Emergency Medical Technician Lab Skill

Transcript

Emergency Medical Technician Lab Skill Competencies © 2010 Santa Fe College EMS Programs Excerpt from Student Conduct Code Rule: 7.23Article III: Prohibited Conduct B. Conduct, Rules, and Regulations: Any student found to have committed the following misconduct is subject to the disciplinary sanctions outlined in the Code. 1. Acts of dishonesty, including but not limited to the following: a. Cheating, plagiarism, or other forms of academic dishonesty. b. Furnishing false information to any College official, faculty member, or office, including writing bad checks to the College. c. Forgery, alteration, or misuse of any College document, record, or instrument of identification. Level I Sanctions A. Required retest, resubmission, rewrite, additional assignment, and/or alternative assignment. B. Reduction of grade on the evaluation instrument/process (text, quiz, assignment, term paper, demonstrated skill, etc.). C. Assignment of “F” grade for course. D. Removal from the course. E. Any combination of the above-listed sanctions. Level II Sanctions A. B. C. D. E. Written reprimand. Probation. Withdrawal from program and/or department. Expulsion from SFC. Cancellation of test scores, including CLAST, and the rescission or invalidation of College credit or of any degree awarded. F. Placement of an “XF” on the student’s transcript to indicate academic dishonesty. G. Denial of academic credit. H. Any or all sanctions available under Level I. I. Other appropriate action. Emergency Medical Programs & Fire Science Programs SFCC EMS LAB EMS-1119L - EMT-BASIC Lab I (print name) ______________________________________________have been given a lab syllabus and skill sheets for Lab and EMS check off on this date ________________. I understand it is my responsibility to read this information. I will place these skill sheets in a binder and bring them to every Lab and Clinical. If I misplace this information it will be my responsibility to replace it, at which time I will need to do the skills again in order to have the skill sheets signed. I will not attempt to forge preceptor or lab staff signatures. If I do I understand I will be removed from the program. Further, I have received, read, and understand my obligations for EMS 1119L. I agree to abide by the requirements of the Syllabus for EMS 1119L. I understand that failure to do so may result in withdrawal from the EMT Program. Student Signature: ________________________________________________ Lab Coordinator Signature: ____________________________________________ First Responder | EMT- B | Paramedic | Fire Science th Institute of Public Safety • 3737 NE 39 Avenue • Gainesville, FL 32609 Office 352.271-2900 • Fax 352.271-2929 • E-mail [email protected] www.sfcollege.edu EMT – Preceptor/Evaluattor Acknow wledgemeent of Stud dent Skill SSheets    Student Name (printed): _ __________ ___________ ___________ _______________________________________    For the Pre eceptor/Evaaluator    TThis  form  is  to  acknowledge  that  th he  Student  has  shown  you,  the  Preeceptor/Evaaluator,  his/her  Skills  C Check‐Off Bo ooklet prior to beginningg this Clinicaal.  This bookklet shows the skills that have been checked  o off  by  Santaa  Fe  College e  Lab  Instrucctors  and  in ndicates  the   skills  that  the  EMT  is  allowed  to  perform  d during his/he er Clinical Ro otation.    P Please sign b below to ackknowledge th he student h has providedd this bookleet to you for review.    TThank you fo or time and ssupport of Santa Fe College’s EMS PPrograms.      RESC CUE CLINICA AL  PRECEPTOR R /EVAALUATOR  PRECEPTOR/EVVALUATOR  PRINTED NAME A   SIGNATUURE            CLIINICAL SITE  TIME  DATE  :      :        :          :          :          :    HOSSPITAL / MED DICAL FACILIITY CLINICALL    PRECEPTOR R /EVAALUATOR  PRECEPTOR/EVVALUATOR  PRINTED NAME A   SIGNATUURE            CLIINICAL SITE  TIME  DATE  :      :        :          :          :          :      SF College Document / Record 1 SF College Document / Record EMT Skill Competency Sheet #01 Universal Precautions (1-2.12 & 1-2.13) Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. Goal or purpose for this skill: a. All patients are considered infectious b. To protect the patent from the care giver as well as the care giver from the patient Equipment needed (for instructor preparation) a. Gown b. Gloves c. Mask d. Goggles While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Demonstration of the skill: a. Upon receiving a scenario the student should be able to verbalize the goal of performing this skill. b. After verbalizing the skill the student should dawn the appropriate PPE in the appropriate manner. c. When requested to do so the student should remove PPE and perform hand washing. Points possible # Skill procedure 1 1 6 7 8 9 Student should correctly wear gown, gloves, mask and goggles Students should correctly demonstrate how to properly invert gloves to contain contaminates on the inside of the inverted glove. Contaminated trash should be sealed in a red bio-hazard bag then placed in an approved container for disposal. Contaminated linen should be sealed in a water soluble bag, and placed in a laundry container. Student should demonstrate proper hand washing techniques and state that this should be done after all patient contact. Take a paper towel, turn water on and discard towel Take a second paper towel, dispense soap, discard towel. Wash hands well and rinse Take a third paper towel, turn off water, discard towel 10 Take a forth paper towel, dry hands, discard towel 1 2 3 Verbalize 4 Verbalize 5 Critical Criteria on Next Page 1 1 1 1 1 1 1 1 10 SF College Document / Record Page 1 of 79 Points awarded EMT Skill Competency Sheet #01 Critical Criteria _____ Student did not achieve 80% (8/10) _____ Student unable to verbalize a goal for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student applied PPE ineffectively which leaves the student exposed to patient or patient exposed to student. _____ Student removes PPE in a manner that may expose him/her self to contaminates _____ Student did not place or verbalize placing PPE in a red bio-hazard bag. _____ Student contaminated or spread contamination while performing improper hand washing technique Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 2 of 79 EMT Skill Competency Sheet #02 Blood pressure by auscultation (1-5.36) Skill time ~ 1 minute Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To determine the patients systolic and diastolic blood pressure. a. The systolic pressure is the pressure of the blood on the walls of the arteries when the heart is contracting. b. The diastolic pressure is the pressure of the blood on the walls of the arteries when the heart is relaxed. Equipment needed (for instructor preparation) a. Stethoscope b. Blood pressure cuff While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 2 3 Verbalize Body substance isolation Explain the procedure to the patient DO NOT take the BP on the same side as a mastectomy in a woman or shunts in dialysis patients Properly place cuff on patient’s arm A. Bladder of cuff over the brachial artery B. Cuff should be snug and correct size for the patient’s arm (covers 2/3 of the arm) C. The cuff should be at the same level as the heart Palpate the patient’s pulse in the antecubital area Place the stethoscope properly in ears Palpate the radial pulse Inflate the cuff until the pulse is not felt then squeeze the bulb one more time (approx. 20mm above where the pulse disappeared) Place the stethoscope over the antecubital site Slowly deflate the cuff Note the point at which the first sound is heard (Systolic pressure). Note the point in which the last sound is heard (Diastolic pressure). If you have trouble taking the BP either use the patients other arm or deflate the cuff, wait one minute, and retake the BP Record the systolic pressure first then the diastolic pressure making sure the numbers are rounded to even numbers Student should take a BP and show proper documentation: Ex:120/80 4 5 6 7 8 9 10 11 12 13 14 Critical Criteria on Next Page Points possible 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14 SF College Document / Record Page 3 of 79 Points awarded EMT Skill Competency Sheet #02 Critical Criteria _____ Student did not achieve 80% (11/14) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration _____ Student failed to consider BSI _____ Student used the BP cuff or stethoscope in a manner that could not possibly attain an accurate blood pressure ie; inappropriate sized cuff, wrong side of stethoscope bell etc. _____ Student did not consider a mastectomy or dialysis shunt as a caution _____ Student was off by more than 6mm high or low on either the systolic or diastolic. The instructor must be using the dual stethoscope to measure the BP for this CC. _____ Student was unable to accurately document the blood pressure Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 4 of 79 EMT Skill Competency Sheet #03 Blood pressure by palpation (1-5.36) Skill time ~ 1 minute Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To determine the patient’s systolic blood pressure. a. The systolic pressure is the pressure of the blood on the walls of the arteries when the heart is contracting. b. Used as a second method of obtaining a BP when auscultation is not possible due to noise in the environment or an extremely low blood pressure. Equipment needed (for instructor preparation) a. Blood pressure cuff While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 2 3 Verbalize Body substance isolation Explain the procedure to the patient DO NOT take the BP on the same side as a mastectomy in a woman or shunts in dialysis patient’s Properly place cuff on patient’s arm A. Bladder of cuff over the brachial artery B. Cuff should be snug and correct size for the patient’s arm (covers 2/3 of the arm) C. The cuff should be at the same level as the heart Palpate the patient’s pulse at the radial artery Inflate the cuff until the pulse is not felt then squeeze the bulb one more time (approx. 20mm above where the pulse disappeared) Slowly deflate the cuff Note the point at which the radial artery returns (systolic) If you have trouble taking the BP either use the patient’s other arm or deflate the cuff, wait one minute, and retake the BP Record the systolic pressure as an even numbers Student should take a BP and show proper documentation Example: 120/P Student states palpation provides an approximate reading and is not as accurate as by auscultation because only the systolic pressure can be obtained. 4 5 6 7 8 9 10 11 12 Verbalize Points possible 1 1 1 1 1 1 1 1 1 1 1 12 Critical Criteria on Next Page SF College Document / Record Page 5 of 79 Points awarded EMT Skill Competency Sheet #03 Critical Criteria _____ Student did not achieve 80% (9/12) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student failed to consider BSI _____ Student used the BP cuff in a manner that could not possibly attain an accurate blood pressure i.e.; inappropriate sized cuff, wrong area on the arm etc. _____ Student did not consider a mastectomy or dialysis shunt as a caution _____ Student was off by more than 6mm high or low _____ Student was unable to accurately document the blood pressure Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 6 of 79 EMT Skill Competency Sheet #04 Oxygen Administration – Infant / Child / Adult (2-1.38, 2-1.39, 2-1.41 & 6-26) Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. # 1 2 3 4 5 6 7 8 Goal or purpose for this skill: a. To deliver the correct amount and percentage of oxygen to the bodies vital organs. Equipment needed: a. Oxygen supply b. B. Oxygen delivery device While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Skill procedure Points possible Body substance isolation Explain the need for 02 to the patient Open the main valve of the 02 tank. Check for leaks and tank pressure Attach the appropriate 02 delivery device to the 02 tank Set appropriate 02 flow for the device used for an infant/child/adult 1. Nasal cannula flow rate is 1-6 lpm which delivers 24-44% 02 2. Simple face mask flow rate is 6-10lpm which delivers 35-60% 02 3. Non re-breather mask flow rate is >15lpm which delivers 100% 02. Make sure the reservoir bag is full prior to application 4. Venturi mask flow rate and percentage of 02 administrations vary with carburetor type used. The use of this device is usually for in-hospital settings for COPD patients. Place 02 delivery device on the patients face explaining the procedure to the pt. Secure 02 tank during transport If removal of 02 is needed: 1. Remove the device from the pt 2. Close the main valve and bleed the flow meter Critical Criteria on Next Page SF College Document / Record Page 7 of 79 1 1 1 1 4 1 1 1 11 Points awarded EMT Skill Competency Sheet #04 Critical Criteria _____ Student did not achieve 80% (9/11) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student dropped or mishandled the oxygen tank _____ Student placed the 02 delivery device on the pt in a manner that would be ineffective _____ Student failed to verbalize securing 02 tank Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 8 of 79 EMT Skill Competency Sheet #05 Helmet Removal (5-4.41, 5-4.42 & 5-4.43) Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. Goal or purpose for this skill: To remove a helmet of any kind from a patient in a manner that does not result in damage to the patient’s cervical spine. The helmet should be removed for the following reasons: a. The helmet does not immobilize the pts head within b. You cannot securely immobilize the helmet to the LSB c. The helmet prevents airway care d. The helmet prevents assessment of anticipated injuries e. There are or you anticipate airway or breathing problems f. Helmet removal will not cause further injury While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 2 Body substance isolation EMT #1 stabilizes the pt’s neck in the neutral position EMT #2 checks the pt’s neurological status including sensation and motor function. 1. Have the pt squeeze your finger and wiggle their toes. If they are successful in doing so, they are neurologically intact. EMT #2 unfastens or cuts away the chin strap EMT#2 immobilizes the head by sliding their hands under the helmet and placing them along the sides of the head supporting the occiput OR place one hand on the jaw and the other on the occiput EMT #1 relinquishes C-spine to EMT #2 EMT #1 grasp the helmet and spreads it slightly to clear the ears by pulling laterally just below and anterior to the ear enclosure EMT #1 then rotates the helmet to clear the chin; counter rotates it to clear the occiput, and then rotates it to clear the nose and brow ridge After removal apply the proper size color 3 4 5 6 7 8 9 Critical Criteria on Next Page Points possible 1 1 1 1 1 1 1 1 1 9 SF College Document / Record Page 9 of 79 Points awarded EMT Skill Competency Sheet #05 Critical Criteria _____ Student did not achieve 80% (7/9) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ Student does not immediately order immobilization of the c-spine _____ The helmet is removed in a manner that could potentially worsen injury Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 10 of 79 EMT Skill Competency Sheet #06 Long Spine Board Immobilization from a standing position. Skill time ~ 10 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To maintain correct alignment of the spinal column Equipment needed: a. Cervical collar b. LSB c. CID d. 3 nine foot straps e. padding While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 2 Body substance isolation EMT #1 stabilizes the pts neck in the neutral position EMT #2 checks the pts neurological status including sensation and motor function. 1. Have the pt squeeze your finger and wiggle their toes. If they are successful in doing so, they are neurologically intact. EMT #2 measures the pt from the shoulder to an imaginary line even with the pt’s chin EMT selects the appropriate size collar EMT #2 exposes inspects and palpates the pt’s neck and back EMT #2 applies the C-collar 1. EMT #2 positions self in front of the pt 2. #2 then slides the front of the collar underneath the pts chin 3. #2 then gently pulls the collar around the back of the neck 4. #2 then fastens the Velcro EMT #1 directs another EMT to slide a LSB behind the pt EMT #1 directs 2 other EMT’s to stand beside the pt and place one hand under the pt’s arm and grasp the LSB. Their other arms should hold the pt’s arms securely to his body 3 4 5 6 7 8 9 10 Points possible 1 1 1 1 1 1 4 1 1 EMT #1 directs the 2 EMT’s to lower the pt to the ground EMT #2 secures the pt’s chest and pelvis to the LSB using separate straps that cress –cross the chest and pelvis 1 12 EMT #2 secures the pt’s legs and feet to the LSB 1 13 EMT #2 secures the pt’s head to the LSB using the CID 1 11 SF College Document / Record Page 11 of 79 1 Points awarded EMT Skill Competency Sheet #06 14 EMT #1 releases manual stabilization of the pt’s head 1 15 Pads any voids around straps on board 1 16 Rechecks the neurological status of the pt including sensation and motor responses 1 19 Critical Criteria on Next Page SF College Document / Record Page 12 of 79 EMT Skill Competency Sheet #06 Critical Criteria _____ Student did not achieve 80% (15/19) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ Student does not immediately order immobilization of the c-spine _____ At any time during immobilization to the LSB manual C-spine immobilization is lost _____ At any time during immobilization to the LSB the pt’s body was manipulated in a manner that could cause damage to the spine _____ Student forgets to apply cervical collar prior to going from standing to laying position _____ Student secures the pt’s head to the LSB prior to the body _____ Final spinal immobilization allows movement of the pt’s body up/down, left/right Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 13 of 79 SF College Document / Record Page 14 of 79 EMT Skill Competency Sheet #07 Long Spine Board Immobilization from a supine position. Skill time ~ 10 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To maintain correct alignment of the spinal column Equipment needed: a. Cervical collar b. LSB c. CID d. 3 nine foot straps e. padding While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 2 Body substance isolation EMT #1 stabilizes the pts neck in the neutral position EMT #2 checks the pts neurological status including sensation and motor function and pulses. EMT #2 measures the pt from the shoulder to an imaginary line even with the pt’s chin EMT selects the appropriate size collar EMT #2 exposes inspects and palpates the pt’s neck and back EMT #2 applies the C-collar 1. EMT #2 positions self in front of the pt 2. #2 then slides the front of the collar underneath the pts chin 3. #2 then gently pulls the collar around the back of the neck 4. #2 then fastens the Velcro EMT #2 places the LSB next to the pt with the bottom of the board at knee level EMT #1 directs and coordinates 2 other EMT’s in rolling the pt onto the side close to the person doing the roll EMT #2 inspects the pt’s back then slides the board behind/under pt 3 4 5 6 7 8 9 10 Points possible 1 1 1 1 1 1 4 1 1 1 12 EMT #1 directs the roll back onto the pt’s back then the pt is moved up onto the board as a unit EMT #2 secures the pt’s chest and pelvis to the LSB using separate straps that cris –cross the chest and pelvis EMT #2 secures the pt’s legs and feet to the LSB 1 13 EMT #2 secures the pt’s head to the LSB using the CID 1 11 12 1 1 SF College Document / Record Page 15 of 79 Points awarded EMT Skill Competency Sheet #07 14 EMT #1 releases manual stabilization of the pt’s head 1 15 Pad any voids around straps on board 1 16 Rechecks the neurological status of the pt including sensation and motor responses 1 Critical Criteria 20 _____ Student did not achieve 80% (16/20) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ Student does not immediately order immobilization of the c-spine _____ At any time during immobilization to the LSB manual C-spine immobilization is lost _____ At any time during immobilization to the LSB the pt’s body was manipulated in a manner that could cause damage to the spine _____ Student secures the pt’s head to the LSB prior to the body _____ Final spinal immobilization allows movement of the pt’s body up/down, left/right Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 16 of 79 EMT Skill Competency Sheet #08 Kendrix Extrication Device (KED) (5-4.39) Skill time ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To immobilize the spinal column when used in conjunction with a stiff neck extrication collar on a semi-fowler or sitting pt. Equipment needed: a. Universal precautions b. KED with head straps c. Cervical collar d. LSB e. 3, 9 foot straps f. Padding While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 Body substance isolation EMT #1 places pt’s head in a neutral in – line position and maintains manual immobilization of the head EMT #2 performs a neurological assessment including sensation and motor function EMT #2 applies C-Collar and KED 1. Measure and choose appropriate size collar and apply to pt 2. slide the KED behind the pt making sure it is snug under the armpit 3. secure the middle strap around the chest 4. secure the bottom strap around the chest 5. secure the leg straps by going under the legs then up through the groin area and attach to the buckle on the same side 6. secure the head strap applying padding where needed to maintain the neck in neutral position 7. secure the top strap around the chest 8. make sure all straps are snug 2 3 4 5 6 HINT for strapping order (My Baby Looks Hot Tonight) middle, bottom, legs, head, top Remove pt as a unit onto spine board while maintaining pt’s legs in a sitting position Remove pt’s leg straps and allow pt to lower legs into supine position Points possible 1 1 1 8 1 1 SF College Document / Record Page 17 of 79 Points awarded EMT Skill Competency Sheet #08 7 Verbalize 8 Secure the pt to a LSB 1 Performs a neurological assessment including sensation and motor function 1 15 Critical Criteria _____ Student did not achieve 80% (14/18) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ Student failed to immediately control cervical spine _____ During the application of the KED the pt is manipulated in a manner that could cause further harm to the pt _____ Student failed to check PMS before and after application of KED Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 18 of 79 EMT Skill Competency Sheet #09 Scoop Stretcher (1-6.14 & 6.15) Skill time ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To allow the user to safely pick up pt’s who might have hip fractures or other similar injuries and transfer them to the stretcher. The advantage of this stretcher is that it can be broken apart and placed around the patient without having to move the patient much. THIS IS NOT TO BE USED AS A MEANS OF FINAL SPINAL IMMOBILIZATION. Equipment needed: a. Universal precautions b. Scoop stretcher c. 3 – 9 foot straps While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 Body substance isolation Separate both halves of the scoop by depressing the head and foot latches then applying outward pressure. Place half of the stretcher on one side of the pt and the other half of the scoop on the other side of the pt. The scoop blades should be towards the pt’s body. NEVER MOVE EQUIPMENT OVER THE PT. Measure against the uninjured side and adjust the length of the scoop to fit the pt Place half of the stretcher under the pt by having an assistant gently roll the pt onto his uninjured side 2 3 4 5 6 7 8 9 Points possible 1 1 1 1 1 Slide the other half under the pt without rolling the pt towards the injured side 1 Connect the upper and lower latches 1 Secure the pt’s chest and pelvis to the scoop stretcher using separate straps that cris-cross the chest and pelvis Secure the pt’s feet with a strap 1 1 9 Critical Criteria on Next Page SF College Document / Record Page 19 of 79 Points awarded EMT Skill Competency Sheet #09 Critical Criteria _____ Student did not achieve 80% (7/9) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ The student moved equipment (parts of scoop) over the pt _____ During the application of the scoop the pt is manipulated in a manner that could cause further harm to the pt Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 20 of 79 EMT Skill Competency Sheet #10 Pressure Points time (5-1.4) ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. # 1 2 3 4 5 6 7 Goal or purpose for this skill: To identify points at which pressure can be applied to control bleeding after direct pressure and elevation fail. Equipment Needed a. BSI While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Skill procedure Body substance isolation Locate the brachial artery (behind the bicep) Locate the femoral artery (in the groin) Locate the carotid artery (in the groove of the neck) Locate the temporal artery (just in front of the ear) Locate the facial artery (just in front of the angle of the lower jaw Locate the subclavian artery (under the clavicles) Points possible 1 1 1 1 1 1 1 7 Critical Criteria on Next Page SF College Document / Record Page 21 of 79 Points awarded EMT Skill Competency Sheet #10 Critical Criteria _____ Student did not achieve 80% (6/7) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 22 of 79 EMT Skill Competency Sheet #11 Tourniquet (5-1.4) ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To be used as a last resort to control bleeding. Keep in mind that once applied the part below the tourniquet may require amputation at the hospital. Equipment Needed a. BSI b. Cravat (triangular bandage) c. Pen, stick or other straight object available at the scene d. Padding material (4x4, ABD or multi dressing) e. tape While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # 1 2 Verbalize 3 Verbalize 4 Verbalize 5 6 7 8 9 10 Skill procedure Points possible Body substance isolation Student must recognize that this is a last resort effort to control bleeding 1 Once a tourniquet is placed it may not be removed 1 The following are examples of what not to use as a tourniquet A. wire B. Cord C. Other narrow material that would cut into the body Place tourniquet as close as the injury as possible Pad over the artery Tighten until bleeding is controlled Tape or tie the tightening device Attach a note to the pt’s forehead advising TK and the time it was applied Notify the ED staff upon arrival at the hospital 1 1 1 1 1 1 1 1 10 Critical Criteria on Next Page SF College Document / Record Page 23 of 79 Points awarded EMT Skill Competency Sheet #11 Critical Criteria _____ Student did not achieve 80% (8/10) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student unable to tighten tourniquet in a manner that would stop bleeding Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 24 of 79 EMT Skill Competency Sheet #12 MAST (5-3.11) Skill time ~10 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. Goal or purpose for this skill: a. The main purpose is to improve a pt’s blood pressure by preventing blood from pooling in the extremities and forcing the blood to stay in the central circulation. b. B. It can also be used to stabilize hip and femur fractures while at the same time controlling any I internal bleeding. NOTE: Recent studies indicate that using the MAST in hypovolemia may produce more internal bleeding and decrease survival in the pre-hospital settings due to the pt losing their 02 transportation capabilities. Consult with local protocols concerning application in your location. 2. Indications of MAST a. Signs and symptoms of shock (BP < 90, cool, clammy skin, altered LOC, etc…) b. Stabilize hip and femur fractures 3. Contraindications of MAST a. CHF in presence of pulmonary edema 4. Contraindications of abdominal section a. Pregnancy, eviscerations, impaled objects to the abdomen 5. Precautions a. Chest trauma – due to increase pressure within the chest causing an increase in blood loss 6. While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # 1 2 Verbalize 3 4 5 6 7 Skill procedure Points possible Body substance isolation 1 Remove all clothing from the pt (including undergarments 1 Method #1 for pt not requiring a LSB for immobilization Open the MAST, gather the inner parts of the leg sections together. While holding the wing with one hand and the leg sections in the other hand slide the suit under the pt with the hand holding the leg sections pushing the suit toward the groin. Make sure the top of the suit is just below the ribs. Method # 2 is for use of MAST with a LSB for immobilization Open the MAST and lay on a LSB wrap Velcro straps around the bottom of the board to secure it, fold the abdominal section down. Place the pt onto the MAST unroll onto the pt making sure the top of the suit is at the lowest rib. Snugly wrap the leg and abdominal sections Connect the inflation tubes Inflate one leg at a time then the abdominal section , check the BP after each section is inflated SF College Document / Record Page 25 of 79 1 1 1 1 1 Points awarded EMT Skill Competency Sheet #12 8 Verbalize 9 10 MAST Removal Should only be done in the emergency department while fluid replacement is underway Deflate the abdominal section slowly checking BP during deflation to ensure no decline in BP. Deflate one leg at a time slowly, checking BP during deflation to ensure no decline in BP. 1 1 1 10 Critical Criteria _____ Student did not achieve 80% (8/10) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to provide the indications, contraindications or precautions of MAST use _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 26 of 79 EMT Skill Competency Sheet #13 Dressing and Bandaging (5-1.12, 5-1.13, 2.30) Skill time ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To control bleeding from a crushing injury, abrasion, or laceration to an infant, child or adult. Equipment needed: a. BSI b. Dressing material c. Tape While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure Points possible 1 Body substance isolation 2 3 4 5 Expose entire wound Check distal PMS Select proper size sterile dressing Open sterile dressing package, maintain sterility, place dressing on wound Unroll the gauze around the wound site advancing the wrap from below the wound to above the wound Secure the bandage material in place by applying a knot over the wound site to give it extra pressure Check distal PMS SPIRAL TURNS (tapered extremity injuries) 1 1 1 1 7 Expose entire wound 1 8 Check distal PMS 1 9 Select proper size sterile dressing 1 10 Open sterile dressing package, maintain sterility, place dressing on wound 1 11 Anchor below the wound site and secure with several circular turns 1 12 1 13 Open spiral up the length of the limb to the first joint Return to the wrist or ankle with a closed spiral, secure the bandage in place with adhesive tape or tie off Check distal PMS FIGURE OF EIGHT TURNS (joint injuries / allows for motion of joint) Expose entire wound 1 14 Check distal PMS 1 15 Select proper size sterile dressing 1 6 7 8 13 14 PRESSURE DRESSING SF College Document / Record Page 27 of 79 1 1 1 1 1 1 Points awarded EMT Skill Competency Sheet #13 16 17 18 19 16 17 18 19 Verbalize Open sterile dressing package, maintain sterility, place dressing on wound Anchor above the wrist and secure with two circular turns Complete figure of eight bandage of wrist with “X” on palm, secure the bandage in place with adhesive tape or tie off Check distal PMS RECURRENT HEAD BANDAGE Use kling and drape across the head from one side of the head to the other side until the entire head is covered Anchor bandage by making circular turns around the head leaving the ears exposed Secure the bandage in place with adhesive tape or tie off If bandaging the wound does not control the bleeding then the following should be performed 1. Apply additional dressing to the wound and apply direct pressure 2. Elevate 3. Apply pressure to an arterial pressure point 4. Begin rapid transport and treat for shock if signs continue to develop. This includes preventing heat loss, applying oxygen, and considering MAST 1 1 1 1 1 1 1 4 30 Critical Criteria on Next Page SF College Document / Record Page 28 of 79 EMT Skill Competency Sheet #13 Critical Criteria _____ Student did not achieve 80% (24/30) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ The manner at which the bandages were applied would cause further contamination to the wound _____ When bandaging the wound did not control the bleeding the student was not able to take appropriate steps to prevent shock Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 29 of 79 SF College Document / Record Page 30 of 79 EMT Skill Competency Sheet #14 Bleeding Control / Shock Management (5-1.12, 5-1.13, 2.30) Skill time ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. # 1 2 3 4 5 6 7 8 Goal or purpose for this skill: To control bleeding from a crushing injury, abrasion, or laceration to an infant, child or adult. To treat signs and symptoms of shock. Equipment needed: a. BSI b. Dressing material c. Tape d. Blanket e. 02 tank f. NRBM While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Skill procedure Points possible Points awarded Body substance isolation 1 Applies direct pressure to the wound 1 Elevates the extremity 1 The pt’s wound continues to bleed Remove dressing and find point of bleeding and apply “well aimed direct 1 pressure” The pt’s wound still continues to bleed. Well aimed direct pressure does not control the bleeding Locate and apply pressure to appropriate arterial pressure point 1 The bleeding is controlled Bandage the wound using a pressure dressing 1 The pt is displaying signs indicative of hypo-perfusion Position the pt in trendelenberg 1 Apply high concentration of 02 via a NRBM 1 9 Initiate steps to prevent heat loss 1 10 Indicate the need for immediate transport 1 Critical Criteria on Next Page SF College Document / Record Page 31 of 79 10 EMT Skill Competency Sheet #14 Critical Criteria _____ Student did not achieve 80% (8/10) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Did not apply high concentration of 02 _____ Did not control bleeding in a timely manner _____ Did not indicate the need for immediate transport Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 32 of 79 EMT Skill Competency Sheet #15 AED (Automatic External Defibrillator) (4-3.47) ~10 minutes Cardiac Arrest Management / AED with Bystander CPR in Progress Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Goal or purpose for this skill: a. To deliver electrical therapy to a pt that is in V-Fib or Pulseless VT Contraindications a. Patient under 12 months Caution a. Be sure patient is dry b. Do not place de-fib pads over a pacemaker c. Remove any patches (NTG) before placement of de-fib pads Equipment Needed a. AED b. BVM w/ OPA c. Oxygen tank Skill procedure ASSESSMENT Body substance isolation Briefly questions the rescuer about arrest events Turns on AED Power Attaches AED to patient Directs rescuer to stop CPR and ensures all individuals are clear of the patient Initiate analysis of the rhythm Delivers shock Directs resumption of CPR TRANSISTION Gathers additional information about the arrest event Confirms effectiveness of CPR (ventilations and compressions) INTEGRATION Verbalizes or directs insertion of a simple airway adjunct (oral/nasal airway) Ventilates, or directs ventilation of the patient Assure high concentration of oxygen is delivered to the patient Assures adequate CPR continues without unnecessary/prolonged interruption Continues CPR for 2 minutes Directs rescuer to stop CPR and insure all individuals are clear of the patient Initializes analysis of rhythm Delivers shock SF College Document / Record Page 33 of 79 Points possible 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Points awarded EMT Skill Competency Sheet #15 19 20 Directs resumption of CPR TRANSPORTATION Verbalizes transportation of patient 1 1 20 Critical Criteria _____ Student did not achieve 80% (16/20) _____ Did not take, or verbalize, body substance isolation precautions _____ Did not evaluate the need for immediate use of the AED _____ Did not immediately direct initiation of CPR at appropriate times _____ Did not assure all individuals were clear of the patient before delivering a shock _____ Did not operate the AED properly or safely (inability to deliver shock) _____ Prevented the AED from delivering any shock Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 34 of 79 EMT Skill Competency Sheet #16 Oropharyngeal Airway (2-1.35) Skill time ~30 seconds Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. Goal or purpose for this skill: The OPA is an airway adjunct that is used to keep the tongue from obstructing the airway in an unconscious child or adult without a gag reflex. Indications: Unconscious pt’s without a gag reflex Equipment needed: a. Various OPA sizes While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 Body substance isolation Choose the proper size airway 1. Measure from the corner of the mouth to the angle of the jaw Open the teeth / mouth using appropriate technique (cross finger, tongue – jaw etc) insert the OPA with the tip toward the roof of the mouth than rotate 180 degrees until the flange of the airway rest on the teeth / lips Remove the OPA if the pt starts to gag (be prepared to roll the pt onto his side) To remove the OPA rotate in opposite direction of insertion or pull out of the mouth down toward the chest 2 3 4 5 6 Critical Criteria on Next Page Points possible 1 1 1 1 1 1 6 SF College Document / Record Page 35 of 79 Points awarded EMT Skill Competency Sheet #16 Critical Criteria _____ Student did not achieve 80% (5/6) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ Student uses the inappropriate size airway. Too short would be ineffective, too long could cause the pt to gag or vomit _____ At any time during insertion the student uses a technique that may be harmful to the pt Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 36 of 79 EMT Skill Competency Sheet #17 Nasopharyngeal Airway (2-1.36) Skill time ~30 seconds Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: The NPA is an airway adjunct that is used to keep the tongue from obstructing the airway in a semi-conscious child or adult with a gag reflex who can’t maintain their own airway. Equipment needed: a. Various NPA sizes b. Lubrication jelly While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 Body substance isolation Choose the proper size airway 1. Choose the largest diameter that will easily fit into the nostril. The length is determined by measuring the distance between the nasal septum and the base of the earlobe. 2. Choose the proper size diameter by looking at the size of the pt’s nostril or little finger. Lubricate the NPA with KY jelly Insert the airway bevel edge toward the septum into the pt’s right nostril If resistance or blockage does NOT occur continue inserting the NPA until the flange of the airway rest on the nose If resistance is met, remove the airway and attempt insertion in the left nostril 2 3 4 5 6 Critical Criteria on Next Page Points possible 1 2 1 1 1 1 7 SF College Document / Record Page 37 of 79 Points awarded EMT Skill Competency Sheet #17 Critical Criteria _____ Student did not achieve 80% (5/7) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ Student uses the inappropriate size airway. Too short would be ineffective, too long could cause the pt to gag or vomit _____ At any time during insertion the student uses a technique that may be harmful to the pt Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 38 of 79 EMT Skill Competency Sheet #18 Bag Valve Mask Ventilation, Infant – Child – Adult (2-1.25, 2-1.26, 2-1.30, 1-1.31, 2-1.32, 2-1.40, 6-1.24, 6-1.25) Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: The BVM is a device used to provide artificial ventilations to pt’s who are not adequately breathing on their own. Students will demonstrate the BVM on the infant, child and adult Equipment needed: a. BVM; infant, child and adult b. Oxygen c. Airway adjuncts (NPA or OPA) While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # 1 2 3 4 5 6 7 8 9 10 Verbalize Skill procedure Points possible Body substance isolation Position yourself at the pt’s head Open airway by using either the head tilt chin lift or the modified jaw thrust. Inserts the appropriate size airway adjunct Selects the appropriate sized BVM for the infant, child or adult Apply BVM holding the mask firmly in place w/ C-E clamp method while maintaining head tilt chin lift, jaw thrust or modified jaw thrust. Ventilate the pt on room air while assessing for adequate chest rise at a rate of 12-20 breaths / minute for 30 seconds. Allow the bag to refill before each ventilation After the pt has been ventilated for 30 seconds on room air then connect oxygen at = or >15 lpm. DO NOT INTERUPT VENTILATIONS FOR MORE THAN 20 SECONDS Resume ventilations of the pt at a rate of 12 -20 while assessing for adequate chest rise. 1 1 If a second rescuer is available this should be a two person procedure. 1 Critical Criteria on Next Page 1 1 1 1 1 1 1 10 SF College Document / Record Page 39 of 79 Points awarded EMT Skill Competency Sheet #18 Critical Criteria _____ Student did not achieve 80% (8/10) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ Student uses the inappropriate size airway. Too short would be ineffective, too long could cause the pt to gag or vomit _____ At any time during insertion of the NPA/OPA student uses a technique that may be harmful to the pt _____ The student is unable to provide a C E mask seal as a result there is ineffective chest rise. _____ The student ventilates at a rate that is less than 12 or greater than 20 _____ The student disrupts ventilations for greater than 20 seconds at any time during procedure Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 40 of 79 EMT Skill Competency Sheet #19 Suctioning Technique (2-1.27) Skill time ~1 minute Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To remove oral secretions from the oral cavity of infants, children, and adults. Equipment needed: a. Universal precautions b. Suction catheters (yankauer and French tip) c. Suction device d. Irrigation fluid While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure NON INTUBATED PATIENT 1 2 3 4 5 6 7 Verbalize 8 9 10 11 Verbalize 12 Points possible Body substance isolation Student rolls pt to side and uses manual methods for opening the mouth and removal of secretions until suction device can be set up Assemble the appropriate size catheter to suction unit and turn it on 1. French tip catheter is used when flexibility and smaller size is needed for removal of emesis from the oropharynx 2. Yankauer (tonsil tip) is used when large volume of emesis is in need of removal from the oropharynx Measure the insertion distance of the catheter by measuring from the corner of the mouth to the angle of the jaw Insert the suction catheter into the mouth or nose to the measured depth Put a finger over the t-port to create suction and remove catheter tip ONLY SUCTION DURING WITHDRAWAL OF THE CATHETER FOR NO LONGER THAN 10 SECONDS The minimum vacuum for wall mounted suction device in the ambulance should be 300mm / Hg (NEW) INTUBATED PATIENT Demonstrate tracheobronchial suctioning in the intubated pt by selecting a suction device, catheter and technique Body substance isolation Preoxygenate the patient before and after the procedure You may need to inject 3-5 cm of sterile water down the ETT to help loosen thick secretions Reoxygenate the patient, repeating if necessary Critical Criteria on Next Page SF College Document / Record Page 41 of 79 1 1 2 1 1 1 1 1 1 1 1 1 13 Points awarded EMT Skill Competency Sheet #19 Critical Criteria _____ Student did not achieve 80% (11/13) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to consider BSI _____ Student suctioned during insertion of catheter OR suctioned longer than 10 seconds during withdrawal _____ While suctioning the intubated pt the student failed to oxygenate before and after suctioning Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 42 of 79 EMT Skill Competency Sheet #20 King LT Airway (PTL) Skill time ~ 3 minute Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. Goal or purpose for this skill: To secure the airway in an unconscious patient without a gag reflex. Equipment needed: a. Universal precautions b. King LT Airway (PTL) c. 140cc and 20 cc syringes d. Water soluble lubrication e. Stethoscope f. Ambu bag and 02 supply g. Suction h. Airway adjunct (NPA / OPA) Contraindications: a. Esophageal disease (as seen in alcoholics with spider vein nose) b. Ingestion of caustic substances. (If it burned going down it will burn coming up and it will break down the tube). c. The pt is less than 16 y.o.a. d. The pt has a gag reflex e. The pt is less than 5 foot tall While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure Points possible Points awarded NON INTUBATED PATIENT Body substance isolation 1 Checks for response 1 Opens the airway manually 1 Checks breathing (Minimum 5 seconds; maximum 10 seconds) 1 Gives 2 breaths (1 second each) 1 Checks carotid pulse (Minimum 5 seconds; maximum 10 seconds) 1 Attaches oxygen reservoir to bag-valve mask device and connects to high flow 7 1 oxygen regulator 8 Ventilates patient at a rate of 10-12/minute with appropriate volumes 1 NOTE: After 30 seconds, examiner auscultates and reports breath sounds are present and equal bilaterally and insertion of the King LT airway is indicated. The examiner must now take over ventilation. 9 Directs assistant to preoxygenate patient 1 1 2 3 4 5 6 10 Checks/prepares airway device 1 11 Lubricates the beveled distal tip and posterior aspect of the tube 1 SF College Document / Record Page 43 of 79 EMT Skill Competency Sheet #20 NOTE: Examiner to remove OPA and move out of the way when candidate is prepared to insert device. 12 Positions head in the “sniffing position” 1 13 Holds mouth open and applies chin lift Inserts airway, rotating from the lateral to midline position, until proximal opening of gastric access lumen (LTS-D model) or the base of connector (LT-D model) is aligned with teeth or gums. Inflates cuffs with the volume necessary to seal the airway at the peak ventilatory pressure. Attaches bag mask to the 15 mm connector. 1 14 15 16 1 1 1 While gently bagging patient to assess ventilation, simultaneously withdraws 1 the airway until ventilation is easy and free flowing Confirms placement and ventilation by observing chest rise, auscultation over 18 1 the epigastrium, and bilaterally over each lung. Confirms placement and ventilation by using a colorimetric end-tidal CO2 19 1 detector. NOTE: Examiner confirms adequate chest rise, absent sounds over the epigastrium, equal bilateral breath sounds and color change on the end-tidal CO2 detector consistent with correct placement. Secures airway with a commercial device while continuing ventilatory 20 1 support. 21 Re-confirms airway placement after the device is secured. 1 17 22 Applies cervical collar and immobilization device [may verbalize] 1 23 Continues ventilation with appropriate volumes (no pulse = 8-10/min; pulse = 10-12/min) 1 23 Critical Criteria on Next Page SF College Document / Record Page 44 of 79 EMT Skill Competency Sheet #20 Critical Criteria _____ Student did not achieve 80% (18/23) _____ Interrupts ventilations for greater than 30 seconds at any time. _____ Failure to voice and ultimately provide high oxygen concentrations. _____ Ventilates patient at a rate greater than 12 breaths per minute. _____ Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible]. _____ Failure to insert the airway to the proper depth to provide easy and free flowing ventilation. _____ Failure to inflate cuffs to maintain airway seal. _____ Failure to remove the syringe immediately after inflation of cuffs. _____ Failure to confirm proper placement by observing chest rise, epigastric and bilateral lung auscultation. _____ Failure to confirm proper placement by using a colorimetric end-tidal CO2 detector. _____ Inserts any adjunct in a manner dangerous to patient. Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 45 of 79 SF College Document / Record Page 46 of 79 EMT Skill Competency Sheet #21 Flail Segment ~ 3 minute Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. # 1 2 3 4 5 6 7 8 Goal or purpose for this skill: To seal a puncture to the thorax to allow for inflation of the lung. Equipment needed: a. BSI b. Vaseline gauze c. 1‘ tape d. 6” Ace bandage While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Skill procedure Points possible Body substance isolation Student recognizes flail segment from paradoxical movement Student places gloved hand on flail segment and holds in place Student places a bulky dressing (Sandbag, pillow, IV bag) on flail segment Student tapes bulk dressing tightly on all sides If C-spine allows, student wraps ribs with Ace bandage Student verbalizes importance of monitoring lung sounds for pnuemo/hemothorax Ventilates patient at a rate of 10-12/minute with appropriate volumes 1 1 1 1 1 1 1 1 8 Critical Criteria on Next Page SF College Document / Record Page 47 of 79 Points awarded EMT Skill Competency Sheet #21 Critical Criteria _____ Student did not achieve 80% (6/8) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to recognize flail segment from paradoxical movement Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 48 of 79 EMT Skill Competency Sheet #22 Sucking Chest Wound ~ 3 minute Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. # 1 2 3 4 5 6 Goal or purpose for this skill: To seal a puncture to the thorax to allow for inflation of the lung. Equipment needed: a. BSI b. Vaseline gauze c. 1‘ tape While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Skill procedure Points possible Body substance isolation Student recognizes sucking chest wound from frothy blood coming from wound, and absence of lung sounds on affected side. Student places gloved hand on wound and holds in place Student places an occlusive dressing on wound Student tapes bulk occlusive dressing on three sides Student verbalizes importance of monitoring lung sounds 1 1 1 1 1 1 6 Critical Criteria on Next Page SF College Document / Record Page 49 of 79 Points awarded EMT Skill Competency Sheet #22 Critical Criteria _____ Student did not achieve 80% (5/6) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 50 of 79 EMT Skill Competency Sheet #23 Patient Assessment, Trauma (1-5.37) Skill time ~ 10 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Goal or purpose for this skill: To affectively and systematically do an assessment on a patient (male, female, child or adult) injured in a traumatic event of any kind While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. >>THIS SKILL IS A HANDS ON ASSESSMENT, ALL TREATMENT SHOULD BE VERBALIZED<< Points Points Skill procedure possible awarded Body substance isolation SCENE SIZE UP Determines the scene is safe Determines the M.O.I. Determines the number of P.I. Request and specifies additional help needed Consider stabilization of cervical spine INITIAL ASSESSMENT Verbalize your general impression of the patient Determines pt’s responsiveness 1 1 1 1 1 1 1 1 Determines the chief complaint and apparent life threats 1 Assesses the airway and breathing A. assessment 4 B. initiates appropriate oxygen therapy C. assures adequate ventilation D. performs injury management Assesses the pts circulation A. assesses for and controls major bleeding 3 B. assesses pulse C. assesses skin color, temperature and condition Identifies priority pts and makes transport decisions 1 FOCUSED PHYSICAL EXAM AND HISTORY/ RAPID TRAUMA ASSESSMENT Selects appropriate assessment (focused or rapid) 1 Obtains baseline vital signs 1. BP 2. Pulse 3. RR 4. Skin Temp/condition 4 SF College Document / Record Page 51 of 79 EMT Skill Competency Sheet #23 15 16 17 18 19 20 21 22 23 24 Obtains a SAMPLE history 1. Signs/symptoms 2. Allergies 3. Medications 4. Pertinent/past medical history 5. Last oral intake 6. Events leading to injury DETAILED PHYSICAL EXAM Assesses the head 1. Inspects and palpates the scalp and ears 2. Assesses the eyes 3. Assesses the facial area including the oral and nasal area Assesses the neck 1. Inspects and palpates the neck 2. Assesses for JVD 3. Assesses for tracheal deviation Assesses the chest 1. Inspect 2. Palpate 3. Auscultate Assesses the abdomen / pelvis 1. Assesses the abdomen 2. Assesses the pelvis 3. Verbalizes assessment of genitalia / perineum as needed Assesses the upper extremities X 2 1. Inspects 2. Palpates 3. Assess pulses 4. Assess motor 5. Assess sensory Assesses the lower extremities X 2 6. Inspects 7. Palpates 8. Assess pulses 9. Assess motor 10. Assess sensory Assesses the posterior 1. Assesses the thorax 2. Assesses the lumbar Manages secondary injuries and wounds appropriately Verbalizes reassessment of the vital signs 1. BP 2. P 3. RR 4. Skin Critical Criteria Next Page 6 3 3 3 3 10 10 2 1 4 67 SF College Document / Record Page 52 of 79 EMT Skill Competency Sheet #23 Critical Criteria _____ Student did not achieve 80% (53/67) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration _____ Student did not consider scene safety _____ Student did not consider BSI _____ Student did not immediately order cervical immobilization when indicated _____ Student did other detailed assessment before assessing ABC’s _____ Student decided to stay on scene when pt clearly required expedient transport _____Student did not appropriately manage problems associated with the airway, breathing or circulation _____ Oxygen never delivered in any manner _____ Student did not identify or aggressively treat the signs and symptoms indicating shock Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 53 of 79 SF College Document / Record Page 54 of 79 EMT Skill Competency Sheet #24 Burns (5-2.36 – 5-2.40) ~8 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. Goal or purpose for this skill: To be able to identify lethal and non-lethal burns, degree of burns, and the rule of 9’s for the pediatric and adult pt. Complications of burns: a. Infections b. Temperature control (the inability to control the body temp due to the loss of skin being burned away) c. Hypothermia from too much irrigation of the burn w/ saline Equipment Needed a. BSI b. Sterile burn sheets c. Irrigation fluid While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 Body substance isolation Perform a pt assessment ruling out any airway, breathing or circulatory or life threatening conditions Any complication of airway, breathing or circulation would be rapid transport to a trauma center or burn unit Remove clothing around the burned area, cut around the clothing that is stuck to the skin A. first degree is reddened skin as in a sunburn B. second degree results in blistering of the skin C. Third degree is recognized as charring of the skin The student should be able to estimate the BSA by using the rule of 9’s. Adults: head=9%, chest/abdomen=18%, back=18%, each leg=18%, genitalia=1%, each arm=9% Children: : head=18%, chest/abdomen=18%, back=18%, each leg=13.5%, genitalia=1%, each arm=9% In adults second and third degree burns of >than 15% TBSA should go to a trauma/burn center In children second and third degree burns of > than 10% TBSA should go to trauma/burn center If burning agent is a powder, brush off as much as possible before attempting to irrigate 2 3 Verbalize 4 5 Verbalize 6 Verbalize 7 Verbalize 8 Verbalize 9 Points possible 1 1 1 1 3 Adults 1 Children 1 SF College Document / Record Page 55 of 79 1 1 1 Points awarded EMT Skill Competency Sheet #24 10 11 If burned area is <10% cool the area with sterile saline and wrap w/ dry sterile dressings If the area is >10% wrap the area with dry sterile dressings and transport 1 1 14 Critical Criteria _____ Student did not achieve 80% (11/14) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student is unable to differentiate treatment between wet or dry dressings _____ Student is unable to advise complications of burns Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 56 of 79 EMT Skill Competency Sheet #25 Vacuum Splint (5-3.11) Skill time ~3 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To immobilize an injured extremity that is suspected of being fractured to prevent further damage. Equipment needed: a. Appropriate sized vacuum splint While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 2 3 Body substance isolation EMT #2 manually support the injured extremity EMT #1 check for pulse, motor and sensory EMT #1 select correct size vacuum splint to immobilize above and below the fracture EMT #1 forms the vacuum splint under the pt’s injured extremity and secures the straps EMT #1 places the vacuum pump on the air removal port of the vacuum splint EMT #1 uses the pump to remove the air from the vacuum splint, thus forming a rigid splint to the pt’s injured extremity. EMT #1 rechecks the straps and if lose tightens the straps EMT #1 rechecks pulse, motor and sensory following application of the vacuum splint 4 5 6 7 8 9 Points possible 1 1 1 1 1 1 1 1 1 9 Critical Criteria on Next Page SF College Document / Record Page 57 of 79 Points awarded EMT Skill Competency Sheet #25 Critical Criteria _____ Student did not achieve 80% (7/9) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to check PMS before and after splint applied _____ Student unable to properly splint extremity due to lack of knowledge using equipment Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 58 of 79 EMT Skill Competency Sheet #26 Splint (5-3.11) Skill time ~8 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To immobilize an injured leg that is suspected of having only a mid-shaft femur fracture Equipment Needed a. Traction splint b. Ankle harness c. LSB w/ straps While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Points possible # Skill procedure 1 2 3 4 5 6 Body substance isolation Remove the clothing on the affected leg Control any hemorrhage Check pulse, motor, sensory Manually stabilize the fracture by applying traction to the ankle Apply the ankle harness appropriately Lay the splint next to the uninjured leg and adjust the splint 10 – 12 inches past the foot for proper length Slide the splint under the injured leg until the padded ring rest against the ischial tuberosity, secure w/ Velcro leg strap at the level of the groin making one finger can be slipped under the strap Elevate the heel stand Secure the ankle hitch to the “S” hook of the tension strap. Apply tension equal to or more than being applied manually until the pt feels relief or until the leg is equal length to the uninjured leg Secure the leg with Velcro straps, 2 above the knee, 1 below the knee and 1 above the ankle Re-evaluate the ischial strap and ankle harness Recheck pulse, motor and sensory Place the pt on a LSB and secure the torso to immobilize the hip 1 1 1 1 1 1 Secure the splint to the LSB to prevent movement of the splint 1 7 8 9 10 11 12 13 14 15 16 Verbalize 1 1 1 1 1 1 1 1 1 16 Critical Criteria on Next Page SF College Document / Record Page 59 of 79 Points awarded EMT Skill Competency Sheet #26 Critical Criteria _____ Student did not achieve 80% (13/16) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student did not check PMS before and after splint applied _____ At any time during splinting the pt’s leg was manipulated in a manner that would possibly cause further harm to the leg _____ Student was not able to properly operate splint and traction was not applied Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 60 of 79 EMT Skill Competency Sheet #27 Patient Assessment, Medical (1-5.37) Skill time ~ 10 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. # Goal or purpose for this skill: To affectively and systematically do an assessment on a patient (male, female, child or adult) with an illness of a medical complaint of any kind. While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. >>THIS SKILL IS A HANDS ON ASSESSMENT, ALL TREATMENT SHOULD BE VERBALIZED<< Points Points Skill procedure possible awarded 1 Body substance isolation 2 3 4 5 6 Determines the scene is safe Determines the M.O.I. Determines the number of P.I. Request and specifies additional help needed Consider stabilization of cervical spine INITIAL ASSESSMENT Verbalize your general impression of the patient Determines pts responsiveness/ level of consciousness 7 8 9 10 11 12 SCENE SIZE UP 1 1 1 1 1 1 1 1 Determines the chief complaint and apparent life threats Assesses the airway and breathing A. assessment B. initiates appropriate oxygen therapy C. assures adequate ventilation D. performs injury management Assesses the pts circulation A. assesses for and controls major bleeding B. assesses pulse C. assesses skin color, temperature and condition 1 Identifies priority pt’s and makes transport decisions 1 4 3 SF College Document / Record Page 61 of 79 EMT Skill Competency Sheet #27 FOCUSED PHYSICAL EXAM AND HISTORY/ RAPID MEDICAL ASSESSMENT Signs and symptoms (assess history of present illness) The instructor will select ONE of the following 17 Respiratory: Onset, Provokes, Quality, Radiates, Severity, Time, Interventions Cardiac: Onset, Provokes, Quality, Radiates, Severity, Time, Interventions Altered level of consciousness: Description of the episode, Onset, Duration, Associated symptoms, Evidence of trauma, Interventions, Seizures, Fever Allergic reaction: History of allergies, What you were exposed to, How were you exposed, Effects, Progressions, Interventions Poisoning/ Overdose: Substance, When did you ingest/ become exposed, How much did you ingest, Over what time period, Interventions, Estimated weight, Effects Environmental Emergencies: Source, Environment, Duration, Loss of consciousness, Effects, General or local Obstetrics: Are you pregnant, How long have you been pregnant, Pain or contractions, Bleeding or discharge, Do you feel the need to push, Last menstrual period, Crowning Behavioral: How do you feel, Determine suicidal tendencies, Is the pt a threat to self or others, Is there a medical problem, PMH, Interventions, Medications Allergies / Medications / PMH / Last meal / Events leading to Performs focused physical examination. • Assess affected body part/ system or, if indicated, completes rapid assessment Vitals (obtain baseline vital signs) BP, HR, RR, Skin Interventions • Obtains medical direction or verbalizes standing order for medication interventions and verbalizes proper additional intervention/ treatment Transport (re- evaluates transport decision) 1 18 Completes detailed physical exam 1 19 Repeats initial assessment 1 20 Repeats vital signs BP, HR, RR, Skin 4 21 Repeats focused assessment regarding pt complaint or injuries 1 22 Checks interventions 1 A B C D E F G H 13 14 15 16 7 7 8 6 7 6 7 7 5 1 4 1 42 - 44 Critical Criteria on Next Page SF College Document / Record Page 62 of 79 EMT Skill Competency Sheet #27 Critical Criteria _____ Student did not achieve 80% (34-36 / 42 - 44) _____ Student unable to verbalize a goal / purpose for this skill _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student did not consider scene safety _____ Student did not consider BSI _____ Student did other detailed assessment before assessing ABC’s _____ Student decided to stay on scene when pt clearly required expedient transport _____ Oxygen never delivered in any manner _____ Student administered a medication without first contacting medical control Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 63 of 79 SF College Document / Record Page 64 of 79 EMT Skill Competency Sheet #28 8Metered Dose Inhalers (4-2.14) ~3 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. Goal or purpose for this skill: To assist the pt with an MDI who is having difficulty breathing. Equipment Needed a. BSI b. MDI w/ or w/out spacer Indications a. A pt who appears to be having difficulties breathing While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Points possible # Skill procedure 1 Body substance isolation Assess the pt (including lung sounds and vitals) and initiate appropriate 02 therapy Obtain the pt’s MDI Assure the MDI is prescribed to the pt Check the expiration date of the medication 1 1 1 Contact medical control for authorization of usage 1 Attach the spacer (if provided) or mouthpiece to the inhaler 1 Have the pt fully exhale Advise or assist the pt to spray prescribed dose into the spacer (if available) while pt is inhaling until the mist is completely inhaled If relief is not achieved within 2 – 3 minutes, repeat sequence 1. Continue with pt assessment, 2. Transport, 3. Report 4. Document 1 2 3 4 5 6 7 Verbalize 8 9 Verbalize 10 11 Critical Criteria on Next Page 1 1 1 1 4 14 SF College Document / Record Page 65 of 79 Points awarded EMT Skill Competency Sheet #28 Critical Criteria _____ Student did not achieve 80% (11/14) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to check lung sounds, vitals or administer 02 _____ Student fails to contact medical control prior to administration Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 66 of 79 EMT Skill Competency Sheet #29 Epinephrine Auto-Injector Skill time ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. # 1 2 3 4 5 6 7 8 9 10 11 12 13 Goal or purpose for this skill: To automatically administer a unit dose of epinephrine to a pt who is having an anaphylactic reaction. Equipment Needed a. BSI b. Epi-pen auto injector (containing 0.3mg of epi) c. Epi-pen Jr. auto injector (containing 0.15mg epi) Indications a. A pt who appears to be having an anaphylactic reaction including difficulty breathing, hypotension, urticaria (hives) or signs of shock BP < 90 sys. While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Skill procedure Body substance isolation Assess the pt and initiate appropriate 02 therapy Obtain the pt’s epi injector Assure the injector is prescribed for the pt Check the expiration date Check for cloudiness or discoloration of the medication Obtain a set of vitals 1. BP 2. HR 3. RR 4. Skin Contact medical control for authorization of usage Remove clothing (if possible) from the thigh Clean the site with antiseptic Remove the safety cap from the injector Push the black tip of the injector firmly against the thigh and hold for a minimum of 10 seconds Discard the injector into a sharps container Points possible 1 1 1 1 1 1 4 1 1 1 1 1 1 SF College Document / Record Page 67 of 79 Points awarded EMT Skill Competency Sheet #29 14 Continue with 1. Pt assessment 2. Transport 3. Report 4. Documentation 4 20 Critical Criteria _____ Student did not achieve 80% (16/20) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student failed to check for expiration date _____ Student failed to contact medical control prior to usage Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 68 of 79 EMT Skill Competency Sheet #30 Nitroglycerine Sublingual (4-3.52 – 4-3.53) ~3 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. 5. Goal or purpose for this skill: To assist the adult pt who is having chest pain with self administration of NTG. Equipment Needed a. BSI b. NTG tablet or spray (0.4mg) Indications a. A pt who appears to be having chest pains Contraindications a. Hypotension = systolic blood pressure < 100 b. Use of nitrates for E.D. (other sexual enhancing drugs) c. Head injuries While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # 1 2 3 4 5 6 7 8 Verbalize 9 10 11 Skill procedure Body substance isolation Assess the pt and initiate appropriate 02 therapy Obtain the pt’s NTG Assure the NTG is prescribed to the pt Check the expiration date of the medication Make sure the pt’s systolic BP is > 100 Contact medical control for authorization of usage Advise or assist the pt A. If spray: spray prescribed dose under tongue B. If tablet: place under tongue and allow to dissolve (may feel a slight tingling or burning sensation) Re-assess VS after 5 minutes, particularly BP If relief is not achieved, repeat sequence (total of three times) 1. Continue with pt assessment, 2. Transport, 3. Report 4. Document Critical Criteria on Next Page Points possible 1 1 1 1 1 1 1 1 1 1 4 14 SF College Document / Record Page 69 of 79 Points awarded EMT Skill Competency Sheet #30 Critical Criteria _____ Student did not achieve 80% (11/14) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student fails to administer appropriate 02 therapy _____ Student fails to check blood pressure before and after administering NTG _____ Student fails to contact medical control prior to administration Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 70 of 79 EMT Skill Competency Sheet #31 Medication “Set-Up” ~3 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. # 1 2 3 4 5 6 Goal or purpose for this skill: To assist the paramedic by preparing the medication he / she request. Equipment Needed a. BSI b. Appropriate medications While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. Skill procedure Body substance isolation Set out the appropriate medication when requested to do so by the Paramedic Check for the expiration date on the medication Open the box containing the medication Inspect for 1. Damage to the container 2. Cloudy solution Assemble a pre-filled syringe in an upright position Points possible 1 1 1 1 2 1 7 Critical Criteria on Next Page SF College Document / Record Page 71 of 79 Points awarded EMT Skill Competency Sheet #31 Critical Criteria _____ Student did not achieve 80% (6/7) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student failed to check for expiration date Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 72 of 79 EMT Skill Competency Sheet #32 Oral Glucose (4-4.8 – 4.4.9) ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. Goal or purpose for this skill: To administer oral glucose to a pt that exhibits signs and symptoms of hypoglycemia Equipment Needed a. BSI b. Tube of oral glucose gel c. Bite stick or tongue depressor Indications a. A conscious pt who appears to be hypoglycemic While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # 1 2 3 4 5 6 6 7 Verbalize 8 9 Skill procedure Points possible Body substance isolation Assess the pt and initiate appropriate 02 therapy Obtain the oral glucose gel Assure the glucose tube is intact Check the expiration date Assess pt’s vital signs 1. BP 2. HR 3. RR 4. Skin Contact medical control for usage 1 1 1 1 1 Squeeze the tube onto a bite stick or tongue depressor 1 Advise the pt to open mouth and place the tongue depressor between the cheek and gums (gel side to cheek) Reassess vitals 1. BP 2. HR Pay close attention to AIRWAY 3. RR 4. Skin 4 1 1 4 SF College Document / Record Page 73 of 79 Points awarded EMT Skill Competency Sheet #32 10 Continue with 1. Pt Assessment 2. Transport 3. Report 4. Documentation 4 20 Critical Criteria _____ Student did not achieve 80% (16/20) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student failed to check for expiration date _____ Student fails to re-assess Airway Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 74 of 79 EMT Skill Competency Sheet #33 Activated Charcoal (4-6.12 – 4-6.15) Skill time ~5 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. 4. Goal or purpose for this skill: To administer activated charcoal to a pt who has ingested a non-corrosive poison Equipment Needed a. BSI b. Bottle of activated charcoal Indications a. A conscious pt who has ingested a non-corrosive poison While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # 1 2 3 4 5 6 7 8 9 10 11 Skill procedure Body substance isolation Assess the pt and initiate appropriate 02 therapy Assess vitals 1. BP 2. HR 3. RR 4. Skin Contact poison control (1800-222-1222) Obtain the activated charcoal Check the expiration date Contact medical control for authorization of usage Coax the pt into drinking the entire bottle (240cc) Reassess vitals 1. BP 2. HR 3. RR pay close attention to Airway 4. Skin Continue with 1. Pt assessment 2. Transport 3. Report 4. Documentation Discard the empty bottle of activated charcoal into a red bag Critical Criteria on Next Page Points possible 1 1 4 1 1 1 1 1 4 4 1 20 SF College Document / Record Page 75 of 79 Points awarded EMT Skill Competency Sheet #33 Critical Criteria _____ Student did not achieve 80% (16/20) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student failed to check for expiration date _____ Student failed to contact medical control prior to usage Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 76 of 79 EMT Skill Competency Sheet #34 Impending Childbirth (4-9.20 – 4-9.28) Skill time ~8 minutes Student must avoid all critical criteria to pass this skill Must be completed by the date specified on the master skill competency sheet. (If not completed by target date a 20 percent deduction will be applied for each lab late) Student: _____________________________________________________ Date: _____________________ 1. 2. 3. Goal or purpose for this skill: To deliver and care for a newborn and the mother. Equipment Needed a. BSI b. 02 supply c. OB kit While the student is performing this skill the instructor may ask questions about why the student is doing what they are doing. The student should be able to voice a rational answer to these questions. # Skill procedure 1 Body substance isolation Confirm impending childbirth by asking the following questions 1. Determine the GPA of the mother (Gravida) the # of times she has been pregnant. (Para) the # of live children she has had (Abortions) the # of miscarriages or aborted pregnancies the pt has had. 2. Has your water broken? When? Clarity of the fluid 3. Have you had pre-natal care? 4. Have you had any complications with your pregnancy? 5. Is there more than one baby? Time the “duration” of contractions (from the beginning of the contraction to the end) Time the “interval” of the contractions (from the beginning of one contraction to the beginning of the next contraction) Examine the perineum for crowning. NO PELVIC EXAMS Apply appropriate 02 therapy Prepare the pt for delivery 1. Place the pt in a semi fowlers position 2. Place a sheet under the pt and elevate the pt’s buttocks to assist the delivery of the newborn 3. Drape the pt 4. Calm the pt Delivery of infant 1. As crowning occurs place your hands on the infants head to prevent an explosive delivery 2. As the head emerges check the neck for the umbilical cord. If the cord is present gently slip the cord over the 2 3 4 5 6 7 8 Points possible 1 5 1 1 1 1 4 5 SF College Document / Record Page 77 of 79 Points awarded EMT Skill Competency Sheet #34 9 10 head or if it is too tight clamp and cut the cord before further delivery of the infant. 3. With the head out aspirate the infant’s mouth then nose before the chest is delivered. 4. Gently lower the head down to allow the top shoulder to deliver then lift the head to allow delivery of the bottom shoulder 5. Note the time of delivery Care of the infant 1. Dry the infant by vigorously rubbing 2. Discard wet towel and place a dry towel around baby 3. Check for crying and breathing (look, listen, feel) 4. Perform APGAR score at the 1 and 5 minute mark 5. Place the first clamp on the umbilical cord ~ 7 inches from the infant 6. Place the second clamp on the umbilical cord ~ 10 inches from the infant 7. Cut the cord. If bleeding is present from the cord ends place another clamp behind the first clamp 8. If the babies HR is < 60 begin CPR. If HR is between 60-80 assist ventilations, if no increase is noticed begin CPR. If HR is 80-100 assist ventilations. If HR is 100 or > give blow by 02at 5lpm via supply tubing ½ inch away from infants nose / mouth to deliver 80%. Care of the mother 1. Massage the fundus of the uterus to control bleeding and facilitate a more rapid delivery of the placenta. 2. Have the mother nurse her baby if she wants. 3. Dress the perineum if torn 4. Apply a sanitary napkin 5. Asses all vitals 8 5 32 APGAR Scoring: Appearance Pulse Grimace Activity Respirations 0 points Blue 1 point Body pink / Extremity blue 2 points Fully Pink Absent <100 >100 None Some Motion Vigorous Cry Flaccid Some Flexion Active Absent Slow, Irregular Strong Cry SF College Document / Record Page 78 of 79 EMT Skill Competency Sheet #34 Child Birth complications (all child birth complications are a rapid transport to the hospital) 1. 2. Breech Birth: Feet first a. After the shoulders are delivered and the infants face is in a downward position then elevate the legs and trunk of the infant to facilitate delivery of the head. b. Head should deliver in 30” if not then place 2 sterile gloved fingers into the vagina to locate the infant’s mouth. c. Push the vaginal wall away from the infant’s mouth to form an airway. d. Apply gentile pressure to the fundus. If head does not deliver in 2 minutes, keep your fingers in place to maintain an airway. Prolapsed Cord: Cord protruding from the vagina a. Elevate the mother’s hips to the knee – chest position, explaining to the mother not to push. b. If the cord is not pulsating place a sterile gloved hand into the vagina and gently exert counterpressure until the cord begins to pulsate again. c. Once the cord is determined to be pulsating cover the exposed cord with a moist dressing and keep it warm. Critical Criteria _____ Student did not achieve 80% (26/32) _____ Student unable to verbalize a goal / purpose for this skill _____ Student fails to consider BSI _____ Student unable to rationally answer questions from instructor during skills demonstration. _____ Student failed to apply 02 to mom prior to delivery Instructor Comments: Student Signature: ________________________________________ Instructor Signature: _______________________________________ SF College Document / Record Page 79 of 79