses

26. “What other similar episodes were present?”

27. “Is this an acute or chronic illness?”

28. “What medical care do you currently receive for this illness?”

29. “What medical care do you currently receive for other illnesses?”

30. Allergies “Do you have any allergies to any medications, foods or other things?”

31. Operations What previous surgeries have you had?”

32. Environmental “Have you been living / working at a place with normal temps?”


70

33. Family History Questions patient about pertinent family medical history

34. Psychological History Asks appropriate history questions based upon presentation

Verbal report

35. Completes succinct report

36. Identifies pertinent findings (positives) and pertinent negatives

37. Organizes report in logical sequence (paints an appropriate picture for the patient

Affective

38. Makes the patient feel comfortable

39. Uses good eye contact

40. Establishes and maintains proper distance

41. Uses techniques that show interest in the patient

42. Professional appearance

43. Takes notes of findings during history

44. Preferably uses open-ended questions

45. Follows patient lead to converge questions

46. Uses reflection to gain patient confidence

47. Shows empathy in a professional manner

Failure to take or verbalize appropriate PPE precautions

Failure to complete an appropriate history

Failure to obtain information for the proper assessment, diagnosis and management

You need to get 80 points /94 /94 /94

1. Evaluator Name _________________ Student instructor



Time:

Pass / Fail:

Initials

Comments

1.

2.

3.


71

Team Leader Evaluation – Scenario

Date Scenario Description Age Group • Adult • Geriatric • Pediatric Age ________

Complaint/Problem ______________________________________________________

SCENE MANAGEMENT

1. Directs Team Members well (timely, prioritized)

2. Maintains accountability for team’s actions/outcomes

3. Demonstrates confidence, compassion, maturity and command presence

4. Maintains situational awareness

5. Addresses safety concerns and is safety conscious at all times (scene hazards, agitated

bystanders, sharps handling, etc.)

FLEXIBILITY

6. Adapts treatment plan and sequence as information becomes available, listens to teammates

7. Reconciles incongruent information (reassesses, asks again, engages family or medical record to

confirm information, checks him or herself if delegated information doesn't fit presentation)

COMMUNICATION

8. Uses closed-loop communication

9. Communicates accurately and concisely while listening and encouraging feedback

10. Advises patient of thoughts, feelings, rationale. Keeps everyone involved in treatment plan

11. Utilizes appreciative inquiry (speaking directly and respectfully, asks if others see anything else

that should be considered, solicits input and feedback from Team Members)

AFFECT

12. Establishes basic rapport with the patient and interacts professionally with all on scene

PATIENT ASSESSMENT AND MANAGEMENT CATEGORY

13. Addresses spinal stabilization, airway, ventilation, oxygenation, circulation and hemorrhage

management early in scenario

14. Determines chief complaint, mechanism of injury, associated symptoms

15. Able to obtain an accurate history of present illness (HPI) using SAMPLE

16. Receives, processes, verifies and prioritizes information

17. Obtains vital signs and completes an appropriate physical exam

18. Creates an appropriate list of differential diagnoses

19. Makes accurate clinical judgments about patient acuity

20. Develops treatment plan and implements appropriate treatment

1. Failure to address safety concerns

2. Failure to function as a competent EMT

3. Failure to initiate care and create a reasonable treatment plan

4. Exhibits unacceptable affect with patient or other personnel

Student need 34 points to pass Points: ___/40

Pass/Fail:

Evaluator Name _________________ Student instructor

Initials:

Comments on Reverse side


72

Team Member Evaluation – Scenario

Date Scenario Description Age Group • Adult • Geriatric • Pediatric Age ________

Complaint/Problem ______________________________________________________

FOLLOWERSHIP

1. Able to follow orders /instructions

2. Maintains situational awareness

COMMUNICATION

3. Uses closed-loop communication

4. Clarifies unclear or unsafe order/instructions

5. Immediately suggests corrective action is a harmful intervention is ordered/performed.

6. Advises leader of thoughts, feelings, rationale when appropriate

7. Does not ask patient questions without the “permission” from leader.

8. Communicates clearly with team leader and others on scene

AFFECT

9. Demonstrates confidence, compassion and maturity

10. Does not try to “take over” the scene.

PATIENT ASSESSMENT AND MANAGEMENT CATEGORY

11. Performs tasks in a timely manner

12. Performs skills in an acceptable manner

Basic Airway (NPA, OPA)

Supraglottic Airway

Oral Intubation

Nasal Intubation

BVM Ventilation

Surgical/Needle Cric

I.V. Start

Medication Admin

I.O. Start

IM or SQ injection

Nebulizer

Intranasal

Defibrillation

Cardioversion

Pacing

12-Lead

Splinting

Dressing and Bandage

KED

Backboard

13. Reports progress on skills as appropriate

14. Anticipates the needs of the Team Leader

15. Able to help Team Leader when asked about thoughts on assessment/management

1. Failure to address safety concerns

2. Failure to function as a competent EMT

3. Failure to follow instructions to support a reasonable treatment plan

4. Exhibits unacceptable affect with patient or other personnel

Student need 18 points to pass Points: ___/24

Pass/Fail:

Evaluator Name _________________ Student instructor

Initials:

Comments on Reverse side


73


Team

First 60 seconds





Basic History








Chest pain?



Productive cough?



Smoker? COPD?




Physical Exam





Management






Affective







Initials

Comments:


74


First 60 seconds





Basic History











Short of breath?”

Nausea / Vomiting









Physical Exam

39. Lung sounds.





Management






Affective





Initials

Comments:


75

Stroke Leader Team

First 60 seconds





Basic History

History Allergies, Medical Hx, Medications



29. Follow up questions: “What do you think it is?” “Has this happened before?”

Cincinnati Stroke Scale

30. Speech: “you can’t teach….”, Facial Droop, Arm Drift (eyes closed)

MENDS Exam

31. Visual Fields (checks all four quadrants)

32. Horizontal Gaze (moves eyes back and forth)

33. Sensory feels touch in each extremity (eyes closed)

34. Coordination (finger to nose and heel to shin)



Been sick lately?



Hx of seizures?






Physical Exam



38. Repeat Cincinnati Stroke Scale

Management





Affective





Initials

Comment


76

Altered Mental Status Leader Team

First 60 seconds




23. Rapids Medical Assessment (quick head to toe looking for life threats) Pupils, JVD, Lung Sounds,

Palpate Abdomen, Any Signs of Trauma (with a Good Introduction)

Basic History






Been sick lately?



Trauma?

Hx of seizures?

Problems with bowel or bladder?






Depression or Psychiatric Hx

Physical Exam

28. Lung sounds

29. Inspect and Palpate Abdomen



Management

32. Position, Manage ABCs

33. Oxygen and IV




Affective





Initials

Comment


77


First 60 seconds





Basic History











Short of breath?”

Nausea / Vomiting









Physical Exam

38. Lung sounds.





Management





Affective





Initials

Comments:


78

Anaphylaxis Leader

Team

First 60 seconds





Basic History








Recent Trauma?





Physical Exam


11. Check trunk for Urticaria


13. Any problems with upper airway (hoarseness, difficulty in swallowing)

14. Distal extremities for edema


Management


17. Early us of drugs in an appropriate (prioritized and timely) way.





Affective







Initials

Comments:


79

Medical Emergencies I Module Testing (NREMT)


80



81



82



83



84



85

Medical Emergencies I Module Affective Evaluation

Demographics

Name Class Date






Comments:




Comments:


Comments:




Comments:


Comments:


profession.

Comments:



Date



86

Medical Emergencies I Skills and Scenarios

\


87

Childbirth - Normal Leader Team

First 60 seconds


















Management



49. Check to see if amniotic sac in the way and fix it if it is intact. If amniotic fluid is present is it clear

(looking for meconium)

50. Place hand against baby’s head and allow for gentle delivery

51. Suction Mouth and then Nose

52. Check for nuchal cord and fix it if there is a problem

53. Pull the anterior shoulder downward to clear the mother's symphysis pubis (as needed)

54. Deliver baby and suction again and begin drying off the baby

55. Tie/clamp the umbilical cord in two places and cut the cord when appropriate

56. Dry, warm, position, and suction as needed

57. Continue with appropriate neonatal resuscitation (as needed)

58. 1 minute and 5 minute APGAR

59. Note time of birth

60. Package mom up and assess for delivery of the placenta (lengthening of the cord)

61. Assess for excessive post-partum bleeding and treat appropriately




Initials

Comments:


88

Childbirth - Abnormal Leader Team

First 60 seconds


















Management



36. Check to see if amniotic sac in the way and fix it if it is intact. If amniotic fluid is present is it

clear (looking for meconium)

Abnormal Delivery This area is worth 5 points

Breech Prolapsed Cord Multiple births

Continues with delivery

Provides airway for neonate if birth

is prolonged

Checks for pulsation of the cord

Pushes baby’s head up/off cord

Immediate transport

Proper positioning

Knows that cord should still be cut

Second delivery may be breech

Total needed to pass: 40 Total ____ /

23


Initials


89

General Medical Complaint Leader

Team

First 60 seconds





Basic History









Recent Trauma?





Running a fever?

Smoker?




Physical Exam




38. Temperature



Management






Affective







Initials

Comments:


90

Overdose - Prescription Leader

Team

First 60 seconds





Basic Toxicology

1. What was taken?

2. How much was taken?

3. When was it taken?

4. Accurate weight of the patient

Basic History


6. Tell me more about the poisoning / exposure

7. Is there anything else that was ingested / injected / taken?

8. Follow up questions: “Has this happened before?”




Abdominal Pain? Chest pain?

Drugs or Alcohol?

Shortness of Breath?

Psychiatric/suicidal in the past?

Physical Exam

10. Lung sounds and check skin (rash)

11. Pupils check and H-pattern test

12. Blood sugar check and Temperature


Management

14. Proper Decontamination !! Position, Oxygen and IV(AF)



Opiates

BVM

Narcan

Ca++ blocker

Calcium

Glucogon

(at E.R.)

Aspirin

NaHCO3

Beta blockers

Glucogon

(at E.R.)

TCA

NaHCO3

APAP

Mucomyst

(at E.R.)

Affective







Initials


91

Toxic Exposure Leader

Team

First 60 seconds





Basic Toxicology

5. What was the toxic substance? Asks about MSDSs or Placards / Labels

6. Assessment of how the long the patient was exposed and concentration of substance

7. When did the exposure occur?

8. Accurate weight of the patient

Basic History








Abdominal Pain? Chest pain?

Illicit drug or alcohol?

Shortness of Breath?


Physical Exam





Management




Cyanide

Amyl nitrite

Na+ nitrite

Na+ thiosulfate

Or Cyanokit

Organophophate

Atropine

2-PAM

CO

Oxygen

Hyperbaric chamber

Corrosives

No vomiting

Pulm edema

EKG !

Hydrocarbons

No vomiting

Pulm edema

EKG !

Affective






Initials


92

Overdose – Illicit Drugs Leader

Team

First 60 seconds





Basic Toxicology

9. What was taken?

10. How much was taken?

11. When was it taken?


Basic History








Abdominal Pain? Chest pain? Shortness of Breath?

Drugs or Alcohol?


Physical Exam

10. Lung sounds and check skin (rash)




Management

14. Proper Decontamination !! Position, Oxygen and IV(AF)



CNS stimulant

EKG!

Benzo is OK

hyperthrmia

Opiates

Narcan

CNS depressant

BVM assist

Seizure

precautions

Hallucinogen

Safety #1

Calm / quiet

Methanol

ETOH

NaHCO3

MDMA / X

BVM support

hyperthermia

Affective






Initials


93


First 60 seconds





Basic History











Short of breath?”

Nausea / Vomiting









Physical Exam

14. Lung sounds.





Management





Affective





Initials

Comments:


94

Behavioral Emergency Leader

Team

First 60 seconds





Basic History









Recent Trauma?




Running a fever?

Smoker?




Physical Exam




14. Temperature



Management






Affective







Initials

Comments:


95

Medical Emergencies II Module Testing (NREMT)


96



97



98



99



100

Medical Emergencies II Module Affective Evaluation

Demographics

Name Class Date






Comments:




Comments:


Comments:




Comments:


Comments:


profession.

Comments:



Date



101

Trauma Module Skills and Scenarios


102

Orthopedic Injuries Date

Date

Date

Joint or Long bone fracture (J=Joint and L= Long bone)

Upper or Lower extremity (U=Upper and L=Lower)

Traction Splint (T)

17. “Scene is safe and standard precautions”

18. Asks about general impression of patient (anxiety, position, age, LOC etc)

19. Completes Initial assessment (ABCs and mental status)

20. Asks questions regarding M.O.I.

21. Directs application of manual stabilization of the joint / extremity

22. Removes all clothes from around injury (verbalized when appropriate)

23. Assess PMS (actually checks not verbalized)

Examiner: “PMS is normal.”

24. Selects proper splinting material

25. Immobilizes the bone above and below the injury

26. Reassess PMS (actually checks not verbalized)

Examiner: “PMS is still normal.”

27. Talks to the patient throughout the scenario

28. Gains a SAMPLE history

29. Gives the patient on statement of empathy regarding situation

QUESTIONS

30. Name 6 of the principles of splinting.

31. What would you do to care for an open fracture

32. Later, patient complains of numbness and tingling. What do you do?

CRITICAL CRITERIA

Did not support the joint during immobilization

Did not properly immobilize the joint

Did not check PMS before or after the skill

Total needed to Pass 26 Points: ___/32 ___/32 ___/32

Pass / Fail:

1. Instructor: ______________ 2. Instructor: ________________

3. Instructor _______________

Initials:


103

Bleeding Control and Shock Management Date: Date:

Start: Time

17. Takes, or verbalizes, body substance isolation precautions (AF)

18. Initial Assessment (General Impression and ABCs)

19. Asks about MOI as approaching patient (AF)

20. Has someone hold C-spine (if the MOI suggests c-spine injury)

21. Applies direct pressure to the wound with gloved hand (no delay) (AF)

“The wound continues to bleed”.

22. Applies tourniquet

23. Dresses and bandages wound

“The patient is now showing signs and symptoms of Shock”.

24. States the need for rapid transport to hospital

25. Properly positions the patient (trendelenberg)

26. Administers high concentration oxygen (AF)

27. Initiates steps to prevent heat loss from the patient (AF)

28. Completes secondary survey (head-to-toe)

29. Talks to patient (SAMPLE and empathy statement)

30. Takes vital signs

31. Initiates transport and establishes 1 or 2 IV during transport

32. Knows proper fluid bolus for controlled and uncontrolled bleeding (AF)

End Time


Did not apply high concentration oxygen

Did not control hemorrhage using correct procedures in a timely manner

Did not indicate a need for immediate transportation

Total needed to pass: 18 Points:

AF= Auto Fail or Critical Criteria Pass / Fail: ____/32 ____/32

Initials:


104

Patient Management-Trauma Date Date

MOI Blunt Injury Penetrating Injury Burns Hemorrhagic Shock

1. Scene safety and standard precautions (AF)

2. Asks specific questions about mechanism of injury (MOI) (height, weapons, speed, etc)

3. Determines the # of patients, and requests additional help if necessary

4. Considers stabilization of spine (AF)

Initial Assessment / Primary Survey

1. Verbalizes general impression of the patient (major bleeding, position, acuity, age & sex etc)

2. Determines LOC and asks about chief complaint and MOI (“what happened?”)

3. A

Spontaneous Breathing

Any noises with respiration (AF)

Impending airway problem (facial trauma or epistaxis)

4. B

Breathing rate and tidal volume (AF)

Sign of adequate breathing (AF)

If there is any MOI or signs of difficult breathing – check neck and chest (AF)

5. C

Pulse check Skin color and capillary refill (AF)

Ensure control of any major bleeding (AF)

Checks for major internal bleeding (quick check of abdomen, pelvis and femurs) (AF)

6. Initiates appropriate oxygen / ventilatory therapy (AF)

7. Identifies priority patients/makes transport decision (AF)

Detailed Physical Examination / Secondary Survey

8. Head Assesses the head / face (eyes, ears, nose, mouth)

9. Neck Posterior sweep

Anterior JVD Trachea midline obvious trauma

10. Chest Expose Inspect Palpates checks Lung Sounds

Have patient take a breath while holding rib cage

11. Abdomen Expose Inspect Palpate

12. Back Checks back immediately when necessary (MOI suggests injury)

13. Pelvis DCAP BTLS TIC Genital sweep (priapism, wetness, blood)

14. Femurs DCAP BTLS TIC

15. Extremities Legs – DCAP, BTLS, TIC, Check PMS)

Arms – DCAP, BTLS, TIC, Check PMS)

16. Vital signs: Pulse Blood Pressure Resp.

17. A.M.P.L.E. Allergies Medications History Last meal

Management

18. Manages primary and secondary njuries appropriately (AF)

19. Radio Report: MOI Assessment Treatment Clear and Concise

35 points needed to pass skill evaluation Points: ____/40 ____/40

AF= Auto Fail or Critical Criteria Pass / Fail:

Initials:


105

Needle Decompression Date

Date

1. Assembles Equipment:

16-14 gauge IV catheter, 2.75 – 3.0” (peds can be 2”)

10 mL syringe

4x4s

antiseptic solution

Tape

2. Palpates the chest locating the second intercostal space on the midclavicular line

3. Properly cleanses the insertion site with appropriate solution

4. Reconfirms the site of insertion and directs the needle over the top of the rib on

the midclavicular line

5. Listens for a rush of air or watches for plunger in syringe to withdraw and

aspirates air

6. Removes needle/syringe leaving only the catheter in place

7. Disposes of the needle in proper container

8. Stabilizes the catheter hub with 4x4s and tape

9. Reassesses adequacy of ventilation, lung sounds, blood pressure and pulse for

improvement in patient condition

Passing score is = 15 Total ___ /18 ___ /18

Pass / Fail



106

Needle Cricothyrotomy Date

Date

1. Assembles Equipment:

Oxygen source capable of 50 PSI

Oxygen Tubing

Manual Jet ventilato device (“Y” connector or push button)

Large bore IV catheter

10 -20 mL syringe

3.0 mm ETT adaptor

2. Places the patient supine and hyperextends the head/neck (neutral position if

cervical spine injury is suspected)

3. Palpates neck locating the cricothyroid membrane

4. Cleanse the insertion site with appropriate solution

5. Stabilizes site and inserts needle through cricothyroid membrane at midline

directing at a 45° angle caudally

6. Aspirates syringe to confirm proper placement in trachea

7. Advances catheter while stabilizing needle

8. Disposes of the needle in proper container

9. Attaches ventilation device and begins ventilation (1 sec for inflation, 2 sec for

exhalation using jet ventilator, manually triggered ventilation device, BVM)

10. Secures catheter

11. Continues ventilation while observing for possible complications (subcutaneous

emphysema, hemorrhage, hypoventilation, equipment failure, catheter kink)

Passing score is = 18 Total ___ /22 ___ /22

Pass / Fail



107

Nasal Intubation Date Date



3. Places adjunct airway maneuvers (NPA with Lidocaine use Neosynephrine (AF)



Suction, ETT tube(s), Capnography, 10 cc syringe, water soluble jelly

6. Positions head – start with neutral, but nose, chin and sternum should be aligned

7. Inserts ET tube into selected nostril and guides it along the septum

8. Pauses to assure that tip of ET tube is positioned just superior to the vocal cords

(visualizes misting in the tube, hears audible breath sounds from ET tube)

9. Instructs patient to take a deep breath ( or cough and then wait for breath) while

passing ET tube through vocal cords

10. Inflates cuff to proper pressure and immediately removes syringe

11. If tube is not directed through the first attempt the head/neck can be flexed or

extended and step 9 reapeated

12. Assists patient ventilations and confirms proper tube placement by auscultation

bilaterally over lungs and over epigastrium; observes for misting in tube; listens for

audible breath sounds from proximal end of ET tube; and assures that patient is

aphonic (unable to make noises with their vocal cords)

13. Verifies proper tube placement by secondary confirmation such as capnography,

capnometry, EDD or colorimetric device

14. Secures ET tube

15. Assists patient ventilations patient at proper rate and volume while observing

capnography/capnometry and pulse oximeter


Pass / Fail




108

Trauma Patient Intubation Date Date


2. Assures someone is holding manual C-Spine (neutral position)


4. Appropriately places adjunct airway maneuvers. (AF)



Light should be bright white and tight (AF)

7. Assures the team member holding C-spine continues to hold head and neck in neutral

position (AF)

8. Understands this is a difficult intubation and a Bougie stylet may help

9. Blade is inserted slowly /carefully on the right side of the patient’s mouth and then the

tongue is swept to the left. (AF)

10. Student verbalizes care to stay off teeth and be careful not to pinch tongue. Student

pays close attention to insertion of blade. (AF)

11. Lifts laryngoscope forward to displace jaw without putting pressure on teeth. (do not

touch the teeth or pinch the tongue) (AF)

12. Suctions the hypopharynx as necessary (most likely verbalized)

13. Lifts jaw at 45o angle to the ground, exposing glottis.

(lift up and away without using teeth as a fulcrum) (AF)

14. Directly visualizes vocal cords, passes ETT through the glottic opening until distal cuff

disappears beyond vocal cords.

15. Inflates distal cuff with 5-10 ml of air (until pilot balloon is firms)

16. Immediately used EDD

17. Attaches BVM with ETCO2 detector to ETT.

18. Checks for proper tube placement; equal bilateral breath sounds, symmetrical rise and

fall of chest. (--) Epigastric sounds (AF)

19. Secures ETT with tape or commercial device. Does not let go of the tube until the tube

is secured


Pass / Fail




109

Trauma Module Testing (NREMT)


110



111



112



113



114



115

Trauma Module Affective Evaluation

Demographics

Name Class Date






Comments:




Comments:


Comments:




Comments:


Comments:


profession.

Comments:



Date



116

Operations and Review Module Skills and Scenarios


117

Operations and Review Module Testing (NREMT)


118



119



120



121



122



123



124



125



126

Affective Evaluation

Demographics

Name Class Date






Comments:




Comments:


Comments:




Comments:


Comments:


profession.

Comments:



Date



127

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