National Registry of Emergency Medical Technicians Advanced … · 2018. 12. 7. · p302/09-16 National Registry of Emergency Medical Technicians Advanced Level Psychomotor Examination

© 2016 National Registry of Emergency Medical Technicians, Inc., Columbus, OHAll materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. p304/09-16

National Registry of Emergency Medical TechniciansAdvanced Level Psychomotor Examination

SUPRAGLOTTIC AIRWAY DEVICE

Candidate: ________________________________________________ Examiner: _____________________________________________Date: ________________________________________________ Signature: _____________________________________________Device: ________________________________________________

NOTE: If candidate elects to initially ventilate with BVM attached to reservoir and oxygen, full credit must be awarded for steps denoted by “**” so long as first ventilation is delivered within 30 seconds.

PossiblePoints

PointsAwarded

Critical Criteria___ Failure to initiate ventilations within 30 seconds after taking body substance isolation precautions or interrupts ventilations for greater than 30 seconds at any time___ Failure to take or verbalize appropriate PPE precautions___ Failure to voice and ultimately provide high oxygen concentration [at least 85%]___ Failure to ventilate the patient at a rate of 10 – 12/minute (1 ventilation every 5 – 6 seconds)___ Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible]___ Failure to pre-oxygenate patient prior to insertion of the supraglottic airway device___ Failure to insert the supraglottic airway device at a proper depth or location within 3 attempts___ Failure to inflate cuffs properly and immediately remove the syringe___ Failure to secure the strap (if present) prior to cuff inflation___ Failure to confirm that patient is being ventilated properly (correct lumen and proper insertion depth) by auscultation bilaterally over lungs and over the epigastrium___ Insertion or use of any adjunct in a manner dangerous to the patient___ Failure to manage the patient as a competent EMT___ Exhibits unacceptable affect with patient or other personnel___ Uses or orders a dangerous or inappropriate intervention

You must factually document your rationale for checking any of the above critical items on the reverse side of this form.

Takes or verbalizes appropriate PPE precautions 1Opens the airway manually 1Elevates tongue, inserts simple adjunct [oropharyngeal or nasopharyngeal airway] 1NOTE: Examiner now informs candidate no gag reflex is present and patient accepts adjunct**Ventilates patient immediately with bag-valve-mask device unattached to oxygen 1**Ventilates patient with room air 1NOTE: Examiner now informs candidate that ventilation is being performed without difficulty and that pulse oximetry indicates the patient’s blood oxygen saturation is 85%Attaches oxygen reservoir to bag-valve-mask device and connects to high-flow oxygen regulator [12 – 15 L/minute]

1

Ventilates patient at a rate of 10 – 12/minute (1 ventilation every 5 – 6 seconds) with appropriate volumes 1NOTE: After 30 seconds, examiner auscultates and reports breath sounds are present and equal bilaterally and medical directionhas ordered insertion of a supraglottic airway. The examiner must now take over ventilation.Checks/prepares supraglottic airway device 1Lubricates distal tip of the device [may be verbalized] 1NOTE: Examiner to remove OPA and move out of the way when candidate is prepared to insert device.Positions head properly 1Performs a tongue-jaw lift 1Inserts device to proper depth 1Secures device in patient [inflates cuffs with proper volumes and immediately removes syringe or secures strap]

1

Ventilates patient and confirms proper ventilation [correct lumen and proper insertion depth] by auscultationbilaterally over lungs and over the epigastrium

1

Adjusts ventilation as necessary [ventilates through additional lumen or slightly withdraws tube untilventilation is optimized]

1

Verifies proper tube placement by secondary confirmation such as capnography, capnometry, EDD orcolorimetric device

1

NOTE: The examiner must now ask the candidate, “How would you know if you are delivering appropriate volumes with each ventilation?”Secures device or confirms that the device remains properly secured 1Ventilates patient at proper rate and volume while observing capnography/capnometry and pulse oximeter 1

Actual Time Ended: __________ TOTAL 18

Actual Time Started: __________

Candidate: _______________________________________ Examiner: _____________________________________

Date: _______________________________________ Signature: _____________________________________

PossiblePoints

PointsAwardedActual Time Started: __________

Critical Criteria___ Failure to take or verbalize appropriate PPE precautions___ Failure to immediately begin chest compressions as soon as pulselessness is confirmed___ Failure to deliver shock in a timely manner___ Interrupts CPR for more than 10 seconds at any point___ Failure to demonstrate acceptable high quality, 1-rescuer adult CPR___ Failure to operate the AED properly___ Failure to correctly attach the AED to the patient___ Failure to assure that all individuals are clear of patient during rhythm analysis and before delivering

shock(s) [verbalizes “All clear” and observes]___ Failure to immediately resume compressions after shock delivered___ Failure to manage the patient as a competent EMT___ Exhibits unacceptable affect with patient or other personnel___ Uses or orders a dangerous or inappropriate intervention


National Registry of Emergency Medical TechniciansAdvanced Emergency Medical Technician Psychomotor Examination

CARDIAC ARREST MANAGEMENT / AED


Takes or verbalizes appropriate PPE precautions 1Determines the scene/situation is safe 1Attempts to question any bystanders about arrest events 1Checks patient responsiveness 1Assesses breathing and pulse simultaneously

– Assesses patient for signs of breathing [observes the patient and determines theabsence of breathing or abnormal breathing (gasping or agonal respirations)] (1 point) 2

– Checks carotid pulse [no more than 10 seconds] (1 point)Immediately begins chest compressions [adequate depth and rate; allows the chest torecoil completely] 1

Requests additional EMS response 1Performs 2 minutes of high quality, 1-rescuer adult CPR

– Adequate depth and rate (1 point)– Correct compression-to-ventilation ratio (1 point)– Allows the chest to recoil completely (1 point) 5

– Adequate volumes for each breath (1 point)– Minimal interruptions of less than 10 seconds throughout (1 point)

NOTE: After 2 minutes (5 cycles), patient is assessed and second rescuer resumes compressions while candidate operates AED.Turns-on power to AED 1Follows prompts and correctly attaches AED to patient 1Stops CPR and ensures all individuals are clear of the patient during rhythm analysis 1Ensures that all individuals are clear of the patient and delivers shock from AED 1Immediately directs rescuer to resume chest compressions 1


p302/09-16


PATIENT ASSESSMENT - MEDICAL

Candidate:__________________________________________ Examiner:________________________________________Date:______________________________________________ Signature:________________________________________Scenario:___________________________________________ Possible PointsActual Time Started: __________ Points AwardedTakes or verbalizes appropriate PPE precautions 1SCENE SIZE-UPDetermines the scene/situation is safe 1Determines the mechanism of injury/nature of illness 1Determines the number of patients 1Requests additional help if necessary 1Considers stabilization of spine 1PRIMARY SURVEYVerbalizes general impression of the patient 1Determines responsiveness/level of consciousness 1Determines chief complaint/apparent life-threats 1Assesses airway and breathing

-Assessment (1 point)-Assures adequate ventilation (1 point) 3

-Initiates appropriate oxygen therapy (1 point)Assesses circulation

-Assesses/controls major bleeding (1 point) -Assesses skin [either skin color, temperature, or condition] (1 point) 3-Assesses pulse (1 point)

Identifies priority patients/makes transport decision 1HISTORY TAKING AND SECONDARY ASSESSMENTHistory of present illness

-Onset (1 point) -Severity (1 point)-Provocation (1 point) -Time (1 point) 8-Quality (1 point) -Clarifying questions of associated signs and symptoms as related to OPQRST (2 points)-Radiation (1 point)

Past medical history-Allergies (1 point) -Past pertinent history (1 point) -Events leading to present illness (1 point) 5-Medications (1 point) -Last oral intake (1 point)

Performs secondary assessment [assess affected body part/system or, if indicated, completes rapid assessment]5evitcudorpeR-yratnemugetnI-lacigolorueN-ralucsavoidraC-

-Pulmonary -Musculoskeletal -GI/GU -Psychological/SocialVital signs

-Pulse (1 point) 5)hcae tniop 1( ytilauq dna etar yrotaripseR--Blood pressure (1 point) -AVPU (1 point)

2Diagnostics [blood glucose test, pulse oximetry, etc] as indicatedStates field impression of patient 1

1 )s(noitnevretni etairporppa rof sllac dna tneitap rof nalp tnemtaert sezilabreVTransport decision re-evaluated 1REASSESSMENTRepeats primary survey 1Repeats vital signs 1Evaluates response to treatments 1

1

48

Repeats secondary assessment regarding patient complaint or injuriesActual Time Ended: __________ CRITICAL CRITERIA TOTAL _____ Failure to initiate or call for transport of the patient within 15 minute time limit_____ Failure to take or verbalize appropriate PPE precautions_____ Failure to determine scene safety before approaching patient_____ Failure to voice and ultimately provide appropriate oxygen therapy_____ Failure to assess/provide adequate ventilation_____ Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock [hypoperfusion] _____ Failure to differentiate patient’s need for immediate transportation versus continued assessment and treatment at the scene _____ Does other detailed history or physical examination before assessing and treating threats to airway, breathing, and circulation _____ Failure to determine the patient’s primary problem_____ Orders a dangerous or inappropriate intervention_____ Failure to provide for spinal protection when indicatedYou must factually document your rationale for checking any of the above critical items on the reverse side of this form.

© 2016 National Registry of Emergency Medical Technicians, Inc., Columbus, OHAll materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement.


Candidate: __________________________________________________ Examiner: _____________________________________________Date: __________________________________________________ Signature: _____________________________________________Level of Testing: � Advanced EMT � Intermediate/99 � Paramedic

PossiblePoints


Checks selected IV fluid for:-Proper fluid (1 point) 3-Clarity (1 point)-Expiration date (1 point)

Selects appropriate catheter 1Selects proper administration set 1Connects IV tubing to the IV bag 1Prepares administration set [fills drip chamber and flushes tubing] 1Cuts or tears tape [at any time before venipuncture] 1Takes or verbalizes appropriate PPE precautions [prior to venipuncture] 1Applies tourniquet 1Palpates suitable vein 1Cleanses site appropriately 1Performs venipuncture

-Inserts stylette (1 point)-Notes or verbalizes flashback (1 point) 5-Occludes vein proximal to catheter (1 point)-Removes stylette (1 point)-Connects IV tubing to catheter (1 point)

Disposes/verbalizes proper disposal of needle in proper container 1Releases tourniquet 1Runs IV for a brief period to assure patent line 1Secures catheter [tapes securely or verbalizes] 1Adjusts flow rate as appropriate 1

Actual Time Ended: __________ TOTAL 22NOTE: Check here � if candidate did not establish a patent IV within 3 attempts in 6 minutes. Do not evaluate the candidate in IV Bolus Medications.Critical Criteria___ Failure to establish a patent and properly adjusted IV within 6 minute time limit___ Failure to take or verbalize appropriate PPE precautions prior to performing venipuncture___ Contaminates equipment or site without appropriately correcting the situation___ Performs any improper technique resulting in the potential for uncontrolled hemorrhage, catheter shear, or air embolism___ Failure to successfully establish IV within 3 attempts during 6 minute time limit___ Failure to dispose/verbalize disposal of blood-contaminated sharps immediately in proper container at the point of use___ Failure to manage the patient as a competent EMT___ Exhibits unacceptable affect with patient or other personnel___ Uses or orders a dangerous or inappropriate interventionYou must factually document your rationale for checking any of the above critical items on the reverse side of this form.

INTRAVENOUS BOLUS MEDICATIONS

Critical Criteria___ Failure to continue to take or verbalize appropriate PPE precautions___ Failure to begin administration of medication within 3 minute time limit___ Contaminates equipment or site without appropriately correcting the situation___ Failure to adequately dispel air resulting in potential for air embolism___ Injects improper medication or dosage [wrong medication, incorrect amount, or pushes at inappropriate rate]___ Failure to turn-on IV after injecting medication___ Recaps needle or failure to dispose/verbalize disposal of syringe and other material in proper container___ Failure to manage the patient as a competent EMT___ Exhibits unacceptable affect with patient or other personnel___ Uses or orders a dangerous or inappropriate interventionYou must factually document your rationale for checking any of the above critical items on the reverse side of this form.


INTRAVENOUS THERAPY

PossiblePoints


Asks patient for known allergies 1Selects correct medication 1Assures correct concentration of medication 1Assembles prefilled syringe correctly and dispels air 1Continues to take or verbalize appropriate PPE precautions 1Identifies and cleanses injection site closest to the patient [Y-port or hub] 1Reaffirms medication 1Stops IV flow 1Administers correct dose at proper push rate 1Disposes/verbalizes proper disposal of syringe and needle in proper container 1Turns IV on and adjusts drip rate to TKO/KVO 1Verbalizes need to observe patient for desired effect and adverse side effects 1



Date: _______________________________________ Signature: _____________________________________PossiblePoints


Checks selected IV fluid for:-Proper fluid (1 point)-Clarity (1 point) 3

-Expiration date (1 point)Selects appropriate equipment to include:

-IO needle (1 point)-Syringe (1 point) 4-Saline (1 point)-Extension set or 3-way stopcock (1 point)

Selects proper administration set 1Connects administration set to bag 1Prepares administration set [fills drip chamber and flushes tubing] 1Prepares syringe and extension tubing or 3-way stopcock 1Cuts or tears tape [at any time before IO puncture] 1Takes or verbalizes appropriate PPE precautions [prior to IO puncture] 1Identifies proper anatomical site for IO puncture 1Cleanses site appropriately 1Performs IO puncture:

-Stabilizes tibia without placing hand under puncture site and “cupping” leg (1 point)-Inserts needle at proper angle (1 point)-Advances needle with twisting motion until “pop” is felt or notices sudden lack of resistance 4(1 point)

-Removes stylette (1 point)Disposes/verbalizes proper disposal of needle in proper container 1Attaches syringe and extension set to IO needle and aspirates; or attaches 3-way stopcockbetween administration set and IO needle and aspirates; or attaches extension set to IO needle 1[aspiration is not required for any of these as many IO sticks are “dry” sticks]Slowly injects saline to assure proper placement of needle 1Adjusts flow rate/bolus as appropriate 1Secures needle and supports with bulky dressing [tapes securely or verbalizes] 1


Critical Criteria___ Failure to establish a patent and properly adjusted IO line within 6 minute time limit___ Failure to take or verbalize appropriate PPE precautions prior to performing IO puncture___ Contaminates equipment or site without appropriately correcting the situation___ Performs any improper technique resulting in the potential for air embolism___ Failure to assure correct needle placement [must aspirate or watch closely for early signs of infiltration]___ Failure to successfully establish IO infusion within 2 attempts during 6 minute time limit___ Performs IO puncture in an unacceptable manner [improper site, incorrect needle angle, holds leg in palm and

performs IO puncture directly above hand, etc.]___ Failure to properly dispose/verbalize disposal of blood-contaminated sharps immediately in proper container at the

point of use___ Failure to manage the patient as a competent EMT___ Exhibits unacceptable affect with patient or other personnel___ Uses or orders a dangerous or inappropriate intervention




PEDIATRIC INTRAOSSEOUS INFUSION



SPINAL IMMOBILIZATION (SEATED PATIENT)

Candidate:_________________________________Examiner:_______________________________

Date: _____________________________________Signature:_______________________________

Possible PointsActual Time Started: __________ Points AwardedTakes or verbalizes appropriate PPE precautions 1Directs assistant to place/maintain head in the neutral, in-line position 1Directs assistant to maintain manual immobilization of the head 1Assesses motor, sensory, and circulatory functions in each extremity 1Applies appropriately sized extrication collar 1Positions the immobilization device behind the patient 1Secures the device to the patient’s torso 1Evaluates torso fixation and adjusts as necessary 1Evaluates and pads behind the patient’s head as necessary 1Secures the patient’s head to the device 1Verbalizes moving the patient to a long backboard 1Reassesses motor, sensory, and circulatory function in each extremity 1


CRITICAL CRITERIA_____ Did not immediately direct or take manual immobilization of the head_____ Did not properly apply appropriately sized cervical collar before ordering release of manual immobilization_____ Released or ordered release of manual immobilization before it was maintained mechanically_____ Manipulated or moved patient excessively causing potential spinal compromise_____ Head immobilized to the device before device sufficiently secured to torso_____ Device moves excessively up, down, left, or right on the patient’s torso_____ Head immobilization allows for excessive movement_____ Torso fixation inhibits chest rise, resulting in respiratory compromise_____ Upon completion of immobilization, head is not in a neutral, in-line position_____ Did not reassess motor, sensory, and circulatory functions in each extremity after voicing

immobilization to the long backboard_____ Failure to manage the patient as a competent EMT_____ Exhibits unacceptable affect with patient or other personnel_____ Uses or orders a dangerous or inappropriate intervention

You must factually document your rationale for checking any of the above critical items on thereverse side of this form.



SPINAL IMMOBILIZATION (SUPINE PATIENT)

Candidate:_________________________________ Examiner:_______________________________

Date:______________________________________ Signature:_______________________________

Possible Points Point AwardedActual Time Started: __________

Takes or verbalizes appropriate PPE precautions 1Directs assistant to place/maintain head in the neutral, in-line position 1Directs assistant to maintain manual immobilization of the head 1Assesses motor, sensory, and circulatory function in each extremity 1Applies appropriately sized extrication collar 1Positions the immobilization device appropriately 1Directs movement of the patient onto the device without compromising the integrityof the spine 1Applies padding to voids between the torso and the device as necessary 1Immobilizes the patient’s torso to the device 1Evaluates and pads behind the patient’s head as necessary 1Immobilizes the patient’s head to the device 1Secures the patient’s legs to the device 1Secures the patient’s arms to the device 1Reassesses motor, sensory, and circulatory function in each extremity 1


CRITICAL CRITERIA

_____ Did not immediately direct or take manual immobilization of the head_____ Did not properly apply appropriately sized cervical collar before ordering release of manual immobilization_____ Released or ordered release of manual immobilization before it was maintained mechanically_____ Manipulated or moved patient excessively causing potential spinal compromise_____ Head immobilized to the device before device sufficiently secured to torso_____ Patient moves excessively up, down, left, or right on the device_____ Head immobilization allows for excessive movement_____ Upon completion of immobilization, head is not in a neutral, in-line position_____ Did not reassess motor, sensory, and circulatory functions in each extremity after immobilizing patient

to the device_____ Failure to manage the patient as a competent EMT_____ Exhibits unacceptable affect with patient or other personnel_____ Uses or orders a dangerous or inappropriate intervention



National Registry of Emergency Medical TechniciansAdvanced Level Practical Examination

BLEEDING CONTROL/SHOCK MANAGEMENT

Candidate: ________________________________Examiner: ________________________________

Date: ____________________________________Signature: ________________________________

Possible Points Points AwardedActual Time Started:__________

Takes or verbalizes appropriate PPE precautions 1Applies direct pressure to the wound 1NOTE: The examiner must now inform the candidate that the wound continues to bleed.Applies tourniquet 1NOTE: The examiner must now inform the candidate that the patient is exhibiting signs and

symptoms of hypoperfusion.Properly positions the patient 1Administers high concentration oxygen 1Initiates steps to prevent heat loss from the patient 1Indicates the need for immediate transportation 1


CRITICAL CRITERIA_____ Did not take or verbalize appropriate PPE precautions_____ Did not apply high concentration of oxygen_____ Did not control hemorrhage using correct procedures in a timely manner_____ Did not indicate the need for immediate transportation_____ Failure to manage the patient as a competent EMT_____ Exhibits unacceptable affect with patient or other personnel_____ Uses or orders a dangerous or inappropriate intervention

You must factually document your rationale for checking any of the above critical items on this form (below or turn sheet over).


BLEEDING CONTROL/SHOCK MANAGEMENT

Candidate: ________________________________Examiner: __________________________________

Date: ____________________________________Signature: __________________________________

PossiblePoints


Critical Criteria___ Did not immediately stabilize the extremity manually___ Grossly moves the injured extremity___ Did not immobilize the bone above and below the injury site___ Did not reassess distal motor, sensory, and circulatory functions in the injured extremity before and

after splinting___ Failure to manage the patient as a competent EMT___ Exhibits unacceptable affect with patient or other personnel___ Uses or orders a dangerous or inappropriate intervention



Date: _______________________________________ Signature: _____________________________________


JOINT IMMOBILIZATION


Takes or verbalizes appropriate PPE precautions 1Directs application of manual stabilization of the injury 1Assesses distal motor, sensory, and circulatory functions in the injured extremity 1NOTE: The examiner acknowledges, “Motor, sensory, and circulatory functions are present and normal.”Selects the proper splinting material 1Immobilizes the site of the injury 1Immobilizes the bone above the injury site 1Immobilizes the bone below the injury site 1Secures the entire injured extremity 1Reassesses distal motor, sensory, and circulatory functions in the injured extremity 1NOTE: The examiner acknowledges, “Motor, sensory, and circulatory functions are present and normal.”



Critical Criteria___ Did not immediately stabilize the extremity manually___ Grossly moves the injured extremity___ Did not immobilize the joint above and the joint below the injury site___ Did not immobilize the hand or foot in a position of function___ Did not reassess distal motor, sensory, and circulatory functions in the injured extremity before and

after splinting___ Failure to manage the patient as a competent EMT___ Exhibits unacceptable affect with patient or other personnel___ Uses or orders a dangerous or inappropriate intervention


PossiblePoints



Date: _______________________________________ Signature: _____________________________________


LONG BONE IMMOBILIZATION


Takes or verbalizes appropriate PPE precautions 1Directs application of manual stabilization of the injury 1Assesses distal motor, sensory, and circulatory functions in the injured extremity 1NOTE: The examiner acknowledges, “Motor, sensory, and circulatory functions are present and normal.”Measures the splint 1Applies the splint 1Immobilizes the joint above the injury site 1Immobilizes the joint below the injury site 1Secures the entire injured extremity 1Immobilizes the hand/foot in the position of function 1Reassesses distal motor, sensory, and circulatory functions in the injured extremity 1NOTE: The examiner acknowledges, “Motor, sensory, and circulatory functions are present and normal.”



Critical Criteria___ Failure to initiate oxygenation within 30 seconds of identifying respiratory compromise___ Interrupts ventilations for greater than 30 seconds at any time___ Failure to take or verbalize appropriate PPE precautions within 30 seconds after identifying respiratory failure___ Failure to voice and ultimately provide high oxygen concentration [at least 85%]___ Failure to ventilate the patient at a rate of 12 – 20/minute (1 ventilation every 3 – 5 seconds)___ Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible]___ Failure to recognize and treat respiratory failure in a timely manner___ Insertion or use of any airway adjunct in a manner dangerous to the patient___ Failure to manage the patient as a competent EMT___ Exhibits unacceptable affect with patient or other personnel___ Uses or orders a dangerous or inappropriate interventionYou must factually document your rationale for checking any of the above critical items on the reverse side of this form.


National Registry of Emergency Medical TechniciansAdvanced Emergency Medical Technician Psychomotor Examination

PEDIATRIC RESPIRATORY COMPROMISE

Candidate:________________________________________ Examiner:______________________________________Date:_____________________________________________ Signature:______________________________________

PossiblePoints

PointsAwarded

Takes or verbalizes appropriate PPE precautions 1Verbalizes general impression of patient from a distance before approaching or touchingthe patient 1

Determines level of consciousness 1Assesses the airway [looks for secretions and signs of foreign body airway obstruction;listens for audible noises and voice sounds] 1

Assesses breathing [checks rate, rhythm, chest excursion, audible noises] 1Attaches pulse oximeter and evaluates SpO2 reading 1NOTE: Examiner now informs candidate, “Pulse oximeter shows a saturation of 82%.”Selects proper delivery device and attaches to oxygen 1Administers oxygen at proper flow rate [blow-by oxygen, non-rebreather mask] 1Checks pulse 1Evaluates perfusion [skin color, temperature, condition; capillary refill] 1Obtains baseline vital signs 1NOTE: Examiner now advises candidate that patient begins to develop decreasing SpO2, decreasingpulse rate, see-saw respirations, head bobbing, drowsiness, etc.)Places patient supine and pads appropriately to maintain a sniffing position 1Manually opens airway 1Considers airway adjunct insertion based upon patient presentation [oropharyngeal ornasopharyngeal airway] 1

NOTE: Examiner now informs candidate no gag reflex is present and patient accepts airway adjunct.The patient’s respiratory rate is now 20/minute.Inserts airway adjunct properly and positions head and neck for ventilation 1Selects appropriate BVM and attaches reservoir to oxygen flowing at 12 – 15 L/minute 1Assures tight mask seal to face 1Assists ventilations at a rate of 12 – 20/minute (1 ventilation every 3 – 5 seconds) and with sufficient volume to cause visible chest rise 1

Ventilates at proper rate and volume while observing changes in capnometry/capnography, pulse oximeter, pulse rate, level of responsiveness 1

NOTE: The examiner must now ask the candidate, “How would you know if you are ventilating the patient properly?”Calls for immediate transport of patient 1




PATIENT ASSESSMENT - TRAUMA

Candidate: ___________________________________________________________ Examiner: __________________________________________________

Date: ________________________________________________________________ Signature: __________________________________________________

Scenario # __________

Actual Time Started: __________ NOTE: Areas denoted by “**” may be integrated within sequence of primary surveyTakes or verbalizes appropriate PPE precautions 1SCENE SIZE-UPDetermines the scene/situation is safe 1Determines the mechanism of injury/nature of illness 1Determines the number of patients 1Requests additional help if necessary 1Considers stabilization of spine 1PRIMARY SURVEY/RESUSCITATIONVerbalizes general impression of the patient 1Determines responsiveness/level of consciousness 1Determines chief complaint/apparent life-threats 1Airway

-Opens and assesses airway (1 point) -Inserts adjunct as indicated (1 point)2

Breathing-Assess breathing (1 point)-Assures adequate ventilation (1 point) 4-Initiates appropriate oxygen therapy (1 point)-Manages any injury which may compromise breathing/ventilation (1 point)

Circulation-Checks pulse (1point)-Assess skin [either skin color, temperature, or condition] (1 point) 4-Assesses for and controls major bleeding if present (1 point)-Initiates shock management (1 point)

Identifies priority patients/makes transport decision based upon calculated GCS 1HISTORY TAKINGObtains, or directs assistant to obtain, baseline vital signs 1Attempts to obtain SAMPLE history 1SECONDARY ASSESSMENTHead

-Inspects mouth**, nose**, and assesses facial area (1 point)-Inspects and palpates scalp and ears (1 point)

3

-Assesses eyes for PERRL** (1 point)Neck**

-Checks position of trachea (1 point)-Checks jugular veins (1 point)

3

-Palpates cervical spine (1 point)Chest**

-Inspects chest (1 point)-Palpates chest (1 point)

3

-Auscultates chest (1 point)Abdomen/pelvis**

-Inspects and palpates abdomen (1 point)-Assesses pelvis (1 point)

3

-Verbalizes assessment of genitalia/perineum as needed (1 point)Lower extremities**

-Inspects, palpates, and assesses motor, sensory, and distal circulatory functions (1 point/leg)2

Upper extremities-Inspects, palpates, and assesses motor, sensory, and distal circulatory functions (1 point/arm)

2

Posterior thorax, lumbar, and buttocks**-Inspects and palpates posterior thorax (1 point) 2-Inspects and palpates lumbar and buttocks area (1 point)

Manages secondary injuries and wounds appropriately 1Reassesses patient 1


CRITICAL CRITERIA____ Failure to initiate or call for transport of the patient within 10 minute time limit____ Failure to take or verbalize appropriate PPE precautions____ Failure to determine scene safety____ Failure to assess for and provide spinal protection when indicated____ Failure to voice and ultimately provide high concentration of oxygen____ Failure to assess/provide adequate ventilation____ Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock [hypoperfusion]____ Failure to differentiate patient’s need for immediate transportation versus continued assessment/treatment at the scene____ Does other detailed history or physical exam before assessing/treating threats to airway, breathing, and circulation____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention


PossiblePoints

PointsAwarded

Documents

National Registry of Emergency Medical Technicians Advanced … · 2018. 12. 7. · p302/09-16 National Registry of Emergency Medical Technicians Advanced Level Psychomotor Examination