EMT-Basic Psychomotor Skills Manual (2017)

Transcription

1 Great Lakes EMS Academy (2016) EMT-Basic Psychomotor Skills Manual (2017) 0 Great Lakes EMS Academy 1001 South Division Grand Rapids, MI Phone:

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3 Great Lakes EMS Academy (2016) Page left Blank 0

4 Table of Contents EMT-Basic Psychomotor Skills Manual (2017) Page Introduction 2 Mid-Term and Final Testing 2 To Be Successful AHA BLS Recommendations 5 Cardiac Arrest-ADULT 7 CPR and AED 8 Cardiac Arrest-CHILD 9 Cardiac Arrest-INFANT 10 Choking Patient (FBOA) 11 Learning Checklist for Airway and Ventilation 12 Airway, Oxygen, Suctioning and Ventilation 13 Adult Ventilation Supraglottic Airway 14 Bleeding Control and Shock 16 Learning Checklist for Musculoskeletal Injuries 17 Splinting - Joint Injury 18 Splinting- Long Bone Injury 19 Femur Fracture Traction Splint 20 Spinal Immobilization Seated Patient (KED) 21 Spinal Immobilization Supine Patient 22 Patient Assessment/Management TRAUMA 23 Patient Assessment/Management MEDICAL 25 CPAP 28 Nebulized Albuterol 29 IM Epinephrine (EpiPen) Admin 30 Naloxone (Narcan) Administration (MAD) 31 Assess Vital Signs 32 Blood Glucose Measurement 33 Lifting and Moving with Stretcher 34 NREMT Skill Sheets (Summative Evaluations)

5 Great Lakes EMS Academy Introduction This is the Great lakes EMS Academy EMT-Basic Skills Manual. This book is part of the student s permanent record. The student will have possession of this book throughout the EMT Course. The student should bring this to class every day you never know when there may be time during class to run through some skills or scenarios. We try to teach skills within the first days of class. We follow short discussion on skills with demonstration and then practice practice practice. Following practice, the student will go through skills evaluation. During evaluation, a passing score is determined by how many points the student receives from the skill sheet. The minimal score for successful completion is found on the bottom of each of the skill sheets. In traditional EMS classes, students are taught various skills. Then the students practice under the watchful eye of instructors and then test out at the end of class. The Academy has evolved to a different pattern of practice and evaluation. We start testing on skills within a few weeks after the start of class. This allows the student and faculty to see progression in skills proficiency. EMT-Basic students are required to successfully test out several times for each of the skills. The opportunity to test will begin within the first few weeks of class. As adult learners, we all need to be challenged and see progress. Students who fail skills testing will have an opportunity to retest. If the student fails to successfully complete basic skills evaluation after three attempts, they are required to attend a remedial education opportunity within one week of the failed skills evaluation and then be given two more attempts to pass the skills evaluation. The student needs to successfully complete the retest within two weeks of the failed skills evaluation. The remedial education and retest will be scheduled outside of the regularly scheduled class time. At the mid-term and end of class, the faculty will be reviewing the student s practical skill sheets to assure that the students have passed all the required skills and scenario testing. If there is a problem with the student s documentation for skills evaluation, the student will be required to show competency in that skill. The Academy purposefully leaves equipment out and available for the students to use outside of class-time to practice. The EMT-Basic student learns skills that can mean life or death for future patients. It is important for the student to not only know how to perform various skills, but to also have the confidence to use the skills when they are needed in the dynamic setting of pre-hospital medicine. The student needs to practice until the skill is as natural as riding a bike. Mid-Term Testing At mid-term testing, the students are tested on the skills that have been learned during the first months of class. At this time, the testing is more formal and the instructors will be using the GLEMSA skill sheets that we use during the normal class sessions. All students are required to pass the following skills 1 : 1. CPR and AED (random between adult, child and infant) 2. Airway, Oxygenation, Suction and Ventilation 3. Splinting (random between traction, long bone or joint) 4. Trauma Assessment/Management During the Trauma Assessment/Management skills station, the students are placed into groups of three (3). The student being tested will be required to lead his team members through the testing scenario. The station will involve the management of one patient who has sustained one the following injuries/traumatic events: 1. Head Injury 2. Neurogenic (spinal) shock 3. Hemorrhagic shock 4. Multiple extremity fractures 5. Major bleeding 6. Evisceration 7. Open chest wound 8. Hemothorax 9. Amputation 10. Impaled object 11. Femur fracture Attendance on the day of practical testing at the mid-term is mandatory. If a student is absent on the day of testing, the student must plan with faculty to be tested on the skill within two weeks of the missed evaluation. This will be completed outside of the scheduled class time and will cost the student $50.00/hour for as long as testing takes to complete the testing. That could be 3-4 hours at the end of the course. 1 Failure of practical testing will mean failure of the module. The student will not continue with the course. 2

6 EMT-Basic Psychomotor Skills Manual (2017) Final Testing At the end of the course, practical skills testing is much like the mid-term. However, during the final practical testing we will use the NREMT skill sheets. This testing is the NREMT Practical Skills Evaluation that is mandated as part of the testing process for the National Registry. The students are tested on all the skills that have learned during the entire course. All students are required to pass the following skills 2 : 1. CPR 2. Bag-Valve-Mask Ventilation 3. Supplemental Oxygen Administration 4. Supraglottic Airway 5. Patient Assessment/Management - Medical 6. Bleeding Control/Shock Management 7. Long Bone Fracture Immobilization 8. Joint Injury Immobilization 9. Traction Splint 10. Spinal Immobilization (Seated Patient) 11. Spinal Immobilization (Supine Patient) 12. Patient Assessment/Management - Trauma The students evaluated on their performance in a trauma and medical assessment / management scenario. The trauma scenario will involve the management of one patient who has sustained one of the injuries listed above and a medical patient with one of the problems/complaints listed below: 1. Shortness of breath (asthma) 2. Shortness of breath (pulmonary edema) 3. Chest pain (cardiac) 4. Altered mental status (stroke) 5. Altered mental status (low blood sugar) 6. Altered mental status (high blood sugar) 7. Altered mental status (status seizure) 8. Anaphylaxis (bee sting) 9. O.B. / childbirth (normal) 10. O.B. / childbirth (breech) 11. Hypothermia 12. Heat Exhaustion 13. Pediatric asthma 14. Pediatric dehydration Attendance on the day of practical testing at the end of class is a big deal. If a student is absent on the day of testing, the student must make arrangements with faculty to be tested on the skill within two weeks of the missed evaluation. This will be completed outside of the scheduled class time and will cost the student $50.00/hour for as long as testing takes to complete the testing. That could be 3-4 hours at the end of the course. 2 Failure of practical testing will mean failure of the course. 3

7 Great Lakes EMS Academy To be Successful To pass each practical skill, the student must obtain a score that is at least as high as the minimum score designated at the bottom of the skill sheet and must not violate any of the critical criteria. The student must physically go through all the steps on each practical skill to sufficiently learn it. Simply repeating what is printed on the practical skill sheet is not sufficient, and the student will fail the examination if he or she does that. The student must demonstrate that he or she is capable of physically performing the practical skill, not simply repeating printed lines of text. Each skill must be practiced several times to sufficiently learn it. Simply watching an instructor demonstrate the skill or watching other students practice the skill is not sufficient. The student must physically practice the skill themselves several times to sufficiently learn it. Standard Precautions is the first step on each practical skill, and failure to take appropriate standard precautions is a critical failure on many practical skills. Therefore, the student should form the habit of always taking standard precautions before every practical skill. Many steps must be performed in a specific manner to obtain the corresponding point or to avoid violating critical criteria. Alternatively, many steps can be successfully completed in a variety of manners, and instructors practice different styles of demonstrating these steps. Students are responsible for understanding what constitutes critical criteria and which procedures are open to personal variation in style. Some steps must be performed at specific points during the practical skills while others can be performed at points other than the ones printed on the practical skill sheets. Students are responsible for knowing which procedures must be performed at specific points in the practical skills. The most common reason that the student fails a practical skill is because of anxiety. Stay calm and go through the practical skill at a comfortable pace. If the student forgets what to do next, he or she should remain calm and mentally repeat the steps that he or she has already completed. If the student wishes, he or she is also allowed to physically repeat any steps that he or she has already completed. A capillary refill time of less than two seconds is acceptable for the circulation portion of a CSM (circulation, sensation, and motor function) assessment. 4

8 2015 AHA BLS Recommendations. EMT-Basic Psychomotor Skills Manual (2017) In 2015 the American Heart Association (AHA) updated their recommendations for Basic life Support (BLS). There were no major changes to the recommendations. Listed below are some of the changes that health care providers should be aware of. It is important to note that the NREMT will be asking several questions that reference AHA guidelines. 1. Emphasis has been increased about the rapid identification of potential cardiac arrest by dispatchers, with immediate provision of CPR instructions to the caller (i.e., dispatch-guided CPR). 2. The recommended sequence for a single rescuer has been confirmed: the single rescuer is to initiate chest compressions before giving rescue breaths (C-A-B rather than A-B-C) to reduce delay to first compression. 3. These recommendations allow flexibility for activation of the emergency response system to better match the health care provider s clinical setting. 4. Trained rescuers are encouraged to simultaneously perform some steps (i.e., checking for breathing and pulse at the same time), to reduce the time to first chest compression. 5. Integrated teams of highly trained rescuers may use a choreographed approach that accomplishes multiple steps and assessments simultaneously rather than the sequential manner used by individual rescuers (e.g., one rescuer activates the emergency response system while another begins chest compressions, a third either provides ventilation or retrieves the bag-mask device for rescue breaths, and a fourth retrieves and sets up a defibrillator). 6. Increased emphasis has been placed on high-quality CPR using performance targets (compressions of adequate rate and depth, allowing complete chest recoil between compressions, minimizing interruptions in compressions, and avoiding excessive ventilation). 7. Compression rate is modified to a range of 100 to 120/min. Compression depth for adults is modified to at least 2 inches (5 cm) but should not exceed 2.4 inches (6 cm). To allow full chest wall recoil after each compression, rescuers must avoid leaning on the chest between compressions. 8. Criteria for minimizing interruptions are clarified with a goal of chest compression fraction as high as possible, with a target of at least 60%. Where EMS systems have adopted bundles of care involving continuous chest compressions, the use of passive ventilation techniques may be considered as part of that bundle for victims of out of hospital cardiac arrest. 9. For patients with ongoing CPR and an advanced airway in place, a simplified ventilation rate of 1 breath every 6 seconds (10 breaths per minute) is recommended. 5

9 Great Lakes EMS Academy 2015 AHA BLS Recommendations 6

10 Great Lakes EMS Academy (2016) Cardiac Arrest -ADULT Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent ASSESSMENT 1. Scene is safe and standard precautions 2. Introduction/ briefly questions the witnesses about arrest events. *auto fail 3. Briefly questions the witnesses about arrest events. 4. Asks if there is an AED available and assures that it is retrieved 5. Checks responsiveness and overall signs of life (moving, noises, etc) 6. C - Checks pulse (< 10sec) and initiates compression. (first 30) 7. A - Opens airway with head-tilt, chin-lift and looks listens and feels. 8. B - Ventilates patient twice with BVM. Good technique / tidal volume 9. Continues to do CPR with 30:2 ratio for 5 cycles (2 minutes) TRANSITION 10. Assures ALS is en route and asks for ETA 11. Confirms effectiveness of CPR (ventilation and compressions) 12. Knows that if there are two rescuers they should switch responsibilities after every 2 minutes (switch compressions and ventilations) INTEGRATION 13. Verbalizes or directs insertion of a simple airway adjunct 14. Assures high concentration of oxygen is delivered to the patient 15. Assures adequate CPR continues without unnecessary interruption 16. Communicates efficiently with team QUESTIONS 17. Able to answer questions regarding 2015 BLS guidelines 18. When an advanced has been placed in the patient that ventilations are 10/minute (1 every 6 sec) not synchronized with compressions CRITICAL CRITERIA Did not take (or verbalize) standard precautions Did not ask about the availability of an AED Compressions not hard and fast at least /min and at least 2 inches deep but not more than 2.4 inches deep on the lower ½ of the sternum. Did not start effective compression within 30 seconds. Poor technique or unnecessary interruption of compressions Unable to answer questions regarding AHA guidelines Fail is anything less than 30 points Total: /36 /36 /36 /36 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Initials: 7

11 Great Lakes EMS Academy CPR and Automatic External Defibrillation (AED) Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent ASSESSMENT 1. Scene is safe and standard precautions. 2. Introduction/ briefly questions the witnesses about arrest events. *AF 3. Asks if there is an AED available (or carries AED into scenario). 4. Checks responsiveness and overall signs of life (moving, noises, etc). 5. C - Checks pulse (< 10sec) and initiates compression. 6. B - Ventilates patient twice with BVM. Good technique / tidal volume. 7. A - Opens airway with head-tilt, chin-lift and looks listens and feels. 8. Continues to do CPR with 30:2 ratio for 5 cycles. 9. Applies defibrillation pads. 10. Ensures all individuals are clear of the patient. 11. Initiates analysis of the rhythm after 2 minutes of CPR. 12. Delivers shock and immediately directs resumption of CPR. TRANSITION 13. Assures ALS is en route and asks for ETA. 14. Gathers additional information about the arrest event. 15. Confirms effectiveness of CPR (ventilation and compressions). INTEGRATION 16. Verbalizes or directs insertion of a simple airway adjunct. 17. Assures high concentration of oxygen is delivered to the patient. 18. Continues CPR for 2 minutes. 19. Stops CPR and ensures all individuals are clear of the patient 20. Initiates analysis of the rhythm. Delivers shock if required. Directs immediate resumption of CPR. 21. Communicates effectively with team. QUESTIONS 22. Knows contraindications and precautions associated with AED *AF CRITICAL CRITERIA Did not take, or verbalize, body substance isolation precautions. Did not ask about the availability of an AED. Did not immediately direct initiation/resumption of CPR. Compressions not hard and fast at least /min and at least 2 inches deep but not more than 2.4 inches deep on the lower ½ of the sternum. Did not assure all individuals were clear of patient before a shock. Did not operate the AED properly or safely (inability to deliver shock). Fail is anything less than 28 points Total: /32 /32 /32 /32 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Initials: 8

12 Great Lakes EMS Academy (2016) Cardiac Arrest-CHILD Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent ASSESSMENT 1. Scene is safe and standard precautions. 2. Introduction/ briefly questions the witnesses about arrest events. *AF 3. Briefly questions the witnesses about arrest events. 4. Asks if there is an AED available and assures that it is retrieved. 5. Checks responsiveness and overall signs of life (moving, noises, etc). 6. C - Checks pulse (< 10sec) and starts compression. 7. A - Opens airway with head-tilt, chin-lift and looks listens and feels. 8. B - Ventilates patient twice with BVM. Good technique / tidal volume. 9. Continues to do CPR with 30:2 ratio for 5 cycles (2 minutes). TRANSITION 10. Assures ALS is en route and asks for ETA. 11. Confirms effectiveness of CPR (ventilation and compressions). 12. Knows that if there are two rescuers they should switch responsibilities after every 2 minutes (switch compressions and ventilations). 13. Knows that if there are two rescuers the ratio is 15:2. INTEGRATION 14. Verbalizes or directs insertion of a simple airway adjunct. 15. Assures high concentration of oxygen is delivered to the patient 16. Assures adequate CPR continues without unnecessary interruption 17. Communicate effectively with team QUESTIONS 18. Able to answer questions regarding 2015 BLS guidelines CRITICAL CRITERIA Did not take, or verbalize standard precautions Did not ask about the availability of an AED Did not start effective compression within 30 seconds. Compressions not hard and fast at least 1/3 the AP diameter of the chest (about 2 inches deep) Rate of /min. Can use one or two hands on lower ½ of sternum Poor technique or unnecessary interruption of compressions Unable to answer questions regarding 2015 AHA guidelines Fail is anything less than 14 points Total: /36 /36 /36 /36 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Initials: 9

13 Great Lakes EMS Academy (2016) Cardiac Arrest-INFANT Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent ASSESSMENT 1. Scene is safe and standard precautions 2. Introduction/ briefly questions the witnesses about arrest events. *AF 3. Briefly questions the witnesses about arrest events 4. Checks responsiveness and overall signs of life (moving, noises, etc) 5. C - Checks pulse (< 10sec) and initiates compression at a rate of 120/m 6. A - Opens airway with head-tilt, chin-lift and looks listens and feels 7. B - Ventilates patient twice with BVM. Good technique / tidal volume 8. Continues to do CPR with 30:2 ratio for 5 cycles (2 minutes) TRANSITION 9. Assures ALS is en route and asks for ETA 10. Confirms effectiveness of CPR (ventilation and compressions) 11. Knows that if there are two rescuers they should switch responsibilities after every 2 4 minutes (switch compressions and ventilations) INTEGRATION 12. Verbalizes or directs insertion of a simple airway adjunct 13. Assures high concentration of oxygen is delivered to the patient 14. Assures adequate CPR continues without unnecessary interruption 15. Communicates effectively with team QUESTIONS 16. Able to answer questions regarding 2015 BLS guidelines CRITICAL CRITERIA Did not take, or verbalize standard precautions Did not start effective compressions with in 30 seconds. Poor technique or unnecessary interruption of compressions Did not use proper technique for compressions (100 to 120/min); 1 Rescuer = 2 fingers center of chest just below nipple line at 1 ½ inches depth 2 Rescuer = 2 thumb with hands encircling chest. Thumbs placed just below nipple line and compressing 1/ ½ inches in depth Unable to answer questions regarding 2015 AHA guidelines Fail is anything less than 28 points 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass /Fail: Initials: /32 /32 /32 /32 10

14 Choking Patient (FBOA) Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent ASSESSMENT 1. Scene is safe and standard precautions 2. Introduction and Briefly questions the rescuer about events *AF 3. Asks patient if they can talk 4. Advises patient of Heimlich maneuver 5. Performs abdominal thrusts until the object is expelled or patient becomes unconscious PATIENT CHANGE: Patient becomes unconscious and slumps to the floor. 6. Maintains positive control of patient. Carefully places patient supine on the floor 7. Directs initiation of chest compressions 8. After 30 compressions opens airway and looks for FBAO 9. No blind finger sweeps. Only use finger sweep to remove an object that can visualize. 10. Attempts ventilation with BVM 11. Continues CPR for 30 compressions, opens airway and looks for FBOA 12. Attempts ventilation with BVM 13. Continues CPR for 30 compressions, opens airway and looks for FBOA TRANSITION 14. Assures ALS is en route and asks for ETA PATIENT CHANGE: FBOA is visible in airway during the next check 15. Use finger sweep to remove object. Ventilate patient 16. Checks pulse. PATIENT STATUS: Patient has a carotid pulse. No signs of respirations 17. Ventilate patient at 10 / minute with BVM and then hooks BVM to oxygen QUESTIONS 18. Able to answer questions regarding 2015 BLS guidelines CRITICAL CRITERIA Did not take, or verbalize standard precautions Did not evaluate the need for abdominal thrusts Did not control patient when there was a loss of consciousness Inappropriately uses blind finger sweep Poor technique or unreasonable delays Did not ventilate patient after FBOA was relieved Continued chest compressions after pulse was checked and present Did not appear confident in course of treatment Fail is anything less than 30 points Total: /36 /36 /36 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Initials: 11

15 Learning Checklist for Airway and Ventilation 1. The diaphragm and the muscles of the chest cause the thoracic cavity to expand and contract like a bellows to create airflow during ventilation. Inhalation occurs when the diaphragm and intercostal muscles contract and enlarge the thoracic cavity. 2. O 2 and CO 2 exchange occurs at the level of the alveoli and capillaries through the process of diffusion. 3. During respiratory distress, the accessory muscles of breathing help to increase the respiratory volumes. 4. Inadequate breathing is characterized by a respiratory rate outside the normal range, irregular rhythm, and abnormal quality of breathing (breath sounds diminished or absent, chest expansion inadequate or shallow, or use of accessory muscles). Other signs of inadequate breathing include pale, cool, or cyanotic skin; retractions; nasal flaring; seesaw breathing; and agonal respirations. 5. Respiratory distress involves a breathing problem requiring increased work of breathing to ensure adequate oxygenation and ventilation. Signs of respiratory distress include increased respiratory rate, accessory muscle use, nasal flaring, and assumption of a position to aid the muscles of breathing (tripod position or sitting bolt upright). A patient with respiratory distress may have difficulty speaking in complete sentences but can maintain mental status and muscle tone and to move air. 6. Respiratory failure is inadequate ventilation to support life. The patient in respiratory failure is not able to maintain mental status or muscle tone and is unable to move adequate amounts of air to the lungs. Patients with respiratory failure require positive-pressure ventilation. 7. The airway is opened by using the head-tilt/chin-lift or the jaw thrust for patients with suspected spinal injury or when the mechanism of injury is unknown. 8. Suctioning can be used to clear liquid or small solid secretions with a soft or rigid catheter. You should never suction for more than 15 seconds. You may need to turn the patient's head to aid drainage. 9. Positive-pressure ventilation can be provided by using a mouth-to-mask device, bag-mask device, or a flow-restricted, oxygen-powered ventilation device. 10. BVM ventilation is the most common method of positive-pressure ventilation used in emergency care. Adequate tidal volumes must be ensured because a mask seal leak may reduce the volume of air delivered to the patient. The two-person approach to bag-mask ventilation helps reduce the chance for mask seal leak and ensure adequate tidal volumes. 11. Pulse oximetry is a useful adjunct to assess oxygen saturation of the blood. In general, oxygen saturation is 95% or greater; if it is below 90% when the patient is receiving high-concentration oxygen, positive-pressure ventilation may be indicated. 12. When delivering supplemental O 2 to patients with chronic obstructive pulmonary disease (COPD), be prepared to assist with positive-pressure ventilations because some patients may have hypoventilation from high-concentration O Signs of severe (or complete) airway obstruction include a weak ineffective cough, high-pitched noises while inhaling, increased respiratory difficulty, and inability to talk and possibly cyanosis. 12

16 Airway, Oxygenation, Suctioning and Ventilation Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent 1. Scene is safe and standard precautions. 2. Introduction. *AF 3. Checks ABC. s 4. Uses manual airway to start ventilating patient. 5. Selects appropriately sized airway. 6. Ventilates with BVM at a rate of 10 /min with adequate tidal volume. 7. Attaches BVM to oxygen. 8. Measures airway to assure correct size. The examiner should allow the student to demonstrate appropriate ventilation for one (1) minute, and then advise that: the patient is gagging and starting to wake. 9. Removes the oropharyngeal airway. The examiner states, "You hear gurgling now with the patient s spontaneous respirations. 10. Turns on and prepares suction device. 11. Assures presence of mechanical suction (i.e. it works). 12. Inserts the suction tip without suction. 13. Applies suction to the oropharynx or nasopharynx. 14. Knows time limit for suctioning (15 seconds). 15. Knows how to measure suction catheters. The examiner states, "You are asked to place an NPA in the patient who is unconscious but has an intact gag reflex and shallow tidal volume 16. Selects appropriately sized airway. 17. Measures airway to assure correct size. 18. Lubricates the nasal airway. 19. Pulls up on the tip of the nose and send the airway straight back instead of up the nose. 20. Fully inserts the airway with the bevel facing the septum. QUESTIONS 21. Able to answer question regarding the airways, suctioning and ventilation. CRITICAL CRITERIA Did not take or verbalize standard precautions Did not initiate ventilations within 30 seconds Interrupted ventilations for an unnecessary length of time Did not provide adequate volume per breath Did not ventilate the patient at a rate of 10 breaths per minute Inserted any adjunct in a manner that was dangerous to the patient Did not appear confident with treatment Fail is anything less than 36 points 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /42 /42 /42 /42 13

17 Ventilatory Management Supraglottic Airway Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent Designate whether the King (K) or Combitube (C) was used. K C K C K C K C 1. Scene is safe and standard precautions 2. Checks ABCs and confirms apnea (but the patient does have a pulse) *AF 3. Uses a manual airway maneuver and begins to ventilate patient with BVM 4. Ventilates at a rate of 10 /min 5. Attaches BVM to O2 and has O2 set at 12 to 15 liters/minute *AF 6. Checks no gag reflex and properly inserts OPA / NPA 7. Check lungs sounds and place patient on pulse oximetry Ventilate the patient for 30 to 60 seconds at a proper rate and tidal volume. Advise student that the SaO2 is at 90% (if no Oxygen yet, SaO2 = 85%). Protocol allows for a supraglottic airway now. 8. Student should direct the evaluator or helper to ventilate patient 9. Checks/prepares the airway device 10. Lubricates the distal tip of the device The examiner should remove the OPA and move out of the way when the candidate is prepared to insert the device 11. Positions the patient's head properly (Neutral for Combitube and Sniffing for King) 12. Performs a tongue-jaw lift (p 13. Inserts device in the mid-line and to the appropriate depth 14. Inflates the balloon(s) appropriately and removes the syringe(s) 15. Attaches BVM appropriately and ventilates patient 16. Confirms placement /ventilation observing chest rise, 17. Auscultation over the epigastrium and bilaterally over each lung The examiner states, "You see rise and fall off the chest, there are no sounds over the epigastrium and breath sounds are equal over each lung" 18. Secures device or confirms that the device remains properly secured 19. Knows what to do if the Combitube is not ventilating the patient when using the #1 tube 20. Know indications contraindications and/or measurement for device CRITICAL CRITERIA Did not take, or verbalize standard precautions Interrupted ventilations for more than 30 seconds at any time Did not pre-oxygenate the patient prior to placement Did not provide adequate volume per breath or at a rate of 10 breaths per minute Did not confirm placement of the airway properly/timely Inserted any adjunct in a manner that was dangerous to the patient Fail is anything less than 35 points 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /40 /40 /40 /40 14

18 Ventilatory Management Supraglottic Airway Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent Designate whether the King (K) or Combitube (C) was used. K C K C K C K C 1. Scene is safe and standard precautions 2. Checks ABCs and confirms apnea (but the patient does have a pulse) *AF 3. Uses a manual airway maneuver and begins to ventilate patient with BVM 4. Ventilates at a rate of 10 /min 5. Attaches BVM to O2 and has O2 set at 12 to 15 liters/minute *AF 6. Checks no gag reflex and properly inserts OPA / NPA 7. Check lungs sounds and place patient on pulse oximetry Ventilate the patient for 30 to 60 seconds at a proper rate and tidal volume. Advise student that the SaO2 is at 90% (if no Oxygen yet, SaO2 = 85%). Protocol allows for a supraglottic airway now. 8. Student should direct the evaluator or helper to ventilate patient 9. Checks/prepares the airway device 10. Lubricates the distal tip of the device The examiner should remove the OPA and move out of the way when the candidate is prepared to insert the device 11. Positions the patient's head properly (Neutral for Combitube and Sniffing for King) 12. Performs a tongue-jaw lift (p 13. Inserts device in the mid-line and to the appropriate depth 14. Inflates the balloon(s) appropriately and removes the syringe(s) 15. Attaches BVM appropriately and ventilates patient 16. Confirms placement /ventilation observing chest rise, 17. Auscultation over the epigastrium and bilaterally over each lung "You see rise and fall off the chest, there are no sounds over the epigastrium and breath sounds are equal over each lung" 18. Secures device or confirms that the device remains properly secured 19. Knows what to do if the Combitube is not ventilating the patient when using the #1 tube 20. Know indications contraindications and/or measurement for device CRITICAL CRITERIA Did not take, or verbalize standard precautions Interrupted ventilations for more than 30 seconds at any time Did not pre-oxygenate the patient prior to placement Did not provide adequate volume per breath or at a rate of 10 breaths per minute Did not confirm placement of the airway properly/timely Inserted any adjunct in a manner that was dangerous to the patient Fail is anything less than 35 points 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /40 /40 /40 /40 15

19 Bleeding Control and Shock Management Date: Date: Date: 0=incompetent 1=poorly done/needed prompting 2= competent 1. Takes, or verbalizes standard precautions 2. Introduction *AF 3. Asks about MOI as approaching patient 4. Initial Assessment (General Impression and ABCs) 5. Has someone hold C-spine (if the MOI suggests c-spine injury) 6. Applies direct pressure to the wound with gloved hand (no delay) The wound continues to bleed. 7. Applies tourniquet 8. Dresses and bandages wound The patient is now showing signs and symptoms of Shock. 9. States the need for rapid transport to hospital 10. Properly positions the patient (trendelenberg) 11. Administers high concentration oxygen 12. Initiates steps to prevent heat loss from the patient 13. Completes secondary survey (head-to-toe) 14. Talks to patient (SAMPLE and empathy statement) 15. Takes vital signs CRITICAL CRITERIA Start Time: End Time: Did not take, or verbalize, body substance isolation precautions Did not apply high concentration oxygen Did not control hemorrhage using correct procedures in a timely manner Did not indicate a need for immediate transportation Communicates effectively with team Student needs 26 to pass 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /30 /30 /30 16

20 Learning Checklist for Musculoskeletal Injuries 1. Sprains are injuries to ligaments, usually resulting from stretching forces. 2. Strains are injuries to muscles or their tendons, usually from overstretching or violent contractions. 3. A dislocation is a displacement of bones in a joint from the normal anatomic position. 4. A painful, swollen, deformed extremity is treated as if a significant bony or soft tissue injury exists. 5. Examples of direct forces applied to a bone include a vehicle bumper striking the tibia of a pedestrian, a gunshot wound shattering a bone, or a falling person landing on both feet and breaking the heel bones. 6. An open fracture is exposed to the external environment because the skin above the site has been broken. 7. Pain is the most common symptom of a bone or joint injury. Pain may be referred distal or proximal to the site of the injury, so examination of the entire extremity is essential. 8. Fluid or blood loss at the site of injury can result in swelling or discoloration of the affected part. 9. Never attempt to force movement when a patient does not voluntarily move a limb. 10. Crepitus is a grating sensation or sound indicating that bone fragments are rubbing against one another. Do not deliberately attempt to elicit this finding. 11. Signs specific for dislocation include loss of movement and deformity at a joint, joint locked in a deformed position, and pain and swelling over the joint. 12. The presence of vascular compromise is determined by assessing distal pulses, skin color and temperature, capillary refilling time, pain, numbness, tingling, prickling, sensory loss, and paralysis. 13. Common sites where fractures or dislocations cause disruption of nerves include the clavicle, shoulder, humerus, elbow, wrist, hip, femur, knee, and spinal cord. 14. Signs and symptoms of nerve injury include pain, abnormal sensation, and loss of motor ability. 15. Joint injuries can be immobilized in the straightened or angulated position. 16. If the extremity is cyanotic or lacks pulses, try to straighten the extremity as allowed by local protocols. If you encounter resistance, splint the extremity in the angulated position. Principles of Splinting Musculoskeletal Injuries 1. Splint the extremity on the position found. 9. Isolated femur fracture needs a traction splint. 2. Splint first then move the patient. 10. Wrap elastic bandages from distal to proximal. 3. Life before limb (trumps principle #2). 11. It should feel better when you are done. 4. Take care of open wounds first. 12. Check PMS before and after (and during transport). 5. Pad, Pad, Pad. 13. You only get one chance to reduce a complicated fracture. 6. Buddy splint when you can. 14. Sling and swath for most upper extremity injuries. 7. When in doubt splint 15. RICE, rest, ice, compression and elevation. 8. It is a two-person job. 16. The backboard can be a splint. 17

21 Splinting - Joint Injury Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent 1. Scene is safe and standard precautions 2. Introduction of the team*af 3. Asks questions regarding M.O.I. 4. Asks about general impression of patient (anxiety, position, age, LOC etc) 5. Completes Initial assessment (ABCs and mental status) 6. Directs application of manual stabilization of the joint / extremity 7. Removes all clothes from around injury (verbalized when appropriate) 8. Assess PMS (checks not verbalized) Examiner: PMS is normal. 9. Selects proper splinting material 10. Immobilizes the bone above and below the injury 11. Reassess PMS (checks not verbalized) Examiner: PMS is still normal. 12. Talks to the patient throughout the scenario *AF 13. Gains a SAMPLE history 14. Gives the patient on statement of empathy regarding situation QUESTIONS 15. Name 4 of the principles of splinting. 16. What would you do to care for an open fracture 17. Later, patient complains of numbness and tingling. What do you do? CRITICAL CRITERIA Did not take or verbalize standard precautions Did not support the extremity during immobilization Did not properly immobilize the joint Did not check PMS before or after the skill Does not appear confident with treatment Must communicate effectively with team Student needs 26 to pass 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /34 /34 /34 /34 18

22 Splinting Long Bone Injury Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent 1. Scene is safe and standard precautions 2. Introduction of the team*af 3. Asks questions regarding M.O.I. 4. Asks about general impression of patient (anxiety, position, age, LOC etc) 5. Completes Initial assessment (ABCs and mental status) 6. Directs application of manual stabilization of the joint / extremity 7. Removes all clothes from around injury (verbalized when appropriate) 8. Assess PMS (checks not verbalized) Examiner: PMS is normal. 9. Selects proper splinting material 10. Immobilizes the joints above and below the injury 11. Reassess PMS (checks not verbalized) Examiner: PMS is still normal. 12. Talks to the patient throughout the scenario *AF 13. Gains a SAMPLE history 14. Gives the patient on statement of empathy regarding situation QUESTIONS 15. Name 4 of the principles of splinting. 16. What would you do to care for an open fracture 17. Later, patient complains of numbness and tingling. What do you do? CRITICAL CRITERIA Did not take or verbalize standard precautions Did not support the extremity during immobilization Did not properly immobilize the joint Did not check PMS before or after the skill Does not appear confident with treatment Must communicate effectively with team Student needs 26 to pass Total: /34 /34 /34 /34 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Initials: 19

23 Femur Fracture Traction Splinting Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent Which Traction devise was used: 1. Scene is safe and standard precautions 2. Introduction of the team*af 3. Asks questions regarding M.O.I. S=SAGER, K=Kendrick, H=Hare 4. Asks about general impression of patient (anxiety, position, age, LOC etc) 5. Completes Initial assessment (ABCs and mental status) 6. Directs application of manual stabilization with traction to be pulled at the knee Patient: That helps with the pain. 7. Removes all clothes from around injury (verbalized when appropriate) 8. Assess PMS (checks not verbalized) Examiner: PMS is normal 9. Selects proper splinting material (splint plus ice, towels, straps, etc) 10. Applies distal securing device (e.g. ankle hitch). Traction is then turned over to the rescuer that placed the ankle hitch. 11. Applies proximal securing device (e.g. ischial strap) 12. Properly places traction splint 13. Applies mechanical traction 14. Immobilizes leg with straps inherent to device 15. Then immobilizes fractured leg to good leg for further support. 16. Reassess PMS (checks not verbalized) Examiner: PMS is still normal 17. Verbalizes that the patient should be further immobilized unto long board 18. Talks to the patient throughout the scenario 19. Gains a SAMPLE history and good understanding MOI 20. Does not allow for the release of traction once traction has been applied 21. Knows indications and contraindications for the use of a traction devise 22. Gives the patient on statement of empathy regarding situation *AF CRITICAL CRITERIA Did not take or verbalize standard precautions Loss of traction at any time during procedure Did not support the fracture site during immobilization Did not check PMS before or after the skill Must communicate effectively with team Student needs 38 to pass 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /44 /44 /44 /44 20

24 Spinal immobilization Seated Patient (KED) Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent 1. Scene is safe and standard precautions 2. Introduction *AF 3. Asks about general impression of patient (anxiety, position, age, LOC etc) 4. Directs manual C-spine control (neutral position) 5. Completes Initial assessment (ABCs and mental status) 6. Asks about MOI quick RTA or focused assessment 7. Assess PMS x 4 (checks not verbalized) Examiner: PMS is normal in all extremities. 8. Applies appropriately sized c- collar 9. Able to verbalize the correct measurement of the c-collar (the landmarks are the chin (not the angle of the jaw) and where the neck and should meet) 10. Positions the device behind the patient 11. Assures the device is placed appropriately (in the armpits and symmetrical) 12. Secures the torso and then the leg straps 13. Rolls the shoulders and assure the head is properly placed 14. Immobilizes the head 15. Assess PMS x 4 (checks not verbalized) Examiner: PMS is still normal. 16. Talks to the patient throughout the scenario and uses name 17. Gains a SAMPLE history and good understanding MOI 18. Gives the patient on statement of empathy regarding situation 19. Knows how to place the patient on a back board and to check PMS x 4 after immobilization to backboard CRITICAL CRITERIA Did not take or verbalize standard precautions Did not check PMS before or after the skill (total of three times) Device too loose or not effective Patient s head not immobilized or is flexed forward when immobilized Patient manipulated or moved excessively causing a potential c-spine compromise Student needs 32 to pass 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /38 /38 /38 /38 21

25 Spinal Immobilization Supine Patient Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent 1. Scene is safe and standard precautions 2. Introduction *AF 3. Asks about general impression of patient (anxiety, position, age, LOC etc) 4. Directs manual C-spine control (neutral position) 5. Completes Initial assessment (ABCs and mental status) 6. Asks about MOI quick RTA or focused assessment 7. Assess PMS x 4 (checks not verbalized) The examiner should now inform the student that PMS is normal in all extremities 8. Applies appropriately sized c- collar 9. Able to verbalize the correct measurement of the c-collar (the landmarks are the chin (not the angle of the jaw) and where the neck and should meet) 10. Positions the device behind the patient 11. Directs movement of the patient to backboard without compromising the spine 12. Applies padding as necessary for patient comfort and effective immobilization. 13. Secures torso then the pelvis and then the lower extremities 14. Immobilizes the head 15. Assess PMS x 4 (checks not verbalized) The examiner should now inform the student that PMS is still normal 16. Talks to the patient throughout the scenario 17. Gains a SAMPLE history and good understanding MOI 18. Gives the patient on statement of empathy regarding situation 19. Knows how to place the patient on a back board and to check PMS x 4 after immobilization to backboard CRITICAL CRITERIA Did not take or verbalize standard precautions Did not check PMS before or after the skill Straps too loose (patient slides when backboard is tilted 45 o Patient manipulated or moved excessively (potential c-spine compromise) Head immobilized before the chest and pelvis Student needs 32 to pass Total: /38 /38 /38 /38 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Initials: 22

26 Patient Assessment / Management - TRAUMA Date Date Date Date 1. Scene Safe, standard precautions and good self-introduction. *AF 2. Determines the MOI, number of patients, and requests additional help if necessary. 3. Any major (life threatening) bleeding, if so, that bleeding must be controlled. 4. Considers stabilization of spine. *AF INITIAL ASSESSMENT / PRIMARY SURVEY 5. Verbalizes general impression of the patient and determines responsiveness 6. Check to see if airway open and sounds with breathing. *AF 7. Assesses Breathing rate and tidal volume and ensures adequate ventilation. *AF 8. Pulse check, skin and capillary refill and controls major bleeding. *AF 9. Initiates appropriate oxygen therapy. *AF 10. Identifies priority patients/makes transport decision. RAPID TRAUMA ASSESSMENT / CONTINUED PRIMARY SURVEY 11. Major Trauma. Head 12. Impending airway problem (facial trauma or epistaxis). 13. Posterior. Neck 14. Anterior Trauma JVD Trachea Midline 15. Expose and Inspect and Palpate. *AF Chest 16. Lung Sounds. Abdomen 17. Expose and Inspect and Palpate. Back 18. Checks back immediately when necessary (MOI suggests injury). 19. Pain, DCAP BTLS TIC. Pelvis 20. Genital sweep (Priapism, wetness, blood). Femurs 21. DCAP BTLS TIC. 22. Sweep the lower legs (Check PMS). Extremities 23. Sweep the arms (Check PMS). 24. Give direction for initial management / immobilization. 25. C-collar should be placed after neuros are checked in lower extremities. *AF DETAILED PHYSICAL EXAMINATION / SECONDARY SURVEY 26. Assesses the head / face (eyes, ears, nose, mouth). 27. Assess the neck (recheck JVD and Trachea). 28. Assesses the chest (better set of lung sounds). 29. Assesses the abdomen/pelvis (inspection and palpation). 30. Assesses the extremities (looking for soft tissue, musculoskeletal and PMS). 31. Assesses the posterior (usually completed during log roll). 32. Vital signs: Pulse Blood Pressure Resp. and 33. S.A.M.P.L.E. Allergies Medications History last meal 34. Manages primary injuries appropriately. *AF 35. Manages secondary injuries and wounds appropriately. *AF Student needs 60 to pass 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /70 /70 /70 /70 23

27 Patient Assessment / Management - TRAUMA Date Date Date Date 1. Scene Safe, standard precautions and good self-introduction. *AF 2. Determines the MOI, number of patients, and requests additional help. 3. Any major (life threatening) bleeding, if so, that bleeding must be controlled. 4. Considers stabilization of spine. *AF INITIAL ASSESSMENT / PRIMARY SURVEY 5. Verbalizes general impression of the patient and determines responsiveness 6. Check to see if airway open and sounds with breathing. *AF 7. Assesses Breathing rate and tidal volume and ensures adequate ventilation. *AF 8. Pulse check, skin and capillary refill and controls major bleeding. *AF 9. Initiates appropriate oxygen therapy. *AF 10. Identifies priority patients/makes transport decision. RAPID TRAUMA ASSESSMENT / CONTINUED PRIMARY SURVEY Head Neck Chest Abdomen Back 11. Major Trauma. 12. Impending airway problem (facial trauma or epistaxis). 13. Posterior. 14. Anterior Trauma JVD Trachea Midline 15. Expose and Inspect and Palpate. *AF 16. Lung Sounds. 17. Expose and Inspect and Palpate. 18. Checks back immediately when necessary (MOI suggests injury). Pelvis 19. Pain, DCAP BTLS TIC. 20. Genital sweep (Priapism, wetness, blood). Femurs 21. DCAP BTLS TIC. Extremities 22. Sweep the lower legs (Check PMS). 23. Sweep the arms (Check PMS). 24. Give direction for initial management / immobilization. 25. C-collar should be placed after neuros are checked in lower extremities. *AF DETAILED PHYSICAL EXAMINATION / SECONDARY SURVEY 26. Assesses the head / face (eyes, ears, nose, mouth). 27. Assess the neck (recheck JVD and Trachea). 28. Assesses the chest (better set of lung sounds). 29. Assesses the abdomen/pelvis (inspection and palpation). 30. Assesses the extremities (looking for soft tissue, musculoskeletal and PMS). 31. Assesses the posterior (usually completed during log roll). 32. Vital signs: Pulse Blood Pressure Resp. and 33. S.A.M.P.L.E. Allergies Medications History last meal 34. Manages primary injuries appropriately. *AF 35. Manages secondary injuries and wounds appropriately. *AF Student needs 60 to pass Total: /70 /70 /70 /70 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Initials: 24

28 Patient Assessment / Management MEDICAL Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent 1. Scene is safe and standard precautions and Introduction of the team. *AF 2. Number of patients, need for additional help. 3. Clues for mechanism of illness is there an apparent need for c-spine. INITAIL ASSESSMENT 4. Asks about general impression (anxiety, position, age, color) and determines LOC. 5. Check to see if airway open and sounds with breathing. *AF 6. Assesses Breathing rate and tidal volume and ensures adequate ventilation. *AF 7. Pulse check, skin and capillary refill and controls major bleeding. *AF 8. Initiates appropriate oxygen therapy. *AF 9. Determines chief complaint / obvious life threats. 10. Identifies the priority and makes transport decision. *AF Respiratory Cardiac AMS Allergic Poisoning OB / GYN Acute abdomen Onset Provokes Severity Time Associated symptoms Pertinent negatives Good?s for asthma, P.E. COPD, pneumonia Onset Provokes Quality Radiates Severity Time Associated symptoms Pertinent negatives Good questions for cardiac as well as anything that could cause C.P. Onset Duration Associated symptoms Pertinent negatives r / o AEIOU TIPS Good?s for stroke, seizure, diabetic History of similar event? What were you exposed to? Itchiness? Hives? Wheezes? Airway problems? 11. POINTS FROM FOCUSED HISTORY ABOVE Max of 5 points. 12. AMPLE Allergies, Medicine, Med Hx, last meal, Events of the day. PHYSICAL EXAM 13. Vital signs. *AF 14. Lung sounds. *AF 15. Palpate abdomen (if appropriate). 16. Checks pupils. 17. Extremities for movement, strength, edema, color, and medic alert tags. QUESTIONS 18. Knows what the ongoing assessment would entail. Substance When How much How much do you weigh? Self-Interventions ETOH 19. Communicates effectively with patient and team (patient s name and shows empathy. 20. Knows that if the patient was unconscious the student should perform a rapid medical assessment (head-to-toe) and checks medical alert tags. 21. Figures out primary problem, understand pathology and offers proper treatment. When was your last menstrual period? Are you Pg How far along Pain or contraction? Bleeding or water broke? Do you feel the need to push? How many kids Onset Provokes Quality Radiates Severity Associated symptoms Pertinent negatives Diet Bowel and bladder Good?s for GI bleeds, appendicitis, and AAA Menstrual and Pg Student needs 34 to pass 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Initials: /42 /42 /42 /42 25

29 Patient Assessment / Management MEDICAL Date Date Date Date 0=incompetent 1=poorly done/needed prompting 2= competent 1. Scene is safe and standard precautions and Introduction of the team. *AF 2. Number of patients, need for additional help. 3. Clues for mechanism of illness is there an apparent need for c-spine. INITAIL ASSESSMENT 4. Asks about general impression (anxiety, position, age, color) and determines LOC. 5. Check to see if airway open and sounds with breathing. *AF 6. Assesses Breathing rate and tidal volume and ensures adequate ventilation. *AF 7. Pulse check, skin and capillary refill and controls major bleeding. *AF 8. Initiates appropriate oxygen therapy. *AF 9. Determines chief complaint / obvious life threats. 10. Identifies the priority and makes transport decision. *AF Respiratory Cardiac AMS Allergic Poisoning OB / GYN Acute abdomen Onset Provokes Severity Time Associated symptoms Pertinent negatives Good?s for asthma, P.E. COPD, pneumonia Onset Provokes Quality Radiates Severity Time Associated symptoms Pertinent negatives Good questions for cardiac as well as anything that could cause C.P. Onset Duration Associated symptoms Pertinent negatives r / o AEIOU TIPS Good?s for stroke, seizure, diabetic History of similar event? What were you exposed to? Itchiness? Hives? Wheezes? Airway problems? Substance When How much How much do you weigh? Self-Interventions ETOH When was your last menstrual period? Are you Pg How far along Pain or contraction? Bleeding or water broke? Do you feel the need to push? How many kids Onset Provokes Quality Radiates Severity Associated symptoms Pertinent negatives Diet Bowel and bladder Good?s for GI bleeds, appendicitis, and AAA Menstrual and Pg 11. POINTS FROM FOCUSED HISTORY ABOVE Max of 5 points 12. AMPLE Allergies, Medicine, Med Hx, last meal, Events of the day PHYSICAL EXAM 13. Vital signs. *AF 14. Lung sounds. *AF 15. Palpate abdomen (if appropriate). 16. Checks pupils. 17. Extremities for movement, strength, edema, color, and medic alert tags. QUESTIONS 18. Knows what the ongoing assessment would entail. 19. Communicates effectively with patient and team (patient s name and shows empathy. 20. Knows that if the patient was unconscious the student should perform a rapid medical assessment (head-to-toe) and checks medical alert tags. 21. Figures out primary problem, understand pathology and offers proper treatment. Student needs 34 to pass Total: /42 /42 /42 /42 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Initials: 26

30 This skill will be practiced/tested as a scenario. The patient should present with SOB and pulmonary edema. Blood pressure should be normal and the patient should be able to follow commands. Continuous Positive Airway Pressure (CPAP) Skill Sheet 0=incompetent 1=poorly done/needed prompting 2= competent 1. Scene is safe and standard precautions. *AF 2. Introduction of the team and form a general Impression. *AF 3. Place patient in position that will optimize ease of ventilation (high fowler, tripod, etc.). 4. Primary and secondary survey, especially lung sounds, oxygen saturation and vital signs. 5. Explain procedure to patient. Prepare the Equipment 6. Connect CPAP device to oxygen source. 7. Assemble mask and tubing per manufacturer instructions. 8. Has patient hold mask to his own face or apply head straps and ensure proper mask seal. 9. Coach patient to breathe normally and adjust to air pressure. 10. Reassess patient for desired effects: a. Decrease in level of ventilatory distress/anxiety. b. Oxygen saturation >92%. c. Decreased adventitious lung sounds. d. Absence of adverse reactions (barotrauma and pneumothorax). 11. Knows Indication: A patient experiencing respiratory insufficiency or failure, including pulmonary edema or bronchoconstrictive disease, can follow commands, and has SaO2 < 90%. 12. Knows Contraindications: Patients with pneumothorax, apnea, unconsciousness, and full cardiopulmonary arrest. Relative contraindications include trauma with suspicion of elevated ICP, abdominal distention with risk for vomiting, and hypotension. Patients who have emphysema should be monitored closely, as they are at increased risk for barotrauma and pneumothorax. Date Date Student needs 22 points to pass the skill. Total: /26 /26 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail Instructor Initials Comments: 27

31 This skill will be practiced/tested as a scenario. The patient should present with SOB and wheezing with a history of asthma. Blood pressure should be normal and the patient should be able to follow commands. Nebulizer / Albuterol Skill sheet 1. Scene is safe and standard precautions. *AF 0=incompetent 1=poorly done/needed prompting 2= competent 2. Introduction of the team and form a general Impression. *AF 3. Place patient in position that will optimize ease of ventilation (high fowler, tripod, etc.). 4. Primary and secondary survey, especially lung sounds, oxygen saturation and vital signs. 5. Explain procedure to patient. Prepare the Equipment Date Date 6. Selects appropriate device to administer Albuterol and prepares equipment. 7. Explains procedure to patient. 8. Checks medication for name, expiration date, dosage and clarity and places drug in nebulizer. 9. Knows the adult dose of Albuterol (25 mg in 3 ml) Pediatric dose is 1.25 mg (1/2 the adult). 10. Has oxygen connected and running at 6-8 liters/minute. 11. Gives device (mouth-piece) to patient with instructions or applies device to patient s face (mask). 12. Reassess patient for desired effects: Decrease in level of ventilatory distress/anxiety. Oxygen saturation >94%. Decreased adventitious lung sounds (wheezing). Absence of adverse reactions (chest pain, palpitations, pulmonary edema). 13. Knows the onset of relief takes 5 minutes and the drug will have peak effects is minutes. 14. Knows Indication: A patient experiencing shortness of breath with signs of bronchoconstriction, can follow commands, and has oxygen saturations < 95%. 15. Knows Contraindications: Patients with a known hypersensitivity to Albuterol, cardiac chest pain, apnea or unconsciousness. Tachycardia may be an issue. Student needs 26 points to pass the skill. 0 = incompetent 1 = poorly done/needed prompting 2 = competent Total: Pass / Fail: Instructor Initials: /30 /30 Comments: 28

32 This skill will be practiced/tested as a scenario. The patient should present with obvious anaphylaxis with a history of a life-threatening allergy. Blood pressure should be low and the patient should be able to respond to verbal commands with anxiety. (+) stridor, (+) hive, (+) wheezing, (+) facial and tongue swelling. IM Epinephrine (EpiPen) Administration Skill Sheet 0=incompetent 1=poorly done/needed prompting 1. Scene is safe and standard precautions. *AF 2= competent 2. Introduction of the team and form a general Impression. *AF 3. Completes a primary and secondary survey, especially vital signs and signs of anaphylaxis. 4. Assure the patient has proper airway and ventilatory care. *AF 5. Knows indications for EpiPen: Stridor with impending airway closure. Hypotension due to anaphylaxis. Wheezing, urticaria and facial swelling associated with Hx of anaphylaxis. Prepare the Equipment 6. Checks medication: Right med, exp. date and clarity (clarity is usually a small window one the EpiPen). 7. Prepares syringe with correct amount of medication using aseptic technique OR Removes the safety cap on the EpiPen and places hand around EpiPen correctly 8. Properly administers medication: Ampoule or Vial: 0.3 mg epi 1:1,000 using correct syringe (1 cc) and needle (19 22 gauge, 1-2 long needle). Stretches skin out and enters tissue at a 90 o. Can use: Deltoid, Dorsal Gluteal, Vastus Lateralis, and Rectus Femoris OR EpiPen: Bares the Vastus Lateralis and firmly presses EpiPen against the muscle and holding that for sec. 9. Properly disposes of the sharp 10. Watches patient for improvement and knows that a second dose may be required. 11. Possible side effects: Tachycardia, hypertension, tremors, irritability, sweating Nausea and vomiting Cardiac-type chest pain 12. Knows that all patients who were given epinephrine are required to go to emergency room 13. Knows Contraindications: None in true anaphylaxis. Be careful with elderly people with cardiac Hx Date Date Student needs 22 points to pass the skill. Total: /26 /26 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Instructor Initials: 29

33 This skill will be practiced/tested as a scenario. The patient should present with decreased level of consciousness and slow and shallow respiration with circumoral cyanosis. Blood pressure should be normal and the patient will not respond to verbal commands. There is an obvious suspicion of drug use. Narcan Administration (Intranasal-MAD) Skill Sheet 0=incompetent 1=poorly done/needed prompting 1. Scene is safe and standard precautions. *AF 2= competent 2. Introduction of the team and form a general Impression. *AF 3. Completes primary and secondary survey, especially vital signs, oxygen saturation and pupil size. 4. Assures the patient has proper airway and ventilatory care. *AF 5. Knows indications for Naloxone (Narcan): Obvious narcotics use (paraphernalia, empty pill bottles, witnesses, history of OD). Slow and shallow respirations. Pinpoint pupils. Blood sugar >60 mg/dl. Prepare the Equipment 6. Checks medication: Right medication, expiration date, concentration and clarity 7. Prepares syringe with correct amount of medication and attaches MAD Possible dosing regiments 0.4 mg or 1.0 mg 8. Verbalizes the consideration of immobilizing the patient prior to administration. 9. Inserts MAD device into nare and quickly pushes the medication. 10. Watches patient for improvement and knows that a second dose may be required (opposite nare). 11. Possible side effects: Patients have a predictable period of combative behavior after the administration of Narcan. Nausea and vomiting. Hypotension and hypertension. Tremors, irritability, sweating and narcotics withdrawals. Seizures. 12. Knows that all patients who were given Narcan are required to go to emergency room. 13. Knows Contraindications: Allergy or hypersensitivity to Narcan. Date Date Student needs 22 points to pass the skill. Total: /26 /26 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Instructor Initials: Comments: 30

34 Assess Vital Signs 0=incompetent 1=poorly done/needed prompting 1. Scene is safe and standard precautions. *AF 2= competent 2. Introduction of the team and form a general Impression. *AF 3. Place patient in position of comfort. 4. Breathing Rate (patient should not know that the provider is checking respiratory rate). Observe chest rise and fall. Count number of breaths in 30 seconds and multiply by two. Identify quality of breathing Normal Shallow Labored Noisy. Obtain SaO2 (pulse oximetry) if available. 5. Pulse Rate Assess radial pulse on awake patients and carotid pulses on unresponsive patients. Count number of beats in 30 seconds and multiply by two. Identify quality of pulse Strong/Weak Regular/Irregular. 6. Blood Pressure Determine proper size BP cuff - bladder of cuff should cover one half of the arm circumference. Place BP cuff on arm 1 above crease of elbow with bladder centered over brachial artery. Wrap snugly and assure no wrinkled clothes or tight fitting sleeves. 7. Palpate the brachial artery and place diaphragm of stethoscope over the brachial artery. Student knows to place gentle pressure on stethoscope bell. 8. Inflate cuff to approximately 160 mmhg while listening with stethoscope and then deflate cuff at approximately 2 mmhg / second. 9. Systolic pressure level where pulse beat is first heard. 10. Diastolic level where last pulse beat was heard (or where there was a noticeable change in the sound). 11. Skin Color: Pale - Poor perfusion due to decreased blood flow Cyanotic - Poor oxygenation Flushed - Exposure to heat or vasodilation Jaundice - yellow color indicates liver difficulty. 12. Temperature: Touch patient with gloved hand to determine temperature. If the patient is warm, consider obtaining an accurate temperature through use of a thermometer. 13. Skin Condition: Dry Clammy Wet Moist. 14. Capillary Refill: Assess by pressing on nail bed of finger or toe or by pressing on skin at the sternum, chin, or forehead. Capillary refill should be less than two seconds. 15. Pupils Size: Assess patient s eyes to determine size: Dilated Normal Constricted. 16. Pupil Equality: Check patient s eyes to determine equality: Equal Unequal. 17. Pupil Reaction: Shine a light into patient s eyes to determine reactivity: Reactive Non-reactive. Date Date Student needs 28 points to pass the skill. 0 = incompetent 1 = poorly done/needed prompting 2 = competent Comments: Total: Pass / Fail: Instructor Initials: /34 /34 31

35 This skill will be practiced/tested as a scenario. The patient should present with an altered mental status (AMS). Blood Glucose Measurement 0=incompetent 1=poorly done/needed prompting 1. Scene is safe and standard precautions. *AF 2= competent 2. Introduction of the team and form a general Impression. *AF 3. Talks with patient even if the seem unresponsive 4. Assembles Glucometer Gauze equipment: Test-strip Band-aid or tape Lancet Sharps container 5. Places test strip into the glucometer. 6. Finds proper site for poke and cleans site with alcohol or substitute. 7. Empathy statement for poke and then warning for poke. 8. Uses proper lancet technique to poke patient. 9. Correct specimen placement on test strip. 10. Reads glucometer and record results. 11. Proper disposal sharps and any possible body fluids. 12. Knows indications for blood sugar checks. 13. Knows normal blood sugar levels. 14. Knows proper treatment for low/high blood sugar levels. Date Date Date Student needs 12 points to pass the skill. Total: /28 /28 /28 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Instructor Initials: Comments: 32

36 This skill will be practiced/tested as a scenario. The patient should present with needs to be moved on a stretcher. Lifting and Moving-Stretcher Use 0=incompetent 1=poorly done/needed prompting 1. Talks with patient even if they have an AMS. 2= competent Date Date 2. Appropriately moves patient to the stretcher (stand and pivot, arm-knee, sheet drag). 3. Stretcher should not be too low. It should be at the highest level for which the move to the stretcher can be effectively managed. 4. Assures patient is comfortable. 5. Empathy statement for straps and frightening feeling associated with stretcher. 6. Communicate with patient about the impending lift. 7. Students should be looking at each other when lifting. 8. Student at head lifts as student at foot of stretcher pulls trigger and lifts cot. 9. Patient lifted to below maximum height where the stretcher is horizontal to floor. 10. Student knows to never move the stretcher from side to side. Only length-wise. 11. When lowering the stretcher First talk to patient about the move. 12. Students should be looking at each other when lifting. 13. Student at head lifts as student at foot of stretcher and pulls trigger and lifts cot. 14. Patient lowered to appropriate level/height where the patient can now stand or be sheeted. Student needs 24 points to pass the skill. Total: /28 /28 0 = incompetent 1 = poorly done/needed prompting 2 = competent Pass / Fail: Instructor Initials: Comments: 33

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