If you work as an emergency medical technician (EMT), it's important to be familiar with the Emt Trauma Assessment Form. This form can help you quickly and accurately assess a patient's condition after a traumatic injury. The form is divided into four sections: chief complaint, history, physical examination, and disposition. Each section includes information that is essential for assessing and treating trauma patients. Knowing how to use this form can help you provide timely, life-saving care to patients in need.
You'll find information regarding the type of form you would like to prepare in the table. It can tell you just how long it should take to complete emt trauma assessment, exactly what fields you will need to fill in, and so on.
Question | Answer |
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Form Name | Emt Trauma Assessment |
Form Length | 12 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 3 min |
Other names | patient assessment trauma scenarios, emt trauma assessment sheet, trauma assessment emt scenarios, emt trauma assessment cheat sheet |
State of Indiana EMR Psychomotor Skills Examination
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Patient Assessment/Management - Trauma |
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Candidate: |
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Examiner Name: |
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Date: |
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Scenario #: |
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Actual Time Started |
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Takes or verbalizes appropriate body substance isolation precautions |
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SCENE |
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Determines the scene/situation is safe |
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Determines the mechanism of injury |
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Determines the number of patients |
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Request additional help, if necessary |
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Considers stabilization of the spine |
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PRIMARY SURVEY/RESUSCITATION (Initial Assessment) |
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Verbalizes general impression of the patient |
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Determines responsiveness/level of consciousness |
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Determines chief complaint/apparent life threats |
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Airway |
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Opens and assesses the airway |
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Inserts an adjunct as indicated |
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Assesses breathing |
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Breathing |
Assures adequate ventilation |
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Initiates adequate oxygen therapy |
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Manages any injury which may compromise breathing/ventilation |
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Checks for pulse |
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Assesses skin (color, temperature, & condition) |
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Circulation |
Assess for and controls major bleeding, if present |
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Evaluates for and initiates shock management, if applicable |
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(includes patient positioning, oxygen, and body heat conservation) |
1 |
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Identifies patient priority and makes treatment/transport decision |
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History Gathering |
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Selects appropriate assessment (focused or rapid assessment) |
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Attempts to obtain a SAMPLE history |
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SECONDARY ASSESSMENT (Detailed Exam) *Credit should be given to candidates |
that use a |
brief |
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exam for |
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Inspects mouth, nose, and assesses facial area |
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Head |
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Inspects and palpates scalp and ears |
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Assesses eyes |
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Checks position of trachea |
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Neck |
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Checks jugular veins |
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Palpates cervical spine |
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Inspects chest |
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Chest |
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Palpates chest |
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Auscultates chest |
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Inspects and palpates abdomen |
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Abdomen/pelvis |
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Assesses pelvis |
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Verbalizes assessment of genitalia/perineum, as needed |
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Lower Extremities |
Inspects, palpates, & assesses motor, sensory & |
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distal function (1 point per each leg) |
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Upper Extremities |
Inspects, palpates, & assesses motor, sensory & |
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distal function (1 point per each arm) |
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Posterior |
Inspects & palpates posterior thorax |
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Inspects & palpates lumbar and buttocks regions |
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Vital Signs |
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Obtains baseline vitals (minimum is heart rate, blood pressure & respiratory) |
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Manages Secondary injuries and wounds appropriately |
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REASSESSMENT |
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Describes how and when to reassess the patient.
Actual Time Ended:
1
TOTAL 43
** Examiner must list times above and then sign on reverse after reviewing Critical Criteria**
Critical Criteria:
Failure to take or verbalize body substance isolation precautions
Failure to determine scene safety before approaching patient
Failure to initially consider and/or provide for stabilization of the spine when indicated Failure to assess/provide adequate ventilations
Failure to verbalize/provide adequate supplemental oxygen as scenario indicates
Failure to find or manage problems associated with airway, breathing, hemorrhage or shock. Failure to differentiate between patient's need for immediate transportation versus continued assessment or treatment on the scene
Performs secondary assessment before assessing or treating threats to airway, breathing or circulation
Requests, uses or orders a dangerous or inappropriate intervention
Failure to manage the patient as a competent EMR
Exhibits unacceptable affect with patient or other personnel
You must factually document your rationale for checking any of the above critical items on this form in the space below, being specific as what occurred or did not occur versus repeating the statement above.
Critical Criteria Explanation:
or
There were NO observed Critical Criteria per my evaluation.
Signature of the Examiner
Notes or Clarifications:
State of Indiana EMR Psychomotor Skills Examination
Candidate:
Date:
Actual Time Started
Oxygen Administration
Examiner Name:
Signature:
Possible Points
Points Awarded
Demonstrates/verbalizes initial or continued consideration of BSI precautions |
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Cracks the oxygen tank valve before attaching the regulator |
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Attaches the regulator to the oxygen tank |
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Opens the oxygen tank valve with the regulator attached |
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Checks oxygen regulator and tank for leaks |
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Checks and verbalizes the oxygen tank pressure |
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Attaches |
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Prefills the oxygen reservoir mask with oxygen |
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Adjusts the regulator to assure oxygen flow rate of fifteen (15) liters per minute |
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Attaches mask to patient's face and adjusts to fit snugly |
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NOTE: Examiner must now inform the candidate that the patient is not tolerating the
Removes |
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Adjusts liter flow to six (6) liters per minute or less |
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Applies nasal cannula to the patient properly |
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NOTE: Examiner must now instruct the candidate to discontinue oxygen therapy. |
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Removes the nasal cannula from the patient |
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Shuts off the regulator |
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Relieves the pressure within the regulator |
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Actual Time Ended:
TOTAL 16
** Examiner must list times above and then sign below after reviewing Critical Criteria**
Critical Criteria:
Failure to assemble the oxygen tank and regulator without leaks.
Failure to
Failure to adjust the oxygen flow rate for the
Failure to manage the patient as a competent EMR.
Exhibits unacceptable affect with patient or other personnel.
You must factually document your rationale for checking any of the above critical items on this form in the space below, being specific as what occurred or did not occur.
Critical Criteria Explanation:
or
There were NO observed Critical Criteria per my evaluation.
Signature of the Examiner
State of Indiana EMR Psychomotor Skills Examination
Mouth to Mask with Supplemental Oxygen
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Candidate: |
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Examiner Name: |
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Date: |
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Signature: |
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Possible |
Points |
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Actual Time Started |
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Points |
Awarded |
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Demonstrates/verbalizes initial or continued consideration of BSI precautions |
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Connects the one way valve to the mask |
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Opens the patient's airway or confirms the patient's airway is open |
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(may be done manually or with an adjunct) |
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Establishes and maintains a proper mask to face seal |
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Ventilates the patient with visible chest rise and fall |
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(The observed rates should be between |
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Connects the mask to a high concentration of oxygen |
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Adjusts the oxygen flow rate to at least fifteen (15) liters/minute |
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Continues ventilations of the patient with visible chest rise and fall |
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(The observed rates should be between |
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NOTE: Examiner must witness ventilations for at least 30 seconds. |
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TOTAL |
8 |
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Actual Time Ended:
** Examiner must list times above and then sign below after reviewing Critical Criteria**
Critical Criteria:
Failure to correctly connect the
Failure to adjust the oxygen flow rate to at least 15 liters/minute.
Failure to produce visible chest rise and fall with ventilations .
(more than 2 inadequate ventilations per minute observed) Failure to ventilate the patient at a rate of
Exhibits unacceptable affect with patient or other personnel
You must factually document your rationale for checking any of the above critical items on this form in the space below, being specific as what occurred or did not occur.
Critical Criteria Explanation:
or
There were NO observed Critical Criteria per my evaluation.
Signature of the Examiner
State of Indiana EMR Psychomotor Skills Examination
Candidate:
Date:
Actual Time Started
Long Bone Immobilization
Examiner Name:
Signature
Possible Points
Points Awarded
Demonstrates/verbalizes initial or continued consideration of BSI precautions |
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Candidate directs application of manual stabilization of the injury |
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Assesses motor, sensory, & circulatory function in the injured extremity. |
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NOTE: The examiner acknowledges "motor, sensory, & circulatory function are present and normal."
Measures the splint. |
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Applies the splint |
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Immobilizes the joint above the injury site |
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Immobilizes the joint below the injury site |
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Secures the entire injured extremity |
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Immobilizes the affected hand/foot in the position of function |
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Reassesses motor, sensory & circulatory function in the injured extremity |
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NOTE: The examiner acknowledges "motor, sensory, & circulatory function are present and normal."
TOTAL 10
Actual Time Ended:
** Examiner must list times above and then sign below after reviewing Critical Criteria**
Critical Criteria:
Grossly moves the injured extremity.
Did not immobilize the joint above and the joint below the injury site.
Did not immobilize the affected hand or foot in a position of function.
Uses or orders a dangerous or inappropriate intervention.
Did not assess motor, sensory, and circulatory function in the injured extremity.
BOTH BEFORE AND AFTER splinting.
Failure to manage the patient as a competent EMR.
Exhibits unacceptable affect with patient or other personnel.
You must factually document your rationale for checking any of the above critical criteria below.
Critical Criteria Explanation:
or
There were NO observed Critical Criteria per my evaluation.
Signature of the Examiner
State of Indiana EMR Psychomotor Skills Examination
Bleeding Control/Shock Management
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Date: |
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Possible |
Points |
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Actual Time Started |
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Points |
Awarded |
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Demonstrates/verbalizes initial or continued consideration of BSI precautions |
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Candidate applies direct pressure to the wound |
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Candidate elevates the extremity |
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NOTE: The examiner must now inform the candidate that the wound continues to heavily bleed.
Candidate applies tourniquet in an appropriate manner and location
1
NOTE: The examiner must now inform the candidate that the patient is now showing signs and symptoms indicative of hypoperfusion.
Candidate properly positions the patient
Candidate administers high concentration of oxygen
Candidate initiates steps to prevent heat loss from the patient
Candidate indicates need for immediate transport
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TOTAL 8
Actual Time Ended:
** Examiner must list times above and then sign below after reviewing Critical Criteria**
Critical Criteria:
Did not apply high flow oxygen with an appropriate mask.
Applied a tourniquet before attempting other methods of bleeding control.
Did not control hemorrhage using correct procedures in a timely manner.
Did not indicate the need for immediate transport.
Uses or orders a dangerous or inappropriate intervention.
Failure to manage the patient as a competent EMR
Exhibits unacceptable affect with patient or other personnel
You must factually document your rationale for checking any of the above critical criteria below.
Critical Criteria Explanation:
or
There were NO observed Critical Criteria per my evaluation.
Signature of the Examiner
State of Indiana EMR Psychomotor Skills Examination
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Ventilation & Airway Management for Apneic Patient |
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Candidate: |
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Examiner Name: |
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Date: |
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Signature: |
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Possible |
Points |
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Actual Time Started |
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Awarded |
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Demonstrates/verbalizes initial or continued consideration of BSI precautions |
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Checks |
NOTE: After checking responsiveness and breathing for |
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Responsiveness |
at least 5 but no more than 10 seconds, examiner informs |
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Checks Breathing |
the candidate: "The patient is unresponsive & apneic" |
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Checks for pulse for at least 5 but no more than 10 seconds |
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NOTE: Examiner must now inform the candidate: "Your palpate a weak carotid pulse of 60." |
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Candidate opens the airway manually |
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NOTE: Examiner must now inform the candidate: "The mouth is full of secretions and vomitus." |
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Candidate turns on/prepares the suction device |
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Candidate assures presence of mechanical suction |
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Candidate attaches and inserts rigid suction catheter without applying suction |
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Candidate suctions the mouth and oropharynx |
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NOTE: Examiner must now inform the candidate: |
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"The mouth and oropharynx are now |
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Candidate |
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Candidate measures airway and selects an appropriately sized OP airway |
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Candidate inserts OP airway without pushing the tongue to the posterior |
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NOTE: Examiner must now inform the candidate: "No gag reflex is present and the patient accepts the |
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airway adjunct." |
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Ventilates the patient immediately (within 30 seconds) with a BVM device. |
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Candidate attaches the BVM assembly to high flow oxygen (15 liters per minute) |
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NOTE: Examiner must now inform the candidate: "ventilation is being performed without difficulty." |
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Candidate adequately ventilates and confirms there is chest rise/fall |
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Ventilates patient at a proper rate |
1 |
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TOTAL |
17 |
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Actual Time Ended: |
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** Examiner must list times above and then sign on reverse after reviewing Critical Criteria**
Critical Criteria:
Failure to initiate ventilations within 30 seconds after suctioning or interrupts ventilations for greater than 30 seconds.
Failure to suction before ventilating the patient.
Did not demonstrate acceptable suction technique (including suctioning for prolonged time). Failure to check responsiveness, breathing or pulse for a period of between
Failure to voice and ultimately provide high flow/concentration of oxygen.
Failure to ventilate the patient at a rate of at least 10 per minute and no more than 12 per minute.
Failure to provide adequate volumes per breath (maximum of 2 errors/minute permissible) Uses or orders a dangerous or inappropriate intervention.
Failure to manage the patient as a competent EMR
Exhibits unacceptable affect with patient or other personnel
You must factually document your rationale for checking any of the above critical items on this form in the space below, being specific as what occurred or did not occur versus repeating the statement above.
Critical Criteria Explanation:
or
There were NO observed Critical Criteria per my evaluation.
Signature of the Examiner
Notes or Clarifications:
State of Indiana EMR Psychomotor Skills Examination
Spinal Immobilization (Supine Patient)
Candidate:
Date:
Actual Time Started
Examiner Name:
Signature
Possible Points
Points Awarded
Demonstrates/verbalizes initial or continued consideration of BSI precautions |
1 |
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Directs assistant to place and maintain manual immobilization of the head |
1 |
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in the neutral, |
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Assesses motor, sensory, and circulatory function in each extremity |
1 |
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Appropriately sizes and correctly applies extrication collar |
1 |
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Directs/supervises assistants to assist with moving the patient onto the device |
1 |
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in a manner that prevents compromising the integrity of the spine |
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Evaluates and VERBALIZES need for padding of voids, and pads as necessary |
1 |
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Immobilizes the patient's torso (chest AND hip straps) to the device |
1 |
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Evaluates and VERBALIZES need for padding behind the head, and pads as needed |
1 |
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Immobilizes the patient's head to the device |
1 |
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Secures the patient's legs to the device |
1 |
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Secures the patient's arms to the device |
1 |
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Reassesses motor, sensory, and circulatory function in each extremity |
1 |
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Actual Time Ended:
TOTAL 12
** Examiner must list times above and then sign below after reviewing Critical Criteria**
Critical Criteria:
Did not immediately direct, take, or maintain manual immobilization of the head. Released or ordered release of manual stabilization before it was maintained mechanically. Did not properly apply appropriately sized cervical collar before ordering the release of manual stabilization.
Manipulated or moved the patient excessively causing potential spinal compromise. Upon completion of immobilization, device allows for excessive patient movement. Head immobilized to the device before device sufficiently secured to the torso.
Head immobilization allows for excessive movement.
Upon completion of immobilization, head is not in a neutral,
Did not assess motor, sensory, and circulatory function in each extremity
BOTH BEFORE AND AFTER immobilization to the long board device.
Exhibits unacceptable affect with patient or other personnel.
Failure to manage the patient as a competent EMT.
You must factually document your rationale for checking any of the above critical criteria below.
Critical Criteria Explanation:
or
There were NO observed Critical Criteria per my evaluation.
Signature of the Examiner
State of Indiana EMR Psychomotor Skills Examination
Cardiac Arrest Management/AED
Candidate:
Date:
Actual Time Started
Examiner Name:
Signature
Possible Points
Points Awarded
Demonstrates/verbalizes initial or continued consideration of BSI precautions |
1 |
Determines the scene/situation is safe |
1 |
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Attempts to question bystanders about arrest events |
1 |
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Determines patient responsiveness |
1 |
NOTE: The examiner must now inform the candidate: "The patient is unresponsive."
Assesses patient for spontaneous signs of breathing |
1 |
NOTE: The examiner must now inform the candidate: "The patient is apneic, agonal, or gasping"
Checks carotid pulse (no more than 10 seconds)
NOTE: The examiner must now inform the candidate: "The patient is pulseless."
1
Immediately begins chest compressions
**Adequate depth and rate must be performed with chest recoil
Candidate performs 2 minutes of high quality,
1
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Requests additional EMS response |
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1 |
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Adequate depth and rate observed |
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1 |
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Correct compression to ventilation ratio observed |
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1 |
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Candidate allows the chest to recoil completely |
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1 |
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Directs or controls adequate volumes delivered for each breath with OPA/NPA |
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1 |
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and BVM Device |
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Minimal interruptions of less than 10 seconds throughout |
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1 |
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NOTE: After 2 minutes (5 cycles), patient is assessed and remains pulseless & apneic. |
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A second rescuer arrives to perform compressions while the candidate operates the AED. |
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Candidate turns power on AED |
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1 |
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Candidate follows prompts and correctly attaches AED pads to patient |
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1 |
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Directs CPR to be halted and ensures all individuals are clear for rhythm analysis |
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1 |
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Ensures all individuals are clear of the patient and delivers AED shock. |
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1 |
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Immediately directs rescuer to resume chest compressions |
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1 |
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Minimal interruptions of less than 10 seconds throughout |
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1 |
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Actual Time Ended:
TOTAL 19
** Examiner must list times above and then sign on reverse after reviewing Critical Criteria**
Critical Criteria:
Did not confirm patient to PULSELESS and APNEIC.
Failure to initiate or resume CPR at appropriate periods
Interrupts CPR for more than 10 seconds at any point .
Failure to demonstrate CPR rates & depths consistent with current AHA guidelines.
Failure to operate the AED properly (failure to deliver shock or turns off AED during testing). Failure to attach AED pads correctly on the patient.
Failure to provide high flow/concentration of oxygen.
Failure to assure that all individuals are clear of the patient during rhythm analysis and before delivering shock(s). Must verbalize and observe "All Clear."
Requests, uses or orders a dangerous or inappropriate intervention
Failure to manage the patient as a competent EMR.
Exhibits unacceptable affect with patient or other personnel.
You must factually document your rationale for checking any of the above critical items on reverse side.
State of Indiana EMR Psychomotor Skills Examination
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Patient Assessment/Management - Medical |
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Candidate: |
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Examiner Name: |
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Date: |
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Scenario #: |
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Possible |
Points |
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Actual Time Started |
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Points |
Awarded |
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Takes or verbalizes appropriate body substance isolation precautions |
1 |
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SCENE |
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Determines the scene/situation is safe |
1 |
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Determines the mechanism of injury/nature of illness |
1 |
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Determines the number of patients |
1 |
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Request additional help, if necessary |
1 |
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Considers stabilization of the spine |
1 |
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PRIMARY SURVEY/RESUSCITATION |
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Verbalizes general impression of the patient |
1 |
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Determines responsiveness/level of consciousness |
1 |
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Determines chief complaint/apparent life threats |
1 |
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Airway |
Opens and assesses the airway |
1 |
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Inserts an adjunct as indicated |
1 |
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Assesses breathing |
1 |
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Breathing |
Assures adequate ventilation |
1 |
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Initiates adequate oxygen therapy |
1 |
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Checks for pulse |
1 |
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Circulation |
Assesses skin (color, temperature, & condition) |
1 |
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Assess for and controls major bleeding and/or shock, if present |
1 |
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Identifies patient priority and makes treatment/transport decision |
1 |
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History Taking |
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History of present illness |
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Candidate should ask |
No questions about present illness asked |
Critical Fail/ 0 points |
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pertinent signs & |
One question about present illness asked |
Award 1 point |
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Two questions about present illness asked |
Award 2 points |
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symptoms questions |
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Three questions about present illness asked |
Award 3 points |
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related to illness (such as |
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Four or more questions about present illness asked |
Award 4 points |
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OPQRST) |
Examiner should award |
4 |
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Past Medical History |
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Allergy questions asked |
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1 |
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Medication questions asked |
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1 |
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Past pertinent medical history questions asked |
1 |
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Last oral intake questions asked |
1 |
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Events leading to present illness questions asked |
1 |
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Secondary Assessment |
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Assesses appropriate body part/systems related to the present illness |
1 |
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**Could include: cardiovascular, pulmonary, neurological, musculoskeletal, |
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skin, GI/GU, reproductive, and psychological/social |
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Vital Signs / Application of assessment |
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Obtains baseline vitals (minimum is heart rate, blood pressure & respiratory) |
1 |
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States field impression of patient (including ALS or BLS transport requested) |
1 |
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Interventions: |
Verbalizes proper interventions/treatment |
1 |
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REASSESSMENT |
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Describes/demonstrates how and when to reassess the patient |
1 |
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Gives brief report to arriving transport unit |
1 |
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TOTAL |
33 |
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Actual Time Ended: |
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** Examiner must list times above and then sign on reverse after reviewing Critical Criteria**
Critical Criteria:
Failure to take or verbalize body substance isolation precautions
Failure to determine scene safety before approaching patient
Failure to initially consider and/or provide for stabilization of the spine when indicated Failure to assess/provide adequate ventilations
Failure to verbalize/provide adequate supplemental oxygen as scenario indicates
Failure to find or manage problems associated with airway, breathing, hemorrhage or shock. Failure to differentiate between patient's need for immediate transportation versus continued assessment or treatment on the scene
Performs secondary assessment before assessing or treating threats to airway, breathing or circulation
Requests, uses or orders a dangerous/inappropriate intervention or outside scope of practice Failure to manage the patient as a competent EMR
Exhibits unacceptable affect with patient or other personnel
You must factually document your rationale for checking any of the above critical items on this form in the space below, being specific as what occurred or did not occur versus repeating the statement above.
Critical Criteria Explanation:
or
There were NO observed Critical Criteria per my evaluation.
Signature of the Examiner
Notes or Clarifications: