College of Central Florida of Central Florida EMT Program Lab ... States Department of Transportation Emergency Medical Technician ‐ Basic National Standard Curriculum

1

College of

Central Florida

EMT Program Lab Skills Book

Fundamental Skills EMS 1119L

Copyright 2013 Graves, McGinnes, Gesner

2

CF EMERGENCY MEDICAL SERVICES PROGRAMS

SKILLPERFORMANCESUMMARYEMERGENCYMEDICALTECHNICIAN‐BASIC

Name:_________________________________________________________StudentID:__________________________________

MODULE1‐PREPARATORY Checkwhencompetenceisdemonstrated

SKILL PEER LAB1-1 Cardiopulmonary Resuscitation 1-2 Foreign Body Airway Obstruction 1-3 Cardiac Arrest Management / AED 1-4 Body Substance Isolation (BSI) Precautions 1-5 Lifting and Moving Patients 1-6 Oral Reports / Written Documentation 1-7 Cardiac Monitor Function

MODULE2‐AIRWAYMANAGEMENTSKILL PEER LAB

2-1 Oxygen Administration 2.2 Airway Maneuvers 2-3 Ventilatory Support 2-4 Upper Airway Adjuncts and Suction 2-5 Dual Lumen Airway / Combi-tube 2-6 King Airway 2-7 Continuous Positive Airway Pressure (CPAP) 2-8 Pulse Oximetry (SpO2)

MODULE3‐PATIENTASSESSMENTSKILL PEER LAB

3-1 Patient Assessment Techniques 3-2 Assessment Tools 3-3 Medical Assessment 3-4 Glucometer Operation

MODULE4‐MEDICALEMERGENCIESSKILL PEER LAB4-1 Assessment / Management - Respiratory 4-2 Assessment / Management - Angina Pectoris 4-3 Assessment / Management - Thromboembolism 4-4 Assessment / Management - Infectious Disease 4-5 Assessment / Management - Aortic Aneurism 4-6 Assessment / Management - Hypertensive Crisis 4-7 Assessment / Management - Heart Failure 4-8 Assessment / Management - Neuromuscular Emergencies 4-9 Assessment / Management - Sickle Cell Crisis 4-10 Assessment / Management - Dialysis Emergencies 4-11 Assessment / Management - Musculoskeletal Injuries 4-12 Assessment / Management - Pregnant Patient 4-13 Assessment / Management - Allergic Reaction 4-14 Assessment / Management - Poisoning / Overdose 4-15 Assessment / Management - Behavioral Emergencies 4-16 Assessment / Management - Hypoglycemia 4-17 Assessment / Management -Seizures 4-18 Assessment / Management - Hyperthermia 4-19 Assessment / Management - Hypothermia

3

MODULE5‐TRAUMASKILL PEER LAB5-1 Trauma Scoring Methodology: Adult 5-2 Trauma Scoring Methodology: Child 5-3 Trauma Assessment / Management: Adult 5-4 Assessment / Management - Brain / Spinal Cord Injury 5-5 Assessment / Management - Submersion Incident 5-6 Assessment / Management - Dysbarism 5-7 Assessment / Management - Lightning injury 5-8 Assessment / Management - Envenomation 5-9 Assessment / Management - Pediatric Trauma Patient 5-10 Assessment / Management - Hypovolemic Shock 5-11 Assessment / Management - Open / Closed Chest Injury 5-12 Assessment / Management - Abdominal Injury 5-13 Assessment / Management - Injuries to Neck and Face 5-14 Assessment / Management - Orthopedic Injuries 5-15 Assessment / Management - Traction Splint 5-16 Assessment / Management - Burns 5-17 Spinal Immobilization - Supine Patient 5-18 Spinal Immobilization - Standing Patient 5-19 Spinal Immobilization - Seated Patient 5-20 Spinal Immobilization - Prone Patient 5-21 Helmet Removal

MODULE6‐INFANTSANDCHILDRENSKILL PEER LAB6-1 Assessment / Management - Obstetrical 6-2 Assessment / Management - Prolapsed cord 6-3 Assessment / Management - Breech birth 6-4 Assessment / Management - Postpartum bleeding 6-5 Assessment / Management - Gynecologic emergencies 6-6 Assessment / Management - Pediatric emergencies 6-7 Assessment / Management - SUID 6-8 Assessment / Management -Pediatric trauma

MODULE7‐OPERATIONSSKILL PEER LAB7-1 Use of Radio Transmitter 7-2 Mass Casualty Incident (MCI) with Triage 7-3 Patient Restraint 7-4 Peripheral IV Set-Up 7-5 Metered Dose Inhaler (MDI) 7-6 Nitroglycerine Administration 7-7 Aspirin Administration 7-8 Oral Glucose Administration 7-9 Epinephrine Autoinjector (Epi Pen) 7-10 Pneumatic Antishock Garment (PASG) 7-11 Activated Charcoal Administration 7-12 Flail Segment Management 7-13 Occlusive Dressing Application 7-14 Bleeding Control - Tourniquet 7-15 Impaled Object 7-16 Amputation 7-17 Cincinnati Prehospital Stroke Scale (CPSS)

4

COMMENTS:________________________________________________________________

_______________________________________________________________________________ I have satisfactorily demonstrated all psychomotor skills required. I have completed all of these skills personally and all information is correct on this form.

_______________________________________________________ __________________________ (STUDENT) (DATE)

TheabovestudenthassatisfactorilydemonstratedallpsychomotorskillsrequiredbythelatestversionoftheUnitedStatesDepartmentofTransportationEmergencyMedicalTechnician‐BasicNationalStandardCurriculum.

________________________________________________________ __________________________ (LEAD INSTRUCTOR) (DATE)

CF EMERGENCY MEDICAL SERVICES PROGRAMS

5

Module 1

Basic Skills

6

CF EMERGENCY MEDICAL SERVICES PROGRAMS SKILL PERFORMANCE EVALUATION AND REMEDIATION

SKILL 1-1 CARDIOPULMONARY RESUSCITATION

Name: _____________________________________________________

THE STUDENT WILL VERBALIZE THE THERAPEUTIC EFFECTS, INDICATIONS, CONTRAINDICATIONS, AND POSSIBLE SIDE EFFECTS FOR THE EQUIPMENT/PROCEDURE. STUDENT MUST TAKE OR VERBALIZE BODY SUBSTANCE ISOLATION PRECAUTIONS BEFORE INITIATING PATIENT CONTACT.

Performance Guidelines Completed Explains the rationale for having unit / equipment prepared to respond Establish unresponsiveness. Opens airway (head tilt - chin lift or jaw thrust) and checks for breathing by looking, listening, and feeling for exhalations.

If breathing is absent or inadequate, gives two breaths (1 seconds per breath) with pocket mask or bag valve mask device while visually confirming effective chest rise and allowing for adequate exhalation

Checks for pulse at appropriate location for age/size of patient and other signs of circulation. If signs of circulation are present but breathing is absent or inadequate, rescue breathing provided at appropriate rate for age/size of patient

If no signs of circulation are present, cycles of breaths to compressions at appropriate rate for age/size of patient are administered

STUDENT IS ADVISED THAT SECOND RESCUER IS NOW ABLE TO ASSIST After five cycles of 30 compressions and two breaths (approximately two minutes), rescuer one delivers two breaths and rechecks for signs of circulation.

If signs of circulation are still absent, rescuers will deliver cycles of breaths to compressions at appropriate rate for age/size of patient. Rescuers will alternate the role of compressor and ventilator until AED or Advanced Life Support is available

THE STUDENT WILL DEMONSTRATE APPROPRIATE USE OF EQUIPMENT/PROCEDURE FOR:

ADULT _____ CHILD _____ INFANT _____ STOMA _____

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not obtain a patient airway with head tilt - chin lift or jaw thrust _____ Did not achieve adequate face mask seal during ventilations _____ Did not confirm adequate chest rise during ventilations _____ Performed skill in a manner that could endanger patient or other rescuers

COMMENTS/REMEDIATION: __________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________

Evaluator Printed Name: __________________ Evaluator Signature: __________________ Date: _________ Please remember to check each item individually and assure that the student’s name is on this sheet.

7


SKILL 1-2 FOREIGN BODY AIRWAY OBSTRUCTION

Name: _____________________________________________________


Performance Guidelines Completed RESPONSIVE VICTIM Assess for signs of breathing difficulty and complete or partial airway obstruction Delivers back blows, chest or abdominal thrusts based on age/size and other preexisting conditions Repeats previous step until obstruction is relieved or victim becomes unresponsive STUDENT IS ADVISED THAT VICTIM IS OR HAS BECOME UNRESPONSIVE Activates the emergency response system (if applicable) Opens airway attempts to visualize obstruction and performs appropriate intervention based on age/size of patient

Opens airway and attempts to ventilate while observing for signs of chest rise. If efforts to deliver ventilations is unsuccessful, re-opens airway and attempts to ventilate again

Delivers back blows, chest or abdominal thrusts based on age/size and other preexisting conditions Opens airway attempts to visualize obstruction and performs appropriate intervention based on age/size of patient

Opens airway and attempts to ventilate while observing for signs of chest rise Checks for pulse at appropriate location for age/size of patient and other signs of circulation. If no signs of circulation are present, cycles of breaths to compressions at appropriate rate for age/size of patient are administered

After approximately one minute, rescuer one delivers two breaths and rechecks for signs of circulation. If signs of circulation are still absent, cycles of breaths to compressions at appropriate rate for age/size of patient are performed until AED or Advanced Life Support is available

STUDENT IS ADVISED THAT SIGNS OF SPONTANEOUS BREATHING HAS RESUMED If no trauma present, victim is placed in the recovery position


ADULT _____ CHILD _____ INFANT _____

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not reopen airway with head tilt - chin lift or jaw thrust _____ Did not confirm adequate chest rise during ventilations _____ Performed skill in a manner that could endanger patient or other rescuers



8


SKILL 1-3 CARDIAC ARREST MANAGEMENT / AED

Name: _____________________________________________________


Performance Guidelines Completed AUTOMATIC EXTERNAL DEFIBRILLATOR MAINTENANCE CHECKLIST Defends the reasons for rapid application of AEDs Defends the reason for inspection and preventative maintenance of AEDs Explains the rationale for having unit / equipment prepared to respond Demonstrates inspection of AED, cables and connectors for cracks or damage Assures all supplies available ASSESSMENT Ensure that Effective CPR continues while obtaining a brief history and information on event Turns on AED Attaches AED electrodes to patient in correct location while chest compressions are being performed and plugs in cable connector

Ensures all persons are clear of patient and initiates analysis of rhythm Verifies that everyone is clear of patient and delivers shock Immediately directs resumption of CPR for two minutes (30 compressions/2 breaths) TRANSITION Gathers additional patient history and information on arrest event Confirms effectiveness of CPR INTEGRATION Directs insertion of airway adjunct Directs correct ventilation of patient with high concentration of oxygen Assures CPR performed correctly without unnecessary or prolonged interruption Reevaluates patient after two minutes of CPR Repeats AED sequence TRANSPORTATION Verbalizes rapid transport of patient and documents appropriate information


ADULT _____ CHILD _____

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not recognize the need for or apply/operate AED immediately/properly _____ Did not direct initiation/resumption of CPR at appropriate times _____ Did not assure all persons clear before initiating rhythm analysis or shocking sequence _____ Performed skill in a manner that could endanger patient or other rescuers



9


SKILL 1-4 BODY SUBSTANCE ISOLATION PRECAUTIONS

Name: _____________________________________________________

THE STUDENT WILL VERBALIZE THE THERAPEUTIC EFFECTS, INDICATIONS, CONTRAINDICATIONS, AND POSSIBLE SIDE EFFECTS FOR THE EQUIPMENT/PROCEDURE

Performance Guidelines Completed Student explains the rationale for the use of appropriate protective equipment STUDENT WILL DEMONSTRATE APPROPRIATE USE OF: Gloves Gowns/suits Eye protection GIVEN A SCENARIO WITH POTENTIAL INFECTIOUS EXPOSURE, THE EMT WILL: Demonstrate appropriate use of personal protection equipment/procedure Demonstrate procedures for cleaning/disinfection of equipment and patient care area Correctly dispose of contaminated items / bio-hazardous waste and document appropriately

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not demonstrate acceptable cleaning/disinfection/disposal procedures _____ Performed skill in a manner that could endanger patient or other rescuers



10


SKILL 1-5 LIFTING AND MOVING PATIENTS

Name: _____________________________________________________


Performance Guidelines Completed Student explains rationale for properly lifting and moving patients

Student demonstrates correct technique and body mechanics for: One-rescuer assist Two-rescuer assist Extremity carry Properly identifying patients prior to transfer Properly prioritizing patients for care and transport Transferring patient from stretcher to bed and bed to stretcher

Student assembles device and demonstrates correct technique and body mechanics for: Ambulance stretcher Scoop stretcher Stair chair

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not demonstrate proper body mechanics _____ Did not demonstrate appropriate use of technique or device _____ Performed skill in a manner that could endanger patient or other rescuers



11


SKILL 1-6 ORAL AND WRITTEN REPORTING / DOCUMENTATION

Name: _____________________________________________________

Performance Guidelines Completed Explains the rationale for appropriate documentation and using correct medical terminology Explains the rationale for using accurate and synchronous times to identify trends in patients

ORAL REPORT Given a scenario, student will obtain and convey all pertinent information into a clear and concise manner On scene report to ALS crew receiving transfer Radio report to receiving facility Bedside report when transferring patient care to accepting physician

WRITTEN DOCUMENTATION Student will verbalize minimum data sets as described in 64E-2 F.A.C. Given a scenario, student will organize and document pertinent information using the S.O.A.P format, in a clear and concise manner

ADVANCE DIRECTIVES / DO NOT RECUSSITATE ORDERS Student explains the role of EMS regarding the DNRO as stated in 64E-2 F.A.C. Explains the rationale for the needs, benefits, and usage of Advance Directives Explains the rationale for the concept of varying degrees of DNRO

REFUSAL OF CARE Student determines and documents mental and legal capacity to refuse care Patient advised of need for care based on complaint, signs/symptoms, findings, obvious injury, or mechanism, and patient response to advice documented

Patient advised of health consequences of refusal of care and patient response documented Medical control contacted and advised of refusal of care Patient signature obtained in the presence of witness Witness signature obtained

CRITICAL CRITERIA: _____ Did not report or document required or pertinent information _____ Did not obtain appropriate signatures on refusal



12


SKILL 1-7 CARDIAC MONITOR FUNCTION

Name: _____________________________________________________


Performance Guidelines Completed Student is able to turn on/off the monitor Student is able to print a cardiac rhythm strip Student is able to correctly change the roll of paper Student is able to properly able to replace batteries Student is able to locate the pulse oximeter connection Student is able to locate the end tidal CO2 connection Student has a basic understand of correct 4 lead placement

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not demonstrate appropriate use of technique or device _____ Performed skill in a manner that could endanger patient or other rescuers



13

Module 2 Airway

14


SKILL 2-1 OXYGEN ADMINISTRATION

Name: _____________________________________________________


Performance Guidelines Completed Student explains rationale for providing supplemental oxygenation Assembles regulator to tank Opens valve, checks for leaks and verifies tank pressure, applies humidifier SIMPLE FACE MASK Attaches mask to regulator Adjusts flow rate to 8 -10 L/min Applies and adjusts mask to patient’s face NON-REBREATHER MASK Attaches non-rebreather mask to regulator and pre-fills reservoir Adjusts flow rate to 15 L/min Applies and adjusts mask to patient’s face NASAL CANNULA Attaches mask to regulator Adjusts flow rate up to 6 L/min Applies and adjusts nasal cannula to patient’s face VENTURI MASK Attaches mask to regulator Adjusts flow rate and venturi to deliver prescribed concentration Applies and adjusts mask to patient’s face STUDENT IS INSTRUCTED TO DISCONTINUE OXYGEN THERAPY Removes mask or cannula Shuts off regulator Shuts off tank valve and relieves pressure in regulator


ADULT _____ GERIATRIC _____ CHILD _____ INFANT _____

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not assemble tank and regulator without leaks _____ Did not adjust device to correct flow rate or concentration or pre-fill reservoir _____ Performed skill in a manner that could endanger patient or other rescuers



15


SKILL 2-2 AIRWAY MANEUVERS

Name _____________________________________________________


Performance Guidelines Completed OPENING THE AIRWAY WITH SUSPECTED SPINAL INJURY Demonstrates proper technique to manually open airway using head tilt chin lift maneuver Student properly inserts adjunct airway Attaches one-way valve to mask Establishes and maintains mask to face seal Ventilates at correct rate and volume based on age/size of patient Connects mask to regulator and adjusts flow rate to 15 L/min

OPENING THE AIRWAY WITHOUT SUSPECTEDSPINAL INJURY Demonstrates proper technique to manually open airway using jaw thrust maneuver Student properly inserts adjunct airway Attaches one-way valve to mask Establishes and maintains mask to face seal Ventilates at correct rate and volume based on age/size of patient Connects mask to regulator and adjusts flow rate to 15 L/min

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not assemble tank and regulator without leaks _____ Did not adjust device to correct flow rate or concentration or pre-fill reservoir _____ Performed skill in a manner that could endanger patient or other rescuers



16


SKILL 2-3 VENTILATORY SUPPORT

Name _____________________________________________________


Performance Guidelines Completed Student explains rationale for artificial ventilation and airway protective skills taking priority over most other skills MOUTH TO MASK WITH SUPPLEMENTAL OXYGEN Attaches one-way valve to mask Demonstrates proper technique to manually open airway and insert adjunct airway Establishes and maintains mask to face seal Ventilates at correct rate and volume based on age/size of patient Connects mask to regulator and adjusts flow rate to 15 L/min Continues ventilation at correct rate and volume based on age/size of patient

BAG VALVE MASK, UNCONSCIOUS Demonstrates proper technique to manually open airway and insert adjunct, including jaw thrust and head tilt, chin lift.

Selects appropriate size mask and maintains mask to face seal Ventilates at correct rate and volume based on age/size of patient Connects mask to regulator and adjusts flow rate to 15 L/min Continues ventilation at correct rate and volume based on age/size of patient STUDENT INSTRUCTED TO CONTROL MASK/AIRWAY WITH BOTH HANDS WHILE SECOND RESCUER VENTILATES PATIENT Student verbalizes re-opening airway Continues ventilation at correct rate and volume based on age/size of patient

BAG VALVE MASK TO STOMA Connects bag valve to trachea tube and adjusts flow rate to 15 L/min Connects mask to regulator and adjusts flow rate to greater than 15 L/min Ventilates at correct rate and volume based on age/size of patient

AUTOMATIC TRANSPORT VENTILATOR Student attaches ventilator to regulator port, opens tank valve, and confirms tank pressure Student selects and attaches correct size mask to ventilator Demonstrates proper technique to manually open airway and insert adjunct Establishes and maintains mask to face seal Ventilates at correct rate and volume based on age/size of patient Confirms adequate ventilation by observing chest rise Student increases tidal volume until adequate chest rise noted


ADULT _____ CHILD _____ INFANT _____ STOMA _____

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not obtain a patent airway with airway adjunct and maintain mask seal _____ Did not deliver ventilation at appropriate rate or volume _____ Performed skill in a manner that could endanger patient or other rescuers

COMMENTS/REMEDIATION: __________________________________________________________________ _______________________________________________________________________________ Evaluator Printed Name: __________________ Evaluator Signature: __________________ Date: _________ Please remember to check each item individually and assure that the student’s name is on this sheet.

17


SKILL 2-3 VENTILATORY SUPPORT - CONTINUED

Name _____________________________________________________


Performance Guidelines Completed BAG VALVE MASK, CONSCIOUS Demonstrates proper technique to manually open airway and insert adjunct, including jaw thrust and head tilt, chin lift.

Selects appropriate size mask and maintains mask to face seal Ventilates at correct rate and volume based on age/size of patient Connects mask to regulator and adjusts flow rate to greater than 15 L/min Continues ventilation at correct rate and volume based on age/size of patient

FLOW RESTRICTED OXYGEN POWERED VENTILATION DEVICE Student attaches ventilator to regulator port, opens tank valve, and confirms tank pressure Student selects and attaches correct size mask to their ventilation device Demonstrates proper technique to manually open airway and insert adjunct airway device Establishes and maintains mask to face seal Student activates the valve by depressing the trigger Student releases the trigger as soon as the patient’s chest begins to rise Confirms adequate ventilation by observing chest rise Student ventilates the adult patient every 5 to 6 seconds Student continuously monitors the patient for adequate chest rise and fall during ventilation

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not obtain a patent airway with airway adjunct and maintain mask seal _____ Did not deliver ventilation at appropriate rate or volume _____ Performed skill in a manner that could endanger patient or other rescuers

COMMENTS/REMEDIATION: __________________________________________________________________ _______________________________________________________________________________


18


SKILL 2-4 UPPER AIRWAY ADJUNCTS AND SUCTION

Name _____________________________________________________


Performance Guidelines Completed OROPHARYNGEAL AIRWAY Demonstrates proper technique to manually open airway.

Properly measures OPA from the corner of the mouth to the tip of the ear lobe and selects appropriate size oropharyngeal airway

Inserts airway without pushing tongue posterior

STUDENT IS ADVISED THAT THE PATIENT IS GAGGING AND BECOMING CONSCIOUS Removes oropharyngeal airway

SUCTION Turns on/prepares suction device

Assures presence of mechanical suction

Student demonstrates knowledge of Hard tip and Soft tip suction devices

Student properly inserts suction tip, applies suction and evacuates the oropharynx/nasopharynx using a withdrawal motion

Student applies suction no more than 15 seconds at a time for adults and no more than 5 seconds at a time for pediatrics

STOMA SUCTION Turns on/prepares suction device

Assures presence of mechanical suction

Student selects soft tip catheter

Student properly inserts suction tip, applies suction and evacuates the stoma using a withdrawal motion

Student applies suction no more than 15 seconds at a time for adults and no more than 5 seconds at a time for pediatrics

NASOPHARYNGEAL AIRWAY Measures NPA from the base of the nare to the tip of the ear lobe and selects appropriate size nasopharyngeal airway

Lubricates nasopharyngeal airway prior to insertion

Fully inserts airway with bevel facing septum

Rotates airway 180 degrees during insertion



CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not correctly size or establish a patent airway with airway adjunct _____ Did not demonstrate acceptable suction technique _____ Performed skill in a manner that could endanger patient or other rescuers



19


SKILL 2-5 DUAL LUMEN / COMBI-TUBE Name _____________________________________________________


Performance Guidelines Completed Student properly identifies a need for an advanced airway Student verbalizes the contraindications of a dual lumen/Combitube

Under 16 years old Less than 5 feet tall Has esophageal disease Ingested a caustic substance Has an intact gag reflex

Demonstrates proper technique to manually open airway Measures and selects and inserts appropriate simple airway adjunct and assures adequate ventilation / oxygenation throughout procedure

Directs assistant to hyper-oxygenate patient for at least 2 minutes prior to attempting insertion Selects the appropriately sized device Inspects / lubricates airway device Positions patient’s head properly and removes airway adjunct Performs tongue / jaw lift Gently introduces tube, advances to correct depth, and inflates cuff to correct pressure Directs ventilation through correct lumen of device while confirming proper placement by auscultation over epigastrium / chest, observing chest rise, and attaching end tidal CO2 (EtCO2) detector

Student performs ongoing assessment and documents appropriate information STUDENT INFORMED THAT CHEST DOES NOT RISE AND FALL AND BREATH SOUNDS ONLY OVER EPIGASTRIUM Student performs rapid assessment, verbalizes possible causes, and initiates corrective action (ventilates through alternate lumen) within 30 seconds

Student reconfirms correct placement and adequate ventilations by observing chest rise and auscultation over chest and epigastrium and secures device

Performs ongoing assessment and documents corrective actions



CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not obtain a patent airway with airway adjunct _____ Did not provide high concentration oxygen _____ Did not assure adequate ventilation / oxygen _____ Did not hyper-oxygenate prior to attempting intubation _____ Did not confirm correct placement of device _____ Did not perform ongoing assessment _____ Performed skill in a manner that could endanger patient or other rescuers



20


SKILL 2-6 KING AIRWAY

Name _____________________________________________________


Performance Guidelines Completed Student properly identifies a need for an advanced airway Student verbalizes the contraindications of a King Airway

Has esophageal disease Ingested a caustic substance Has an intact gag reflex

Student selects the proper size King Airway based on patients height Demonstrates proper technique to manually open airway Measures and selects and inserts appropriate simple airway adjunct and assures adequate ventilation / oxygenation throughout procedure

Directs assistant to hyper-oxygenate patient for at least 2 minutes prior to attempting insertion Selects the appropriately sized device Inspects / lubricates airway device Positions patient’s head properly and removes airway adjunct Performs tongue / jaw lift Gently introduces tube, advances to correct depth, and inflates cuff to correct pressure Student ventilates through the device while confirming proper placement by auscultation over epigastrium / chest, observing chest rise, and attaching end tidal CO2 (EtCO2) detector

Student secures device Student performs ongoing assessment and documents appropriate information



CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not obtain a patent airway with airway adjunct _____ Did not provide high concentration oxygen _____ Did not assure adequate ventilation / oxygen _____ Did not hyper-oxygenate prior to attempting intubation _____ Did not confirm correct placement of device _____ Did not perform ongoing assessment _____ Performed skill in a manner that could endanger patient or other rescuers



21


SKILL 2-7 CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE (CPAP)

Name _____________________________________________________


Performance Guidelines Completed Student demonstrates and understanding that the patient must be awake and alert, able to maintain his or her own airway, and able to breathe on his or her own.

Student is able to recall relative contraindications of CPAP, including pulmonary trauma, Increased ICP, abdominal distention and hypotension.

Student explains the procedure to the patient and gains their understanding and consent. Student correctly assembles the CPAP device and circuit, and connects it to an oxygen source Student applies the mask, secures the head straps and begins applying CPAP at the lowest setting (0-2 cmH2O) while continuously reassuring the patient.

Student GRADUALLY increases CPAP pressure to a maximum of 10 cmH2O for CHF patients, or 5 cmH2O for all other respiratory conditions.

Student verbalizes that CPAP therapy needs to be continuous and should not be removed unless the patient cannot tolerate the mask, requires suctioning or airway intervention, experiences continued or worsening respiratory failure, or a pneumothorax is suspected.

Student continuously monitors the patient’s respiratory status and correctly addresses any deterioration.

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not obtain observe contraindications _____ Did not provide high concentration oxygen _____ Did not assure adequate ventilation / oxygen _____ Did not perform ongoing assessment _____ Performed skill in a manner that could endanger patient or other rescuers



22


SKILL 2-8 PULSE OXIMETRY

Name _____________________________________________________


Performance Guidelines Completed Turns unit on and selects appropriate probe site Places probe on patient and evaluates signal quality to determine accuracy of data Correctly reads pulse rate and SpO2 Initiates or modifies treatment based on reading Student performs ongoing assessment and documents appropriate information STUDENT ADVISED OF DECLINE IN SpO2 Student performs rapid assessment, verbalizes possible causes, and initiates corrective action within 30 seconds

Performs ongoing assessment and documents corrective actions

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not identify conditions that affect data _____ Did not take or verbalize corrective actions _____ Performed skill in a manner that could endanger patient or other rescuers



23

Module 3

Assessment and Management:

Medical

24


SKILL 3-1 PATIENT ASSESSMENT TECHNIQUES

Name _____________________________________________________


Performance Guidelines Completed Explains the rationale for feelings that patients may experience

Explains the rationale of obtaining baseline and additional sets of vital signs

Recognizes and responds to the feelings experienced by the patient during the assessment

Defends the need for obtaining and recording accurate vital signs and S.A.M.P.L.E. history

SKIN Student demonstrates the correct assessment of pallor

Student demonstrates the correct assessment of skin temperature

Student demonstrates the correct assessment of skin moisture

Student demonstrates the correct assessment of capillary refill

PULSE Student demonstrates locating and assessing carotid pulse

Student demonstrates locating and assessing antecubital and mid-humeral brachial pulses

Student demonstrates locating and assessing radial pulse

Student demonstrates locating and assessing femoral pulse

Student demonstrates locating and assessing dorsalis pedis pulse

Student demonstrates locating and assessing posterior tibial pulse

BLOOD PRESSURE Student selects correct size cuff for age/size of patient and location of measurement

Pulse palpated at point of measurement and cuff correctly applied to extremity

Student demonstrates correct technique for measurement / documentation of brachial B/P

Student demonstrates correct technique for measurement / documentation of radial B/P

Student demonstrates correct technique for measurement / documentation of popliteal B/P

PUPILS Student demonstrates correct technique for evaluating visual acuity and size / shape of pupils

Student demonstrates correct technique for assessing reactivity in bright and dim light conditions

Student verbalizes and correctly documents normal or abnormal findings

BREATHING/LUNG SOUNDS Student correctly determines respiratory rate, quality and rhythm

Student identifies landmarks and demonstrates correct technique for auscultation of breath sounds

Student differentiates between normal / abnormal / adventitious sounds and underlying pathologies

Student verbalizes and correctly documents normal or abnormal findings



CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not demonstrate acceptable technique _____ Did not differentiate between normal and abnormal findings _____ Did not correctly document findings _____ Performed skill in a manner that could endanger patient or other rescuers



25


SKILL 3-2 ASSESSMENT TOOLS S.A.M.P.L.E O.P.Q.R.S.T DCAP-BTLS T.I.C

Name _____________________________________________________


Performance Guidelines Completed STUDENT VERBALIZES AND UNDERSTANDS:

S.A.M.P.L.E S - Signs and symptoms A - Allergies M - Medications L - Last oral intake E - Events leading up to this incident

O.P.Q.R.S.T O - Onset P - Provocation Q - Quality S - Severity T - Time (how long have you had these symptoms)

DCAP-BTLS D - Deformity C - Contusions A - Abrasions P - Punctures B - Burns/Bruises L - Lacerations S - Swelling

T.I.C T - Tenderness I - Instability C - Crepitus



26


SKILL 3-3 MEDICAL ASSESSMENT / MANAGEMENT - Adult

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY – Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway - Assesses airway and performs intervention to assure airway patency as needed Breathing - Assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation - Controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD - Inspects and palpates scalp, ears, eyes, face NECK - Inspects, palpates and auscultates as appropriate CHEST - Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS - Inspects, palpates and auscultates as appropriate EXTREMITIES - Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR - Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not apply supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication / treatment _____ Performed skill in a manner that could endanger patient or other rescuers



27


SKILL 3-4 GLUCOMETER

Name _____________________________________________________

THE STUDENT WILL VERBALIZE THE THERAPEUTIC EFFECTS, INDICATIONS, CONTRAINDICATIONS, AND POSSIBLE SIDE EFFECTS FOR THE EQUIPMENT/PROCEDURE STUDENT MUST TAKE OR VERBALIZE BODY SUBSTANCE ISOLATION PRECAUTIONS BEFORE INITIATING PATIENT CONTACT.

Performance Guidelines Completed Student identifies the need to obtain a blood glucose reading Student locates the glucometer and ensures that all the necessary supplies are present Student turns the glucometer on, confirms that the battery has an adequate charge and confirms that the code on the test strips matches the code programmed into the glucometer

Student selects one of the patient’s fingers, massages blood into the distal end and cleanses the finger with alcohol prep. Wait for the alcohol to evaporate before continuing.

Student uses a lancet to pierce the patient’s skin Student applies a drop of the patient’s blood to the test strip Student waits for and records the reading. Student disposes of sharps and contaminated items appropriately

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not identify conditions that affect data _____ Performed skill in a manner that could endanger patient or other rescuers



28

Module 4


Medical

29


SKILL 4-1 ASSESSMENT / MANAGEMENT - Respiratory Emergencies

Name _____________________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY - Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.) Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Explains rationale for administration of metered dose inhaler Properly verifies the Five Rights (5 R’s) Demonstrates correct technique for administration of metered dose inhaler Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information, THE STUDENT WILL DEMONSTRATE APPROPRIATE USE OF EQUIPMENT/PROCEDURE FOR:

ADULT _____ CHILD _____ INFANT _____ GERIATRIC _____

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not provide supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication / treatment _____ Performed skill in a manner that could endanger patient or other rescuers


30


SKILL 4-2 ASSESSMENT / MANAGEMENT - Angina Pectoris

Name _____________________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY – Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.) Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Explains rationale for administration of aspirin and nitroglycerine Student confirms 5 R’s

1. Medication 2. Dose 3. Time 4. Route 5. Date

Demonstrates correct technique for administration of aspirin and nitroglycerine Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information



31


SKILL 4-3 ASSESSMENT / MANAGEMENT - Thromboembolism

Name _____________________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.) Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information




32


SKILL 4-4 ASSESSMENT / MANAGEMENT - Infectious Disease

Name _____________________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.) Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information THE STUDENT WILL DEMONSTRATE APPROPRIATE USE OF EQUIPMENT/PROCEDURE FOR:





33


SKILL 4-5 ASSESSMENT / MANAGEMENT - Aortic Aneurism/Dissection

Name _____________________________________________________






34


SKILL 4-6 ASSESSMENT / MANAGEMENT - Hypertensive Crisis

Name _____________________________________________________






35


SKILL 4-7 ASSESSMENT / MANAGEMENT - Heart Failure

Name _____________________________________________________






36


SKILL 4-8 ASSESSMENT / MANAGEMENT - Neurological Emergency

Name _____________________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.), description of episode, and possible trauma Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Performs a stroke assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Explains rationale for administration of oral glucose and other medications Student confirms 5 R’s


Demonstrates correct technique for administration of oral glucose if applicable Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

THE STUDENT WILL DEMONSTRATE APPROPRIATE PROCEDURE FOR:




Evaluator Printed Name: __________________ Evaluator Signature: __________________ Date: _________

37

Please remember to check each item individually and assure that the student’s name is on this sheet.

38


SKILL 4-9 ASSESSMENT / MANAGEMENT - Sickle Cell Crisis

Name _____________________________________________________






39


SKILL 4-10 ASSESSMENT / MANAGEMENT - Dialysis Emergency

Name _____________________________________________________






40


SKILL 4-11 ASSESSMENT / MANAGEMENT - Non-Traumatic Musculoskeletal Injury

Name _____________________________________________________






41


SKILL 4-12 ASSESSMENT / MANAGEMENT - Pregnant Patient

Name _____________________________________________________






42


SKILL 4-13 ASSESSMENT / MANAGEMENT - Allergic Reactions / Anaphylaxis

Name _____________________________________________________ THE STUDENT WILL VERBALIZE THE THERAPEUTIC EFFECTS, INDICATIONS, CONTRAINDICATIONS, AND POSSIBLE SIDE EFFECTS FOR THE EQUIPMENT/PROCEDURE. STUDENT MUST TAKE OR VERBALIZE BODY SUBSTANCE ISOLATION PRECAUTIONS BEFORE INITIATING PATIENT CONTACT.

Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.) Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Explains rationale for administration of Epinephrine auto-injector Student confirms 5 R’s


Demonstrates correct technique for administration of Epinephrine auto-injector Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information






43


SKILL 4-14 ASSESSMENT / MANAGEMENT - Poisoning / Overdose


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Explains the need for contacting medical control early in the management of poisoning or OD Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.), name / amount of substance Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Explains rationale for administration of activated charcoal Student confirms 5 R’s


Demonstrates correct technique for administration of activated charcoal if applicable Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information


COMMENTS/REMEDIATION: _____________________________________________________________________________ __________________________________________________________________________________________________________


44


SKILL4‐15 ASSESSMENT/MANAGEMENT‐BehavioralEmergencies


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains the rationale for learning to modify behavior toward a patient experiencing in crisis Works to ensure the safety of emergency responders, patients and bystanders Explains how patient situations affect determination of illness and mechanisms of injury Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.) Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Demonstrates correct technique for patient restrains Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information




45


SKILL 4-16 ASSESSMENT / MANAGEMENT - DIABETIC / HYPOGLYCEMIC


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Explains the need for contacting medical control early in the management of poisoning or OD Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.), name / amount of substance Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs including blood glucose level Obtains medical direction / verbalizes standing orders and additional treatments/interventions Explains rationale for administration of oral glucose Student confirms 5 R’s


Demonstrates correct technique for administration of oral glucose Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs including blood glucose level Repeats focused assessment based on patient complaint or findings Documents appropriate information




46


SKILL 4–17 ASSESSMENT / MANAGEMENT - Seizures

Name _____________________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.), description of episode, and possible trauma Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information






47


SKILL 4-18 ASSESSMENT / MANAGEMENT - HYPERTHERMIA

Name _____________________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN SYMPTOMS AND TREATMENT METHODS FOR HYPERTHERMIA Skin- pale and moist or dry and hot Altered mental status Decrease in motor and sensory function Pulse- rapid and strong that progresses into weak Remove patient from the environment Administer high flow O2 Remove as much of the patients clothing as possible Begin active cooling with cold packs, wet compresses, and/or misting the patient with water then fanning lightly SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.), source of exposure Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Assesses and adequately addresses the patient’s body temperature related issues Explains rationale for administration of medications Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information



Evaluator Printed Name: __________________ Evaluator Signature: __________________ Date: _________

48


49


SKILL 4-19 ASSESSMENT / MANAGEMENT - HYPOTHERMIA

Name _____________________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN SYMPTOMS AND TREATMENT METHODS FOR HYPOTHERMIA Skin-red, pale, cyanotic, gray Temperature- cool or cold Altered mental status Decreased motor and sensory function Pulse- rapid initially, then slow and weak Low to absent blood pressure Sluggish/dilated pupils Remove patient from the environment Administer high flow O2 Remove wet clothing and make sure patient is dry Begin active warming with blankets, the heater, heat packs Handle the patient gently with no sudden jolts or movements SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY – Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.), source of exposure Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Assesses and adequately addresses the patient’s body temperature related issues Explains rationale for administration of medications Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information


COMMENTS/REMEDIATION: __________________________________________________________________ _______________________________________________________________________________ Evaluator Printed Name: __________________ Evaluator Signature: __________________ Date: _________


50

Module 5


Trauma

51


SKILL 5-1 TRAUMA SCORE CARD / ADULT TRAUMA ALERT

Name: _________________________________________________________

Skill demonstrated by: ___________________________________________________________________________ Print Instructors Name

THE STUDENT TAKES OR VERBALIZE BODY SUBSTANCE ISOLATION BEFORE INITIATING PATIENT CONTACT.

*Signature indicates student’s successful performance of the skill check off sheet

Evaluator Printed Name: __________________ Evaluator Signature: __________________ Date: _________ Please remember to check each item individually and assure that the student’s name is on this sheet

52


SKILL 5-2 TRAUMA SCORE CARD / PEDIATRIC TRAUMA ALERT

Name: _________________________________________________________

Skill demonstrated by: ___________________________________________________________________________ Print Instructors Name

THE STUDENT TAKES OR VERBALIZE BODY SUBSTANCE ISOLATION BEFORE INITIATING PATIENT CONTACT.

*Signature indicates student’s successful performance of the skill check off sheet


53


SKILL 5-3 TRAUMA ASSESSMENT / MANAGEMENT - ADULT

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: – Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not apply supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication / treatment _____ Performed skill in a manner that could endanger patient or other rescuers



54


SKILL 5-4 TRAUMA ASSESSMENT / MANAGEMENT - BRAIN INJURY / SPINAL CORD INJURY

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers the need for stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information




55


SKILL 5-5 TRAUMA ASSESSMENT / MANAGEMENT - SUBMERSION INCIDENT

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information




56


SKILL 5-6 TRAUMA ASSESSMENT / MANAGEMENT - DYSBARISM INCIDENT

Name _________________________________________






57


SKILL 5-7 TRAUMA ASSESSMENT / MANAGEMENT - LIGHTNING INCIDENT

Name _________________________________________






58


SKILL 5-8 TRAUMA ASSESSMENT / MANAGEMENT - ENVENOMATION INCIDENT

Name _________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN SYMPTOMS AND TREATMENT METHODS FOR ENVENOMATION Try to identify the snake, insect, or animal Manage bleeding if necessary If a stinger is still present remove it gently by scraping Cleanse the area around the sting or bite Lower the injury site below the heart if possible Do not apply cold packs Draw a circle around the envenomation site to help show the progression of swelling Keep the patient calm Transport to an appropriate receiving facility SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information




59


SKILL 5-9 TRAUMA ASSESSMENT / MANAGEMENT - PEDIATRIC

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains rationale for evaluating scene safety prior to entering scene and determines scene is safe Explains how patient situations affect determination of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Verbalizes special pediatric considerations and performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not provide supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication / treatment _____ Did not transport within 10 minutes _____ Performed skill in a manner that could endanger patient or other rescuers



60


SKILL 5-10 TRAUMA ASSESSMENT / MANAGEMENT - HYPOVOLEMIC SHOCK

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe and takes body substance isolation precautions Determines nature of problem, mechanisms of injury, and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Assesses: Airway, Breathing, Circulation Identifies significant bleeding Applies direct pressure to wound and elevates extremity (if applicable) STUDENT INFORMED THAT WOUND IS STILL BLEEDING Applies additional dressing material Locates and applies pressure to appropriate arterial pressure point STUDENT INFORMED THAT BLEEDING IS NOT CONTROLLED Student properly applies tourniquet Supplemental oxygen administered, positions patient properly, and takes steps to prevent heat loss Identifies patients that meet trauma alert criteria and verbalizes need for immediate transport Explains the urgency to transport patients bleeding and/or show signs of hypoperfusion SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history Identifies patients that meet secondary trauma alert criteria and revises transport priority decision Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions Verbalizes ongoing assessment and documents appropriate information



CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine in a timely manner _____ Did not verbalize need for immediate transport



61


SKILL 5-11 TRAUMA ASSESSMENT / MANAGEMENT - OPEN/CLOSED CHEST INJURIES

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine in a timely manner _____ Did not provide supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication/treatment _____ Performed skill in a manner that could endanger patient or other rescuers



62


SKILL 5-12 TRAUMA ASSESSMENT / MANAGEMENT - ABDOMINAL INJURY

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not provide supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication/treatment _____ Performed skill in a manner that could endanger patient or other rescuers



63


SKILL 5-13 TRAUMA ASSESSMENT / MANAGEMENT - INJURIES TO HEAD, NECK OR FACE

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, skin color, condition, and temperature Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Verbalizes special considerations for cranio-facial injuries and performs appropriate assessment Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not provide supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication/treatment _____ Performed skill in a manner that could endanger patient or other rescuers



64


SKILL 5-14 IMMOBILIZATION SKILLS - ORTHOPEDIC INJURY, SWOLLEN AND DEFORMED

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Student verbalizes Trauma Scoring Criteria in 64E-2. F.A.C. based on age/size of patient. Identifies priority patients and makes transport decision.

Assesses: Airway, Breathing, circulation, and c-spine Directs or manual stabilization Assesses motor, sensory, and distal circulation Evaluates type and location of injury and verbalizes treatment options and contraindications Explains the rationale for splinting a deformed or swollen extremity Explains the rationale for splinting on scene versus load and go Selects appropriate device/method of immobilization Measures and applies splint immobilizing joint above and below injury Reassesses motor, sensory and distal circulation Recognizes and attends to feelings patients may experience during assessment and treatment SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment (focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs Obtains S.A.M.P.L.E. history Identifies patients that meet secondary trauma alert criteria and revises transport priority decision Manages injuries appropriately Obtains medical direction/verbalizes standing orders and additional treatments/interventions Verbalizes ongoing assessment and documents appropriate information




AIR SPLINT ___ RIGID SPLINT ___ SOFT SPLINT ___ SLING & SWATH ___ VACUUM SPLINT ___

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not obtain medical direction or verbalize standing orders for medication/treatment _____ Performed skill in a manner that could endanger patient or other rescuers

COMMENTS/REMEDIATION: __________________________________________________________________ _______________________________________________________________________________ Evaluator Printed Name: __________________ Evaluator Signature: __________________ Date: _________ Please remember to check each item individually and assure that the student’s name is on this sheet

65


SKILL 5-15 IMMOBILIZATION SKILLS - TRACTION SPLINTING

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Recognizes and attends to feelings patients may experience during assessment and treatment FOCUSED HISTORY AND PHYSICAL EXAM/RAPID ASSESSMENT (Secondary Survey) S.A.M.P.L.E. History and baseline vital signs Directs application of manual stabilization of injured limb and application of manual traction Assesses motor, sensory, and circulatory function in injured extremity STUDENT ADVISED: M,S,C are present and normal Assembles and adjusts splint to correct length Positions splint and applies proximal (ischial strap) and distal (ankle hitch) securing devices Applies traction to appropriate stopping point(s) Correctly positions and applies support straps Reassesses motor, sensory, and distal circulatory function Transfers and secures patient and device to long board ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Contacts medical control and documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Loss of traction at any point after it was applied _____ Failed to reassesses motor, sensory, and distal circulatory function after application of devices _____ Failed to secure patient and device to long board _____ Performed skill in a manner that could endanger patient or other rescuers


66


SKILL 5-16 TRAUMA ASSESSMENT / MANAGEMENT - BURNS

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe, identifies mechanism of injury, and requests additional help if needed Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines chief complaint and identifies any life threatening conditions Airway: Assesses airway and performs intervention to assure airway patency as needed Breathing: Assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: Controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision (64E-2) Recognizes and attends to feelings patients may experience during assessment and treatment FOCUSED HISTORY AND PHYSICAL EXAM/RAPID ASSESSMENT (Secondary Survey) Performs appropriate assessment (focused or rapid assessment) Demonstrates correct application of RULE OF NINES to quantify affected surface area in Demonstrates appropriate treatment for superficial thermal burns Demonstrates appropriate treatment for partial thickness thermal burns Demonstrates appropriate treatment for full thickness thermal burns Demonstrates or verbalizes appropriate treatment for chemical burns S.A.M.P.L.E. history and baseline vitals Reevaluates transport decision and verbalizes consideration for completing detailed physical exam Obtains medical direction/verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs and physical exam based on complaint or findings Contacts medical control and documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Performed skill in a manner that could endanger patient or other rescuers



67


SKILL 5-17 TRAUMA ASSESSMENT / MANAGEMENT - SPINAL IMMOBILIZATION - SUPINE PATIENT

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Direct assistant to place head in neutral position and manual stabilization Performs initial assessment and rapid trauma assessment including motor, sensory, circulation, and c-spine

Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Explains the rationale for immobilization of the entire spine Defends the reasons for removal of a helmet prior to transport versus leaving it in place Demonstrates proper helmet removal technique Applies correctly sized cervical collar Positions immobilization device correctly Directs log roll movement of patient without compromising integrity of spine Student verbalizes which strapping technique will provide best immobilization Applies padding to fill voids between patient and device Immobilizes patient’s torso to device Evaluates position of head and applies padding to maintain neutral alignment Immobilizes patient’s head to device Secures patient’s legs to device Secures patient’s arms to device Reassesses motor, sensory, and distal circulation Performs appropriate assessment and directs assistant to obtain vital signs and S.A.M.P.L.E. history Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions Verbalizes ongoing assessment and documents appropriate information



CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not direct or take manual stabilization of head or released head prior to mechanical immobilization _____ Upon completion of immobilization head/body moved excessively or not in neutral alignment _____ Did not reassess after immobilization _____ Secured head to device before immobilizing torso _____ Performed skill in a manner that could endanger patient or other rescuers



68


SKILL 5-18 TRAUMA ASSESSMENT / MANAGEMENT - SPINAL IMMOBILIZATION - STANDING PATIENT

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Assesses general appearance of patient as approaching patient Student establishes and maintains adequate airway, breathing, circulation Student directs assistant to place/maintain head in neutral in-line position Student directs assistant to maintain manual immobilization of the head Student performs rapid head to toe assessment/assesses motor, sensory, and distal circulation in extremities

Student measures and applies appropriate size c-collar Student positions the long spine board immobilization device appropriately behind patient Student and assistant simultaneously logroll patient Student and assistant gently/safely lower the patient and the backboard to the ground while maintaining in-line stabilization of c-spine

Student directs assistant to continue to maintain in line stabilization of c-spine Student applies padding to voids between the torso and the board if necessary Student immobilizes the patient’s torso to the device using two straps Student secures the patient’s legs to the device using one strap Student ensures patients arms are secured to the device Student immobilizes the patient’s head to the device using CID Student continuously reassesses motor, sensory, and distal circulation in extremities Assesses general appearance of patient as approaching patient Student establishes and maintains adequate airway, breathing, circulation Student directs assistant to place/maintain head in neutral in-line position Student directs assistant to maintain manual immobilization of the head Verbalizes ongoing assessment and documents appropriate information






69


SKILL 5-19 TRAUMA ASSESSMENT / MANAGEMENT - SPINAL IMMOBILIZATION - SEATED PATIENT / KED

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Determines number of patients and requests additional help if necessary Direct assistant to place head in neutral position and manual stabilization Performs initial assessment and rapid trauma assessment including motor, sensory, circulation, and c-spine

Explains rationale for using rapid extrication versus intermediate immobilization device Explains the rationale for using a short spinal immobilization device Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Applies correctly sized cervical collar Positions immobilization device correctly Secures device to patient’s torso and adjusts torso and leg straps Evaluates position of head and applies padding to maintain neutral alignment Immobilizes patient’s head to device Directs movement of patient onto long spine board without compromising integrity of spine Student verbalizes which strapping technique will provide best immobilization to spine board Patient immobilized onto spine board Reassesses motor, sensory, and distal circulation Performs appropriate assessment and directs assistant to obtain vital signs and S.A.M.P.L.E. history Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions Verbalizes ongoing assessment and documents appropriate information






70


SKILL 5-20 TRAUMA ASSESSMENT / MANAGEMENT - SPINAL IMMOBILIZATION - PRONE PATIENT

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Assesses general appearance of patient as approaching patient Student establishes and maintains adequate airway, breathing, circulation Student directs assistant to place/maintain head in neutral in-line position Student directs assistant to maintain manual immobilization of the head Student performs rapid head to toe assessment/assesses motor, sensory, and distal circulation in extremities

Student measures and applies appropriate size c-collar Student positions the long spine board immobilization device appropriately behind patient Student and assistant simultaneously logroll patient Student and assistant gently/safely lower the patient and the backboard to the ground while maintaining in-line stabilization of c-spine

Student directs assistant to continue to maintain in line stabilization of c-spine Student applies padding to voids between the torso and the board if necessary Student immobilizes the patient’s torso to the device using two straps Student secures the patient’s legs to the device using one strap Student ensures patients arms are secured to the device Student immobilizes the patient’s head to the device using CID Student continuously reassesses motor, sensory, and distal circulation in extremities Assesses general appearance of patient as approaching patient Student establishes and maintains adequate airway, breathing, circulation Student directs assistant to place/maintain head in neutral in-line position Student directs assistant to maintain manual immobilization of the head Verbalizes ongoing assessment and documents appropriate information






71


SKILL 5-21 TRAUMA ASSESSMENT / MANAGEMENT - HELMET REMOVAL

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Determines number of patients and requests additional help if necessary Direct assistant to place head in neutral position and manual stabilization Performs initial assessment and rapid trauma assessment including motor, sensory, circulation, and c-spine

Explains rationale for using rapid extrication versus intermediate immobilization device Explains the rationale for using a short spinal immobilization device Identifies priority patients, verbalizes trauma scoring criteria, and makes transport decision Student identifies the need to remove the helmet Student assesses the patient’s neurological status Student instructs another rescuer to hold manual spinal motion restriction on the patient’s helmeted head.

Student removes the helmet strap Student holds manual spinal motion restriction under the helmet by placing one hand under the patient’s neck and the other over the patient’s mandible.

Student communicates to the additional rescuer that he or she has control of the pt’s head. Additional rescuer then moves his or her hands to the sides of the helmet, spreads the sides to facilitate the removal of the helmet over the patient’s ears and carefully removes the helmet as the student slides his or her hand further up to support the patient’s head as the helmet comes off.

Additional rescuer completes removal of the helmet, sets it aside, then takes control of the patient’s head.

Additional rescuer maintains manual spinal motion restriction while the student applies mechanical immobilization devices.

Once spinal motion restriction is complete, the student reassesses the patient’s neurological status and documents the results.




72


SKILL 5-22 TRAUMA ASSESSMENT / MANAGEMENT - RAPID EXTRICATION

Name _________________________________________


Performance Guidelines Completed Initial Steps

1. Upon arrival student determines possible spinal injury 2. Student performs initial assessment 3. Student determines the need for rapid extrication 4. Student maintains c-spine support

Rescuer 1 manual neutral alignment procedure 1. Student is behind patient 2. Student brings head to eyes front position 3. Student holds c-spine until patient is completely packaged 4. Contraindicated if pain increased during maneuver 5. Resistance or pain increases during maneuver 6. If contraindicated, immobilize patient in found position-no c-collar should be applied

Rescuer 2 Procedure 1. Student stands in doorway supporting mid thorax- helps rescuer 1 by position patient up right 2. Student performs rapid assessment and proper sized c-collar 3. Student uses his arms to support front and back of patient’s thorax

Rescuer 3 Procedure 1. Student places long back board on stretcher and moves toward vehicle door 2. Student moves to front of seat and frees patient’s legs and feet

Patient Movement Procedure 1. On Rescuer 1 Command 2. Rescuer 2 and 3 rotate patient in short coordinated moves until patient’s back is in open

doorway and feet are on the seat. Rescuer 4 is outside of vehicle by patient and takes over c-spine from rescuer 1

3. Rescuer 1 places long spine board on seat next to patient’s buttocks 4. Students will support the other end of the board 5. On Rescuers 4’s command, Rescuer 2 and 3 lower the patient onto the board. On the

command of Rescuer 4, Rescuer 2 and 3 slide the patient using short coordinated movements onto the long spine board.

6. Secure patient to long spine board



73

Module 6 Obstetrics

and Pediatrics

74


SKILL 6-1 ASSESSMENT / MANAGEMENT - CHILDBIRTH

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Explains the rationale for understanding the implications of treating two patients (mother & baby) PRIMARY SURVEY: Explains value of performing an initial assessment Verbalizes general impression of patient Determines responsiveness / rates level of consciousness using A.V.P.U. scale Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs interventions as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: assesses pulse, skin color, condition, and temperature Determines frequency/duration of contractions, checks for crowning or limb presenting body parts, and makes transport decision

SECONDARY SURVEY AND RAPID ASSESSMENT Directs or obtains vital signs, O. P. Q. R. S. T., and S .A. M. P. L. E. history Determines last menstrual period, length of pregnancy, risk factors, and estimated due date Determines leakage of fluids, blood, or mucus plug STUDENT ADVISED THAT PATIENT HAS UNCONTROLLABLE URGE TO PUSH AND CHILDBIRTH IS IMINENT Student obtains medical direction or verbalizes standing orders Assembles equipment / supplies and prepares for delivery Positions patient correctly, demonstrates appropriate delivery technique Notes time of birth and A.P.G.A.R. score Uses PEDIATRIC ASSESSMENT TRIANGLE to assess newborn while preventing heat loss Demonstrates proper technique for cutting cord Reassesses newborn using PEDIATRIC ASSESSMENT TRIANGLE and obtains new A.P.G.A.R. ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not provide supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication / treatment



75


SKILL 6-2 ASSESSMENT / MANAGEMENT - CHILDBIRTH, PROLAPSED CORD

Name _________________________________________



SECONDARY SURVEY AND RAPID ASSESSMENT Directs or obtains vital signs, O. P. Q. R. S. T., and S .A. M. P. L. E. history Determines last menstrual period, length of pregnancy, risk factors, and estimated due date Determines leakage of fluids, blood, or mucus plug STUDENT ADVISED THAT PATIENT HAS UNCONTROLLABLE URGE TO PUSH AND CHILDBIRTH IS IMINENT Student obtains medical direction or verbalizes standing orders Assembles equipment / supplies and prepares for delivery Positions patient correctly, demonstrates appropriate delivery technique Student identifies the presence of a prolapsed cord Student instructs the patient not to push, and places her in the knee chest position, face down, buttocks up on the stretcher

Student inserts a sterile, gloved hand into the patient’s vagina and gently pushes the presenting part away from the pulsating cord.

Student covers the prolapsed cord with a moistened sterile dressing and proceeds rapidly to the closest appropriate facility

ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information




76


SKILL 6-3 ASSESSMENT / MANAGEMENT - BREECH BIRTH

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe

Determines nature of illness

Works to ensure the safety of emergency responders, patients and bystanders

Determines number of patients and requests additional help if necessary

Explains the rationale for understanding the implications of treating two patients (mother & baby)

PRIMARY SURVEY: Explains value of performing an initial assessment Verbalizes general impression of patient

Determines responsiveness / rates level of consciousness using A.V.P.U. scale

Determines chief complaint and identifies any life threatening conditions

Airway: assesses airway and performs interventions as needed

Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation

Circulation: assesses pulse, skin color, condition, and temperature

Determines frequency/duration of contractions, checks for crowning or limb presenting body parts, and makes transport decision

SECONDARY SURVEY AND RAPID ASSESSMENT Directs or obtains vital signs, O. P. Q. R. S. T., and S .A. M. P. L. E. history

Determines last menstrual period, length of pregnancy, risk factors, and estimated due date

Determines leakage of fluids, blood, or mucus plug

STUDENT ADVISED THAT PATIENT HAS UNCONTROLLABLE URGE TO PUSH AND CHILDBIRTH IS IMINENT Student obtains medical direction or verbalizes standing orders

Assembles equipment / supplies and prepares for delivery

Positions patient correctly, demonstrates appropriate delivery technique

Student identifies the presence of a breech birth

As the infant delivers, the students supports, but does NOT pull on the infant legs.

The student allows the child to be delivered normally

If the head is not delivered, the student inserts his or her sterile, gloved index and middle fingers into the patient’s vagina, forming a V along the vaginal wall with the baby’s mouth and nose between the fingers to create a space for respiration until the head delivers.

Notes time of birth and A.P.G.A.R. score

Uses PEDIATRIC ASSESSMENT TRIANGLE to assess newborn while preventing heat loss

Demonstrates proper technique for cutting cord

Reassesses newborn using PEDIATRIC ASSESSMENT TRIANGLE and obtains new A.P.G.A.R.

ONGOING ASSESSMENT Repeats initial assessment and vital signs

Repeats focused assessment based on patient complaint or findings

Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not obtain medical direction or verbalize standing orders for medication / treatment



77


SKILL 6-4 ASSESSMENT / MANAGEMENT - CHILDBIRTH AND OBSTETRICS, POST-PARTUM BLEEDING

Name _________________________________________



SECONDARY SURVEY AND RAPID ASSESSMENT Directs or obtains vital signs, O. P. Q. R. S. T., and S .A. M. P. L. E. history Determines last menstrual period, length of pregnancy, risk factors, and estimated due date Determines leakage of fluids, blood, or mucus plug STUDENT ADVISED THAT PATIENT HAS UNCONTROLLABLE URGE TO PUSH AND CHILDBIRTH IS IMMINENT Student obtains medical direction or verbalizes standing orders Assembles equipment / supplies and prepares for delivery Positions patient correctly, demonstrates appropriate delivery technique Notes time of birth and A.P.G.A.R. score Uses PEDIATRIC ASSESSMENT TRIANGLE to assess newborn while preventing heat loss Demonstrates proper technique for cutting cord Reassesses newborn using PEDIATRIC ASSESSMENT TRIANGLE and obtains new A.P.G.A.R. Student identifies excessive post-partum bleeding (More than 500ml) Student applies aggressive oxygen therapy, initiates fundal massage, and encourages the mother to breast feed. Student transport the patient to the closest appropriate facility without delay. ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information




78


SKILL 6-5 ASSESSMENT / MANAGEMENT - GYNECOLOGIC EMERGENCIES

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe, identifies mechanism of injury, and requests additional help if needed Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Explains importance of and verbalizes general impression of patient Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure airway patency as needed Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision (64E-2) Recognizes and attends to feelings patients may experience during assessment and treatment Student identifies a gynecological emergency FOCUSED HISTORY AND PHYSICAL EXAM/RAPID ASSESSMENT (Secondary Survey) Student keeps the patient’s airway patent Student administers oxygen based on the pt.’s SpO2 reading and her signs and symptoms Student controls any vaginal bleeding if present Student places the patient in the position of comfort if no trauma is suspected Student calms and reassures the patient Student transport the patient to the closest appropriate facility without delay. S.A.M.P.L.E. history and baseline vitals Reevaluates transport decision and verbalizes consideration for completing detailed physical exam Obtains medical direction/verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs and physical exam based on complaint or findings Contacts medical control and documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Performed skill in a manner that could endanger patient or other rescuers



79


SKILL 6-6 ASSESSMENT / MANAGEMENT - PEDIATRIC EMERGENCIES

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains the rationale for having knowledge and skills appropriate for dealing with pediatrics Understands the provider’s own response to caring for pediatrics Determines scene is safe Determines nature of illness and mechanisms of injury Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Verbalizes general impression of patient Assesses patient using PEDIATRIC ASSESSMENT TRIANGLE Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure patent airway Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Attends to the feelings of the family when dealing with an ill or injured child SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.) Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Obtains baseline vital signs Obtains medical direction / verbalizes standing orders and additional treatments/interventions Demonstrates correct technique for inhaler or Epi pen as needed Reevaluates transport decision and verbalizes consideration for completing detailed physical exam ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not provide supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication / treatment _____ Performed skill in a manner that could endanger patient or other rescuers COMMENTS/REMEDIATION: __________________________________________________________________ _______________________________________________________________________________


80


SKILL 6-7 ASSESSMENT / MANAGEMENT - SUID

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Explains the rationale for having knowledge and skills appropriate for dealing with pediatrics Understands the provider’s own response to caring for pediatrics Determines scene is safe Determines nature of illness and mechanisms of injury Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Verbalizes general impression of patient Assesses patient using PEDIATRIC ASSESSMENT TRIANGLE Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure patent airway Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Attends to the feelings of the family when dealing with an ill or injured child SECONDARY SURVEY AND RAPID ASSESSMENT Signs and symptoms (O.P.Q.R.S.T.) Allergies Medications Last oral intake Events leading up to present illness Performs focused physical examination assessing affected area / system or rapid assessment Establish the presence of SUID Treatment: In the absence of rigor mortis or dependent lividity the student begins immediate aggressive efforts to resuscitate the patient

The student addresses the emotional needs of the family but DOES NOT provide false assurances. The Student transports the patient to the hospital if indicated. ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Performed skill in a manner that could endanger patient or other rescuers



81


SKILL 6-8 ASSESSMENT / MANAGEMENT - PEDIATRIC TRAUMA

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Works to ensure the safety of emergency responders, patients and bystanders Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Verbalizes general impression of patient Assesses patient using PEDIATRIC ASSESSMENT TRIANGLE Determines chief complaint and identifies any life threatening conditions Airway: Assesses airway and performs intervention to assure patent airway Breathing: Assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: Controls major bleeding, assesses pulse, skin color, condition, and temperature Applies Trauma Scorecard Methodology in 64E-2 to identify priority patient(s) Verbalizes trauma scoring criteria, and transport decision SECONDARY SURVEY AND RAPID ASSESSMENT Performs appropriate assessment ( focused or rapid assessment) Obtains or directs assistant to obtain baseline vital signs and S.A.M.P.L.E history. DETAILED PHYSICAL ASSESSMENT HEAD: Inspects and palpates scalp, ears, eyes, face NECK: Inspects, palpates and auscultates as appropriate CHEST: Inspects, palpates and auscultates as appropriate ABDOMEN / PELVIS: Inspects, palpates and auscultates as appropriate EXTREMITIES: Inspects, palpates, and assesses circulation, sensory, and motor activity POSTERIOR: Inspects and palpates thorax and lumbar areas Manages secondary injuries appropriately Obtains medical direction / verbalizes standing orders and additional treatments/interventions ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Did not identify and manage problems with airway, breathing, circulation, and c-spine _____ Did not provide supplemental oxygen _____ Did not differentiate need for immediate transport versus continued assessment at scene _____ Did not obtain medical direction or verbalize standing orders for medication / treatment _____ Did not transport within 10 minutes _____ Performed skill in a manner that could endanger patient or other rescuers



82

Module 7

Operations

83


SKILL 7-1 USE OF RADIO TRANSMITER

Name _________________________________________


Performance Guidelines Completed Explains the rationale for providing efficient / effective radio communications and patient reports Student turns on unit and demonstrates adjustment Listens for prior to initiating radio transmission Request MCP to radio if other than routine information or need for orders anticipated Speaks clearly utilizing appropriate call signs and pro words INFORMATION ORGANIZED IN A CLEAR AND CONCISE FORMAT INCLUDING:

1. ID of unit and level of service (ALS or BLS) 2. Estimated transport time 3. Age of patient(s) 4. Gender 5. Chief Complaint 6. Subjective information 7. Objective information 8. Assessment findings 9. Plan of action including any treatments already administered

Properly clears channel at end of radio transmission



84


SKILL 7-2 MASS CASUALTY INCIDENT TRIAGE

Name _________________________________________


Performance Guidelines Completed Student properly identifies a mass casualty incident Student correctly identifies a GREEN patient using the START triage method Student correctly identifies a YELLOW patient using the start triage method Student correctly identifies a RED patient using the start triage method Student correctly identifies a DECEASED patient using the start triage method Student correctly tags an MCI patient using triage tags and triage tape



85


SKILL 7-3 ASSESSMENT / MANAGEMENT - PATIENT RESTRAINT

Name _________________________________________


Performance Guidelines Completed SCENE SIZE-UP Determines scene is safe Determines nature of illness and mechanisms of injury Determines number of patients and requests additional help if necessary Considers stabilization of cervical spine PRIMARY SURVEY: Explains value of performing an initial assessment Verbalizes general impression of patient Determines chief complaint and identifies any life threatening conditions Airway: assesses airway and performs intervention to assure patent airway Breathing: assesses breathing, initiates oxygen therapy, and assures adequate ventilation Circulation: controls major bleeding, assesses pulse, assesses skin color, condition, and temperature Identifies priority patients and makes transport decision Attends to the feelings of the family when dealing with an ill or injured child RESTRAINT:

1. Student identifies the need to restrain the patient 2. Student gathers enough emergency responders to rapidly and effectively restrain the patient 3. The student and the other responders plan their activities concerning restraint of the patient

where possible.

4. The student and responders rapidly and safely gain control of the patient’s limbs and secure them with medically approved restraint devices.

5. Student and responders secure the patient to a long spine board SUPINE with limb restraints and straps.

6. Student ensures that restraints or straps do not impair the patient’s breathing. 7. Student continually assesses patient’s condition, circulation, and c-spine including pulses distal

to restraints throughout care and transport.

8. Student does not remove restraints unless it is necessary to the patient’s safety or instructed to do so by a person of equal or higher training.

9. Student documents the incident including the reason for restraint and post restraint assessments.

ONGOING ASSESSMENT Repeats initial assessment and vital signs Repeats focused assessment based on patient complaint or findings Documents appropriate information

CRITICAL CRITERIA: _____ Did not take or verbalize body substance isolation precautions _____ Did not determine scene safety _____ Performed skill in a manner that could endanger patient or other rescuers


86


SKILL 7-4 Peripheral IV Set Up

Name _________________________________________


Performance Guidelines Completed Peripheral IV Set Up Student verbalize B.S.I. precautions Student demonstrates collecting all needed equipment Student demonstrates how to set up IV fluid and infusion line Student demonstrates how to set up IV start kit Student selects the correct size catheter



87


SKILL 7-5 MEDICATIONS - METERED DOES INHALER

Name _________________________________________


Performance Guidelines Completed Student must know appropriate indications/contraindications Generic Name: Albuterol or Metaproterenal Trade Name: Proventil or Advair

INDICATIONS: Patient must be presenting with signs and symptoms of difficulty breathing Patient has a physician prescribed MDI containing medication specifically prepared to be

delivered by nebulization Online medical control must have given permission to administer metered dose inhaler

CONTRAINDICATIONS: Patient is not responsive enough to use the metered dose inhaler The MDI is not prescribed to the patient Medical direction has not granted permission The patient has already taken the maximum allowed doses prior to your arrival

Student determines the need for MDI administration Student confirms 5 R’s:


Student contacts online medical control to receive permission to administer MDI Student shakes the canister vigorously for at least 30 seconds Have patient exhale fully Have patient place his lips around the mouthpiece or open his/her mouth and place inhaler 1 to 1.5 inches from his lips

Have patient begin to slowly and deeply inhale as you depress the canister Remove the canister and coach the patient to hold his/her breath for 10 seconds or as long as comfortable

Reassess patient and consult with online medical control if additional doses are needed Student must continue to observe patient for desired or adverse side effects Student explains documentation of all medication administered to patient





88


Skill 7–6 MEDICATIONS - NITROGLYCERIN ADMINISTRATION - SUBLINGUAL

Name _________________________________________


Performance Guidelines Completed Student must know appropriate indications/contraindications Generic Name: Nitroglycerin Trade Name: Nitro Stat or Nitro Lingual

INDICATIONS: Patient must be presenting with signs and symptoms of cardiac chest pain Patient has a physician prescribed nitroglycerin Online medical control must have given permission to administer nitroglycerin

CONTRAINDICATIONS: Patient’s baseline systolic blood pressure is below 90 mmHg or the systolic pressure has

decreased greater than 30 mmHg from the baseline The heart rate is less than 50bpm or greater than 100bpm The patient has a suspected head injury The patient is an infant or child The patient has already taken three (3) doses prior to your arrival The patient has taken an erectile dysfunction medication in the last 24 hours

Student determines the need for nitroglycerin administration Student confirms 5 R’s:


Student obtains a baseline set of vital signs Student contacts online medical control to receive permission to administer nitroglycerin Have patient lift his tongue and place one spray or tablet sublingually Reassess patient’s blood pressure in 2 minutes and immediately before another dose Reassess patient and consult with online medical control if additional doses are needed Student must continue to observe patient for desired or adverse side effects Student explains documentation of all medication administered to patient





89


Skill 7-7 MEDICATIONS – ASPIRIN - ORAL ADMINISTRATION

Name _________________________________________


Performance Guidelines Completed Student must know appropriate indications/contraindications Generic Name: Aspirin Trade Name: Bayer, ASA, Ectorin, St. Joseph’s

INDICATIONS: Patient must be presenting with signs and symptoms of cardiac chest pain Online medical control must have given permission to administer aspirin

CONTRAINDICATIONS: This medication should not be given to a patient with a known hypersensitivity to the drug

Student determines the need for aspirin administration Student confirms 5 R’s:


Student contacts online medical control to receive permission to administer aspirin Have patient chew 160 - 325mg aspirin Reassess patient and consult with online medical control if additional interventions are needed Student must continue to observe patient for desired or adverse side effects Student explains documentation of all medication administered to patient





90


SKILL 7-8 MEDICATIONS - ORAL GLUCOSE

Name _________________________________________


Performance Guidelines Completed Student must know appropriate indications/contraindications Generic Name: Oral glucose Trade Name: Glutose or Insta-Glucose

INDICATIONS: Patient must be presenting with signs and symptoms of an altered mental status Patient has a history of diabetes controlled by medication or a blood glucose of less than

60mg/dL Patient must have the ability to swallow

CONTRAINDICATIONS: Patient is not responsive enough to use swallow the medication Patient has a confirmed blood glucose level greater than 60mg/dL

Student determines the need for oral glucose administration Student confirms 5 R’s:


Student contacts online medical control to receive permission to administer oral glucose Student places small portions of the gel inside the patients mouth between the gum and cheek Reassess patient’s mental status and blood glucose level and consult with online medical control if additional doses are needed

Student must continue to observe patient for desired or adverse side effects Student explains documentation of all medication administered to patient





91


SKILL 7-9 MEDICATIONS - EPINEPHRINE AUTO-INJECTOR

Name _________________________________________


Performance Guidelines Completed Student must know appropriate indications/contraindications Generic Name: Epinephrine Trade Name: Adrenalin, Epi-Pen, Twinject

INDICATIONS: Patient must be presenting with signs and symptoms of moderate to severe anaphylactic

reaction, including respiratory distress and/or shock (hypoperfusion) The medication is prescribed to the patient Online medical control have given permission to administer the medication

CONTRAINDICATIONS: There is no contraindications for the administration of epinephrine in a life-threatening

anaphylactic reaction

Student determines the need for Epinephrine auto-injector administration Student confirms 5 R’s:


Student contacts online medical control to receive permission to administer Epi auto-injector Remove safety caps from the auto-injector Place the tip of the auto-injector against the lateral aspect of the patient’s thigh midway between the hip and the knee

Push the auto-injector firmly against the thigh until the spring-loaded needle is deployed and the medication has been injected

Hold the auto-injector in place until all of the medication has been injected Properly dispose of the auto-injector in a biohazard sharps container Student must continue to observe patient for desired or adverse side effects Student explains documentation of all medication administered to patient





92


SKILL 7-10 PNEUMATIC ANTI-SHOCK GARMENT (PASG)

Name _________________________________________


Performance Guidelines Completed Initial Steps Student Verbalize B.S.I. precautions Student Demonstrates how to evaluate patient Student Determines the need for PASG Student Determines the method used for placement. Remove clothing below the waist. Student must be able to explain the contra indications for the use of PASG Placement of PASG Student demonstrates position upper border of abdominal section just below the diaphragm Student applies hook and loop straps of the abdominal section for snug fit Student applies hook and loop straps around legs for a snug fit Student shortens legs according to patient size PASG Inflations Student demonstrates how to attach tubes on garment correctly to valves on inflation device Student demonstrates how to inflate leg section prior to abdominal section Student explains the use of PASG for immobilization of lower fractures (30 - 40mm Hg) Student explains the use of PASG for hypodermic shock-systolic pressure not to exceed 100mm Hg Student demonstrates how to close valves once appropriate inflation is obtained Post Inflation Student explains why they need to monitor patient’s condition continuously and PASG pressure Student explains why PASG should not be deflated in the field without medical control orders



93


SKILL 7-11 MEDICATIONS - ACTIVATED CHARCOAL

Name _________________________________________


Performance Guidelines Completed Student must know appropriate indications/contraindications Generic Name: Activated Charcoal Trade Name: SuperChar, InstaChar, Actidose, Liqui-Char

INDICATIONS: Charcoal may be used for a patient who has ingested poison by mouth, upon specific orders

from medical direction. It is most effective when administered within 1 hour after the ingestion of the poison and only in very specific cases of poisoning.

CONTRAINDICATIONS: Has an altered mental status (not fully alert) because it may cause aspiration Has swallowed acids or alkalis (such as hydrochloric acid, bleach, ammonia, ethyl alcohol) Is unable to swallow Overdoses on cyanide

Student determines the need for Activated charcoal administration Student confirms 5 R’s:

1. Medication 2. Dose (1gm/kg) 3. Time 4. Route 5. Date

Student contacts online medical control to receive permission to administer activated charcoal Shake the container of activated charcoal thoroughly Allow patient to drink the activated charcoal Student must continue to observe patient for desired or adverse side effects If the patient vomits, notify online medical control to authorize the repeat of one dose Student explains documentation of all medication administered to patient





94


SKILL 7-12 ASSESSMENT / MANAGEMENT - FLAIL SEGMENT

Name _________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN SYMPTOMS AND TREATMENT METHODS FOR FLAIL SEGMENT

Student recognizes a flail chest is an immediate life threat Student verbalize that a flail chest is 2 or more broken ribs in two or more places Student is aware that blunt chest trauma can cause a pneumothorax

FLAIL CHEST **IMMEDIATE LIFE THREAT** Student must stabilize injury immediately with a gloved hand Student must then apply a bulky dressing over injury and tape it down securely to prevent paradoxical movement



95


SKILL 7-13 ASSESSMENT / MANAGEMENT - OCCLUSIVE DRESSING APPLICATION

Name _________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN SYMPTOMS AND TREATMENT METHODS FOR APPLYING AN OCCLUSIVE DRESSING Sucking Chest Wound: Student recognizes a sucking chest wound is an immediate life threat Student verbalizes that a sucking chest wound is a penetrating injury to the chest or back Student is aware that a sucking chest wound can cause a pneumothorax Student immediately covers wound with a gloved hand Student then places an occlusive dressing over the wound and tapes it on three sides (if the wound is located in the back it will be taped on four sides)

Student verbalizes that a penetrating injury to the head, neck, or torso is a Trauma Alert Penetrating Wound to the neck Student recognizes a penetrating wound to the neck is an immediate life threat Student is aware that a penetrating wound to the neck can cause an air embolism Student immediately covers wound with a gloved hand Student then places an occlusive dressing over the wound and tapes it on four sides Student verbalizes that a penetrating injury to the head, neck, or torso is a Trauma Alert Evisceration: Student never pushes any organs back inside the body Student may rinse the area with sterile water before applying a dressing Student places a large sterile trauma dressing over the area Student then places an occlusive dressing over top of the trauma dressing and tapes it on four sides Student verbalizes that a penetrating injury to the head, neck, or torso is a Trauma Alert



96


SKILL 7-14 ASSESSMENT / MANAGEMENT - BLEEDING CONTROL / TOURNIQUET

Name _________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN SYMPTOMS AND TREATMENT METHODS OF HYPOVOLEMIC SHOCK Student is able to explain venous bleeding Student is able to explain arterial bleeding Student is able to explain capillary bleeding Student recognizes bleeding and applies direct pressure If direct pressure is unsuccessful for severe bleeding Student applies a tourniquet Tourniquet Application Student selects bandage or commercial device that is 4 inches wide Wrap the tourniquet around the extremity just proximal to the bleeding Tighten the tourniquet until bleeding ceases Secure the tourniquet with a rod or device Write the time of tourniquet application on tape and place it on the tourniquet Notify the receiving facility of tourniquet application Documents appropriate information including time of tourniquet application Do not loosen the tourniquet unless directed to do so by online medical control



97


SKILL 7-15 ASSESSMENT / MANAGEMENT - IMPALED OBJECTS

Name _________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN TREATMENT METHODS OF IMPALED OBJECTS Student manually stabilizes object Student exposes the wound area Student controls bleeding if necessary by applying direct pressure to the wound edges Student uses a bulky dressing to secure the object in place Student verbalizes knowledge that an impaled object is never removed unless it interferes with the airway or CPR



98


SKILL 7-16 ASSESSMENT / MANAGEMENT - AMPUTATION

Name _________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN TREATMENT METHODS OF AMPUTATIONS After medical care has been provided to the patient and life threats have been addressed Student removes any gross contamination by flushing the part with sterile water Student wraps the part in dry sterile gauze dressing Student wraps or places the amputated part in plastic Student keeps the amputated part cool (Do not place the part directly on ice or ice packs) Student transports the amputated part with the patient



99


SKILL 7-17 ASSESSMENT - CINCINNATI PREHOSPITAL STROKE SCALE (CPSS)

Name _________________________________________


Performance Guidelines Completed STUDENT IS ABLE TO EXPLAIN SYMPTOMS AND ASSESSMENT METHODS OF POSSIBLE STROKE ALERT PATIENTS Student is able to explain what a TIA is. (Symptoms resolve within 24 hours)

Student verbalizes what a hemorrhagic stroke is

Student verbalizes what an ischemic stroke is

Student verbalizes the knowledge of the Stroke Alert time window

Student assesses blood glucose level

Student assesses for facial droop

Student assesses for unilateral weakness

Student assesses for arm drift

Student assesses speech “you can’t teach an old dog new tricks”

Student appropriately issues a Stroke Alert if proper criteria is met



100

COLLEGE OF CENTRAL FLORIDA Team Leader Record

STUDENT:

Student must demonstrate competence as a team leader in a minimum of 5 medical and 5 trauma scenarios

DATE COMMENTS (Adjunct) Competent? SIGNATURE (Adjunct)

Reviewed by:

Instructor: Date: