Paramedic Psychomotor Skills Manual

GLEMSA/DU Skill Sheet Name ______

Introduction This is the Great Lakes EMS Academy / Davenport University Consortium Paramedic ALS Psychomotor Skills Manual. This manual is part of the student’s permanent record. The student will have possession of this book throughout the Paramedic course. The student should try to bring this to class every day and also with them to their various clinical experiences.

In 2016, the Great Lakes EMS Academy has changed some of the methods in training, evaluation and documentation of skills training. These changes have occurred to make sure that we are in compliance with the NREMT Paramedic Psychomotor Competencies Portfolio (PPCP). This new portfolio structure will necessitate very involved documentation by the student.

Psychomotor skills are an important component of safe and effective out-of-hospital care. Delivery of care, at its most fundamental level, is when and where the importance of EMS is demonstrated to the public. Compassionate care using the complete affective skill set can result in a positive image of EMS and lead to medical and public support for the profession. Psychomotor Skills include the skills lab and scenario lab components. Psychomotor education begins in the skills lab component, where psychomotor learning takes place. The skills lab component is the setting for educational imprinting, cognitive integration, frequent drilling and autonomic development of psychomotor skills. The scenario lab component provides students a contextual opportunity to demonstrate what they have learned in a simulated environment based upon the psychomotor skills established in the skills lab. Once students have demonstrated skill competence in the simulated environment, they progress to assessing and treating real patients in the clinical phase with adequate supervision.

The clinical phase in a student’s education includes “planned, scheduled, educational student experience with patient contact activities in settings, such as hospitals, clinics, free-standing emergency centers, and the ambulance.”

Generally speaking, we try to teach skills within the first days of class. We follow short discussion on skills with demonstration and then practice…practice…practice. During practice time the students are expected to participate in learner-lead skills 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. Next, we will put the student into scenario-based training at the earliest time possible. Only after the completion of scenario-based training may a student practice that skill in the clinical environment. So, for example, students will learn how to start an IV in the second week of class. They will be practicing the skill on a manikin arm, which is setting on a table. The next week will already be “testing” for that skill. Scenario-based training will be the next step. The student will then be “signed off” in their clinical manual. At that time, the student will be able to start IVs in the clinical environment.

Paramedic 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. As we are taught and then practice skills, our abilities and confidence increases with experience.

Students who fail skills testing will have an opportunity to retest. Students may need to complete remedial training outside of the regularly scheduled time frames for class.

At the end of each module, the faculty will be reviewing the student’s practical skill sheets to assure that the student has passed all of the required skills 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 (pass a skill station).

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 (auto fail).

The student must physically go through all of the steps on each practical skill in order 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 in order 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 in order 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 in order 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 huge part of skills training at the Academy is the documentation of that skills training. Pretty much, everything you do during the practical aspect of class needs to be documented on paper and on FISDAP. People do not fail paramedic class because they are not able to start an IV or intubate a manikin. They fail because they are not able to document their performance in the Lab and clinical environment.

Skill Sheets This manual is full of skill sheets that we will be using throughout the time that we are training together. We will often use these skill sheets throughout the module and then at the end switch to a NREMT skill sheet. It is important for students to learn the skill sheets. However, when it comes to doing the skill in the field in a dynamic setting with extra pressure, students need to know why they are doing things and be comfortable with the procedure as a whole.

Routinely we teach the student a skill then we practice that skill for a week. The following week, we try to test that skill. Then later we incorporate the skill into scenarios and we use an abridge version of the skill sheet to “test” students while they are doing the skill during a scenario. Students should always try to perform skills as though they are being tested at the NREMT. Preparatory Module We include all of the skill sheets that we will start with during the Preparatory module. During this module we will be teaching you several ALS SKILLS:

1. Intravenous (IV) therapy, 2. Establishing an intraosseous (IO) line 3. IM and SQ injections 4. IV Drug Administration 5. Use of A nebulizer for medication administration 6. Use of Nasal Mucosal Atomizer Device (MAD) for Medication administration 7. Use of a glucometer 8. Supraglottic Airways We have several SCENARIO skill sheets that we use during this module. They consist of: 1. Cardiac Chest Pain 2. Shortness of Breath 3. Stroke 4. Altered Mental Status (AMS) 5. Acute Abdomen 6. Normal Childbirth 7. Abnormal Childbirth 8. General Medical Complaint 9. Hemorrhage control and shock Management 10. Splinting 11. Trauma Patient Management At the end of this module, students are TESTED on the following skills using the NREMT Skill Sheets: 1. Intravenous (IV) therapy, 2. Establishing an intraosseous (IO) line 3. IM and SQ injections 4. IV Drug Administration 5. Supraglottic Airways 6. Pediatric Airway Compromise 7. Medical Emergency Scenario 8. Traumatic Emergency Scenario

Cardiology Module During the second module (Cardiology), we will give the students several more SKILL SHEETS. They include:

1. Adult Oral-tracheal Intubation 2. Pediatric Oral-tracheal Intubation 3. Task analysis for defibrillation 4. Task analysis for cardioversion 5. Task analysis for pacing 6. 12-Lead ECG 7. IV Drip Skill Sheet 8. NREMT Dynamic Cardiology 9. NREMT Static Cardiology We have several SCENARIO skill sheets that we use during this module. They consist of: 1. Cardiac Chest Pain 2. Shortness of Breath 3. ACLS – Bradycardia 4. ACLS – Tachycardia 5. ACLS – Cardiac Arrest – VF/VT At the end of this module, students are TESTED on the following skills using the NREMT Skill Sheets: 1. Ventilatory Management – Adult 2. Ventilatory Management - Pediatrics 3. NREMT Dynamic Cardiology 4. NREMT Static Cardiology

Medical Emergencies I

During the third module (MEI), we will give the students more SKILL SHEETS. They include:

1. Comprehensive History 2. Comprehensive Physical Exam We have several SCENARIO skill sheets that we use during this module. At this time, we will continue to do many advanced cardiac life support (ACLS) scenarios. The medical scenarios will include: 1. Cardiac Chest Pain 2. Shortness of Breath 3. Stroke 4. AMS 5. Anaphylaxis 6. Acute Abdomen At the end of this module, students are TESTED on the following skills using the NREMT Skill Sheets: 1. NREMT Dynamic Cardiology 2. NREMT Static Cardiology 3. Ventilatory Management – Adult 4. IV start and Medication Administration 5. Medical Emergencies Scenario

Medical Emergencies II

During the fourth module (ME II), the students does not receive any new SKILL SHEETS.

We have several SCENARIO skill sheets that we use during this module. At this time, we will continue to do many advanced cardiac life support (ACLS) scenarios. The medical scenarios will include: 1. Normal Childbirth 2. Abnormal Childbirth 3. General Medical Complaint 4. Comprehensive Pediatric Physical Exam 5. Toxicology (poisons) 6. Toxicology (medications) 7. Toxicology (illegal drugs) 8. Acute Abdomen 9. Psychiatric Emergencies 10. General Medical At the end of this module, students are TESTED on the following skills using the NREMT Skill Sheets: 1. NREMT Dynamic Cardiology 2. NREMT Static Cardiology 3. Ventilatory Management – Pediatric 4. IO start and Medication Administration 5. Medical Emergencies Scenario Trauma Module During trauma the students will receive the following SKILL SHEETS again (we will use these in Preparatory).

1. Bleeding and shock 2. KED AND Backboarding 3. Orthopedic Injuries (Splinting and Traction Splinting) 4. Trauma Management 5. Surgical and Needle Cricothyrotomy 6. Needle Decompression We have several SCENARIO skill sheets that we use during this module. The trauma scenarios will include: 1. Blunt Trauma 2. Penetrating trauma 3. Burns 4. Hemorrhagic Shock At the end of this module, students are TESTED on the following skills using the NREMT Skill Sheets: 1. IO start and Fluid Administration 2. Traumatic Patient Management 3. Random Basic Skill (KED, Splinting, Bleeding control)

Operations and Review

During Operations and Review the student will be tested one final time on the skills listed below: 1. Intravenous (IV) therapy, 2. Establishing an intraosseous (IO) line 3. IV Drug Administration 4. NREMT Dynamic Cardiology 5. NREMT Static Cardiology 6. Ventilatory Management – Adult 7. Ventilatory Management - Pediatrics 8. Oral Station 9. Out-of-Hospital Patient Management (medical scenario)

FISDAP and Skills Documentation As you can imagine the community would really like you, as a Paramedic student, to have some experience with advanced life support (ALS) skills before you start practicing those skills on them.

Generally speaking, we will discuss (lecture) a skill in class before we practice that skill on a manikin. Regarding ALS skills, we should have several successful practice attempts on a skill before we try that skill on a human.

We need to be able to show Preceptors that we are ready to perform skills. We have two methods to assure that we are communicating our skill and knowledge level to preceptors. First, we have a Clinical Progress Table our Paramedic Clinical Manual. We need to bring the Clinical Manual in during practical sessions and have the staff sign off on various skills when we are ready to perform those skills in the field.

We also have FISDAP. FISDAP is the website that we use to schedule and track our clinical experience. We also need to document our skills practice and scenarios in FISDAP. Students will need to document their skills practice every week. This will involve uploading the documents that we used to “test” the skill.

FISDAP Support: http://www.fisdap.net/support?r=student Getting Started with FISDAP How do I create a new FISDSAP account? 1. Once you have a FIISDAP activation code, creating an account is easy. 2. Go to the FISDASP home page, www.fisdap.net. 3. Click Create an Account. 4. Type or paste in your activation code (you get that from Melissa) and click Continue. 5. You will need to enter your billing information, then click Place Order. On the receipt page, click Create Your Account. 6. Enter your profile information, and choose a FISDAP username and password, then click Save & Continue. 7. Read and accept the User Agreement and click Continue. 8. You’re all done! Click Continue to My FISDAP to log in and access your new account.

Scoring Skill Sheets While participating in skills training at the Academy we will usually be using standard GLEMSA / DU skills sheets or the NREMT skill sheets. When using these skill sheets the participant will earn a score on 0, 1 or 2 for each line item. The explanation of how to score the line item can be found below: 0 = Unsuccessful; required critical or excessive prompting; inconsistent; not yet competent. This would be when the student completely skips a step in the skill. For some items there is no way to gently prompt the student. At other times, the instructor may give clues to help the students obtain a “1”. 1 = Not yet competent, marginal or inconsistent, this includes partial attempts. A “1” is given when the student needed a little help in remembering the step. When a student performs the step, but there is a problem with that performance, the student would score a “1” 2 = Successful; competent; no prompting necessary. To score a “2”, there is not much room for improvement. The student has “mastered” that aspect of the skill. Auto-Fail - When there is an “AF” included at the end of the line item the student has to score a 1 or a 2 for that line item. These auto-fails are sometime regraded as critical criteria. Failing to complete that step can have a major impact on the patient or the success of the skill.

Critical Criteria – Towards the bottom of the skill sheets you may find a list of critical criteria. These are easily noticed by the presence of a small check box located in the scoring column. If the student obtains a check here, it is the same as an auto-fail. The skill attempt is recognized as a fail. Level of Competence When we evaluate students as they complete skill, instructors will not only give the student a Pass / Fail mark. We will also describe the competency level while performing that skill. The expectation is that the student will progress from manipulation to naturalization. To graduate from the Academy, student need only be at the precision level. Manipulation (M) = Student completed the skills evaluation with some problems or hesitations during the procedure. The instructor had to give hints or noted flaws in the performance of the skill.

Precision (P) = Instructor was quiet during the skills evaluation and simply allowed the student to go through the skills with no interruptions. The student completed skill with no mistakes.

Articulation (A) = Student completed the task with no mistakes. The instructor asked questions about the procedure, like: “why are we doing this”, “tell me about capnography for monitoring placement”, “what would you do if….”

Naturalization (N) = Student completed the task with no mistakes. The instructor distracts the learner with conversation about something not related to the skill or has students prepping the patient/working a scenario. The student would be able to troubleshoot problems and have confidence while completing the skill.

Skills Tested at the NREMT Psychomotor Evaluation

1. Patient Assessment-Trauma You will be required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:  Scene Size-Up  Initial Assessment/Resuscitation  Focused History and Physical Examination - Rapid Trauma Assessment  Detailed Physical Examination 2. Patient Assessment-Medical You will be required to perform a "hands-on," head-to-toe, physical assessment and voice treatment of a simulated patient for a given scenario, including:  Scene Size-Up  Initial Assessment/Resuscitation  Focused History and Physical Examination - Rapid Trauma Assessment  On-Going Assessment 3. Apneic Adult (supraglottic airway) Given a scenario of having just found an apneic adult patient with a palpable carotid pulse, you must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve- mask device, and supplemental oxygen. You will then complete the adult presentation by placing a supraglottic airway device. 4. Pediatric Respiratory Compromise You will be given a scenario of having just found an infant in respiratory distress and must demonstrate immediate management of the patient using simple airway maneuvers, adjuncts, and supplemental oxygen. You will then be required to demonstrate bag-valve-mask ventilation as the patient progresses from respiratory distress to respiratory failure. 5. Cardiac Arrest Management/AED You will be evaluated on your ability to manage a cardiac arrest situation, including 1-rescuer CPR and usage of the AED given a cardiac arrest scenario where no bystanders are present. 6. IV and Medication Skills  Intravenous Therapy - You will be required to establish a patent IV in a mannequin arm in accordance with a given scenario.  Intravenous Bolus Medications - after establishing a patient IV line, you will be required to administer an IV bolus of medication in accordance with a given scenario. 8. Pediatric Intraosseous Infusion Skills You will be required to establish an intraosseous line in a pediatric IO mannequin. Either manual insertion using Jamshidi® needles or electric, drill-type devices are permitted to establish intraosseous access. 9. Spinal Immobilization (Supine Patient) You will be required to immobilize an adult patient who is found supine with a suspected unstable spine using a long spine immobilization device. An EMT Assistant will be provided and you are also responsible for the direction and subsequent actions of the EMT Assistant. 10. Random EMT Skills You will be evaluated over one (1) of the following EMT skills tested at random. All instruments for these skills will adhere to the National Registry EMT Users Guide material:  Spinal Immobilization (Seated Patient)  Long Bone Immobilization  Joint Immobilization  Bleeding Control/Shock Management

GLEMSA/DU Skill Sheet Name ______

Date Date Supraglottic Airway – King LTd

1. “Scene is safe and standard precautions” and checks ABCs (AF) 2. Uses a manual airway and BVM to ventilate patient within 30 seconds (AF) 3. Ventilates at a rate of 10 /min. Squeeze BVM for 1 second. (AF) (AF) 4. Attaches BVM to O2 and has O2 set at 12 to 15 liters/minute 5. Checks no gag reflex and properly inserts basic airway 6. Check lungs sounds and place patient on pulse oximetry Ventilate the patient for 30 to 60 seconds at a proper rate and tidal volume. “Lung sounds are clear and equal. Pulse oximetry is at 88%. It is time to place an supraglottic airway.” 7. Student should direct the evaluator or helper to ventilate patient 8. Checks/prepares the airway device (chooses correct size) 9. Lubricates the distal tip of the device (AF) 10. Positions the head (sniffing position) 11. Performs a tongue-jaw lift and inserts device to the appropriate depth 12. Inflates the balloon(s) appropriately and removes the syringe(s) (AF) 13. Attaches BVM appropriately and ventilates patient 14. Confirms placement /ventilation observing chest rise, and auscultating over the

epigastrium and bilaterally over each lung 15. Adjusts airway to allow for maximum ventilation (possibly pull back) 16. Uses secondary device/method to monitor the placement of the tube:

capnography, ETCO2 detector, watch patient color and SaO2 17. Secures device or confirms that the device remains properly secured Did not take, or verbalize, body substance isolation precautions   Did not ventilate properly (rate, tidal volume, no interruptions)   Did not pre-oxygenate the patient prior to placement   Did not confirm placement properly/timely   Inserted any adjunct in a manner that was dangerous to the patient   29 points needed to pass skill evaluation Points: __/34 __/ 34 Pass / Fail Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

GLEMSA/DU Skill Sheet Name ______

Supraglottic Airway-Combitube Date Date 1. “Scene is safe and standard precautions” and ABCs 2. Uses a manual airway maneuver and BVM to ventilate patient 3. Ventilates at a rate of 10 /min. Squeeze BVM for 1 second. 4. Attaches BVM to O2 and has O2 set at 12 to 15 liters/minute 5. Checks no gag reflex and properly inserts basic airway 6. Check lungs sounds and place patient on pulse oximetry Ventilate the patient for 30 to 60 seconds at a proper rate and tidal volume. “Lung sounds are clear and equal. Pulse oximetry is at 88%. It is time to place an supraglottic airway.” 1. Student should direct the evaluator or helper to ventilate patient 2. Checks/prepares the airway device (chooses correct size) 3. Lubricates the distal tip of the device 4. Positions the head (neutral position) 5. Performs a tongue-jaw lift and inserts device to the appropriate depth

6. (front teeth between black lines) 7. Inflates the balloon(s) appropriately and removes the syringe(s) 8. Attaches BVM appropriately and ventilates patient 9. Confirms placement /ventilation observing chest rise, and auscultating over the

epigastrium and bilaterally over each lung 10. Adjusts ventilation as necessary (if no lung sounds move to tube #2) 11. Uses secondary device/method to monitor the placement of the tube:

capnography, colorametric ETCO2 watch patient color and SaO2 12. Secures device or confirms that the device remains properly secured Did not take, or verbalize, body substance isolation precautions   Did not ventilate properly (rate, tidal volume, no interruptions)   Did not pre-oxygenate the patient prior to placement   Did not confirm placement properly/timely   Inserted any adjunct in a manner that was dangerous to the patient   29 points needed to pass skill evaluation Points: __/34 __/ 34 Pass / Fail Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

GLEMSA/DU Skill Sheet Name ______

Date Date Intravenous (I.V.) Cannulation

Start Time:

1. Takes/verbalizes “Standard Precautions.” (AF) 2. Checks selected IV fluid for: (student needs all 3 to get credit)  Expiration date,  proper fluid,  clarity. (AF) 3. Selects appropriate catheter 1) medical=20 or 18, 2) trauma=18 or 16)

4. Prepares administration set (makes sure the line is flushed). (AF)

5. Explains the procedure to patient and offers empathy statement

6. Cuts or tears tape at any time before venipuncture. (AF)

7. Applies constricting band and checks distal pulse and palpates suitable vein.

8. Cleanses site appropriately. Betadine scrub then alcohol swipe.

9. States “open sharp” when appropriate. (AF)

10. Uses non-dominant hand to secure vein near insertion site

11. Advises patient of “poke” and inserts catheter at proper angle.

12. Notes or verbalizes flashback and advances needle and catheter 2-3 mm in vein

13. Does not touch/contaminate catheter during cannulation. (AF)

14. Releases tourniquet and then places gauze under hub of the catheter.

15. Occludes vein proximal to catheter to minimize blood loss from the hub.

16. Removes needle and connects IV tubing to catheter NO MESS (AF)

17. Disposes of needle in proper container. (AF)

18. Runs IV for a brief period to assure patent line. 19. Properly Secures catheter and IV line. (AF) 20. Checks IV site for edema, redness, and pain. Adjusts flow rate as appropriate. End Time: Failure to establish a patent IV within 6-minute time limit.   Improper technique resulting in potential harm   17 points needed to pass skill evaluation Points: __/20 __/ 20

Pass / Fail

Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

GLEMSA/DU Skill Sheet Name ______

Date Date Intraosseous Infusion (Jamshidi)

Start Time:

1. Takes/verbalizes “Standard Precautions.” (AF) 2. Checks selected IV fluid for: (student needs all 3 to get credit) (AF)

 Expiration date.  Proper fluid.  Clarity. 3. Prepares administration set and extension tubing. 4. Prepares syringe and ext. tubing. At this time the student will use the stop-cock

on the extension tubing to draw up fluid into the syringe from the IV bag. (AF) 5. Cuts or tears tape and identifies proper anatomical site for I.O. puncture. 6. Cleanses site appropriately. Verbalizes Betadine® scrub 7. Performs IO puncture: Verbalizes: “Open sharp” 8.  Stabilizes tibia –cups extremity under the puncture site 9.  Inserts needle at proper 90o angle. 10.  Advances needle with twisting motion until “pop” is felt. 11.  Unscrews cap and removes stylette from needle. 12. Verbalizes open sharps again and disposes of needle in proper container. 13. Attaches extension set to IO needle and pushes approximately 3-5 cc of saline

then aspirates to look for return of blood 14. Slowly injects saline to assure proper placement of needle. 15. Knows how to check for placement (needle is firmly placed, look for edema). 16. Adjusts the stop-cock on extension tubing to allow the primary administration set

to flow and adjusts flow rate as appropriate. 17. Secures needle with bulky dressing and tape similar to impaled object 18. Knows amount to administer for fluid bolus (20 mL/kg). 19. Knows IV bag will possibly need pressure infuser for proper flow.

End Time:

Failure to establish an IO line within the 6-minute time limit.   Failure to avoid unnecessarily uses open needles or recaps a needle.   Any improper technique resulting in the potential for air embolism.   26 points needed to pass skill evaluation Points: __/30 __/ 30 Pass / Fail Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

GLEMSA/DU Skill Sheet Name ______

The administration of the medication may involve using a pre-load or drawing up a medication from a vial. This station has a 3-minute time limit. Give student a scenario that would require the administration of a typical ALS medication. Date Date Intravenous Medication Administration

1. Continuing to take /verbalizes “Standard Precautions.” (AF) 2. Assures IV is running with no signs of infiltration. 3. Asks patient about allergies and medications. (AF) 4. Checks selected medication: (student needs all 3 to get credit)

 proper medication  Expiration date  concentration (AF) 5. Calculates the correct amount of volume to be administered 6. Uses the correct syringe (smallest one that will hold the volume) 7. Verbalizes a second check of medication (has someone else check) (AF) 8. States “open sharp” when appropriate. (AF) 9. Assures aseptic technique when drawing up medication. 10. Prepares syringe with the appropriate amount of the medication. (AF) 11. Uses a safe practice while drawing up medication 12. Assures the air is dispelled from syringe. And correct dose is drawn (AF) 13. Verbalizes a third check of medication (AF) 14. Assures aseptic technique when placing medication into IV line. (AF) 15. The student should use a needleless system/technique if possible

(stop-cock with extension tubing) 16. Stops IV flow (pinching the tube or using stop-cock). 17. Administers medication at appropriate push rate. 18. Disposes of syringe and needle in proper container. (AF) 19. Flushes tubing (runs IV at wide open for short period of time). Adjusts flow rate to TKO. 20. Verbalizes that the patent should be observed for the effect of the med.

21. Documents who, what, when, how, how much, and any changes.

Failure to administer the medication within 3-minute time limit.   Improper drug or dose is an autofail.   Failure to dispose/verbalize disposal of needle in proper container.   36 points needed to pass skill evaluation Points: __/42 __/ 42 Pass / Fail

Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

GLEMSA/DU Skill Sheet Name ______

The administration of the medication may involve drawing up a medication from a vial. This station has a 3- minute time limit. Give student a scenario that would require the administration of the one of the following medications: Epi, Glucagon, Narcan Date Date IM and SQ Injection 1. Takes PPE precautions. AF 2. Explains procedure to patient and offers empathy statement and ask patient allergies

and current medications. AF 3. Selects correct medication and checks for correct name, concentration, expiration.

Inspects medication for discoloration and particles. 4. Selects proper needle and syringe 23 – 25 gauge, 5/8” long needle for SQ 19 – 23 gauge, 1”-1 ½” long needle for IM 5. Prepares correct amount of medication. AF 6. Second check of label for correct name, concentration, expiration date. AF 7. Student knows: The maximum volume for SQ injection is 2.0 mL for adult 1.0 mL for child The maximum volume for IM injection is 5.0 mL (2.0 mL for Deltoid) 8. States: “open sharps” whenever needle is uncapped. 9. Chooses and cleanses injection site appropriately. SQ: upper arms, thighs, and abdomen IM: Deltoid, Dorsal Gluteal and Vastus Lateralis 10. Third check for correct drug and dose. AF 11. Pinches skin at injection site for SQ

Stretches the skin taut over injection site for IM 12. Inserts needle at 45o angle, bevel up for SQ injection.

Inserts needle at 90o angle for IM injection. 13. Aspirates for blood return. AF

14. If no blood return, injects medication at appropriate rate.

15. Removes needle “open sharp” and disposes of it in proper container.

16. Applies pressure/massages to injection site.

17. Monitors patient for effects of medication. Failure to administer medication within 5-minute time limit   Performs any improper technique resulting in the potential harm to patient   Failure to dispose/verbalize disposal of needle in proper container   29 points needed to pass skill evaluation Points: __/34 __/ 34

Pass / Fail Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

GLEMSA/DU Skill Sheet Name ______

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.

Date Intra-Nasal Medication Administration - Mucosal Atomizer Device (MAD)

1. Don appropriate standard precautions Assure the scene is safe! 2. Form a general Impression

3. Primary and secondary survey, especially vital signs, oxygen saturation and pupil size 4. The patient have proper airway and ventilatory care [manual airway, NPA (possible), BVM]

(AF) 5. Knows indications for 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 (AF) 7. Prepares syringe with correct amount of medication and attaches mucosal atomizer device (MAD). Possible dosing regiments (AF) . 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 with 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

22 points needed to pass skill evaluation Points: __/26 Pass / Fail Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

GLEMSA/DU Skill Sheet Name ______

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.

Date Nebulized Medication Administration – Albuterol

1. Don appropriate standard precautions 2. Place patient in position that will optimize ease of ventilation (high fowler, tripod, etc.) 3. Primary and secondary survey, especially lung sounds, oxygen saturation and vital signs 4. Explain procedure to patient

Prepare the Equipment

5. Selects appropriate device to administer albuterol.

6. Prepares equipment

7. Checks medication for name, expiration date, dosage and clarity and places drug in nebulizer

8. Knows the adult dose of Albuterol (25 mg in 3 mL) Pediatric dose is 1.25 mg (1/2 the adult)

9. Has oxygen connected and running at 6-8 liters/minute

10. Gives device (mouth-piece) to patient with instructions or applies device to patient’s face (mask) 11. 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) 12. Knows the onset of relief takes 5 minutes and the drug will have peak effects is 30-60 minutes 13. Knows Indication: A patient experiencing shortness of breath with signs of bronchoconstriction, is able to follow commands, and has oxygen saturations < 95%. 14. Knows Contraindications: Patients with a known hypersensitivity to Albuterol, cardiac chest pain, apnea or unconsciousness. Tachycardia may be an issue. 23 points needed to pass skill evaluation Points: __/28 Pass / Fail

Competency Level (If this was learner-led, mark “S”)

1. Instructor:______2. Instructor: ______Initials:

GLEMSA/DU Skill Sheet Name ______

This skill will be practiced/tested as a scenario. The patient should present with an altered mental status.

Date Glucometer

1. Verbalizes scene safety and standard precautions

2. Talks with patient even if the seem unresponsive 3. Assembles equipment  Glucometer  Teststrip  Lancet  Gauze  Bandaid or tape  Sharps container 4. Places test strip into glucometer

5. Finds proper site for poke and cleans site with alcohol or substitute

6. Empathy statement for Poke and then warning for Poke

7. Uses proper lancet technique to “poke” patient and properly disposes of the sharp

8. Correct specimen placement on test strip

9. Reads glucometer and record results

10. Applies pressure to fingertip. Uses band-aid. Records/documents appropriately

11. Knows indications for blood sugar checks

12. Knows normal blood sugar levels

13. Knows proper treatment for low/high blood sugar levels

22 points needed to pass skill evaluation ____/26 Points: Pass / Fail Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

GLEMSA/DU Skill Sheet Name ______

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

Date Continuous Positive Airway Pressure (CPAP)

1. Don appropriate standard precautions

2. Form a general Impression

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  Some use 50 psi oxygen source. Do not use oxygen regulator/flow meter  Some use regulator/flow meter at 15 l/min 7. Assemble mask and tubing according to manufacturer instructions

8. Insert the CPAP valve into the mask (5 cm, 7.5 cm, or 10 cm H2O pressure valve)

9. Have patient hold mask to his own face or apply head straps and ensure proper mask seal

10. Coach patient to breathe normally and adjust to air pressure 11. Reassess patient for desired effects  Decrease in level of ventilatory distress/anxiety  Oxygen saturation >92%  Decreased adventitious lung sounds  Absence of adverse reactions (barotrauma and pneumothorax) 12. Knows Indication: A patient experiencing respiratory insufficiency or failure, including pulmonary edema or bronchoconstrictive disease, is able to follow commands, and has oxygen saturations < 90%. 13. Knows Contraindications: Patients with pneumothorax, apnea, unconsciousness, and full cardiac arrest. Relative contraindications include trauma with suspicion of elevated intracranial pressure, abdominal distention with risk for vomiting, and hypotension. Patients who have emphysema should be monitored closely with CPAP, as they are at increased risk for barotrauma and pneumothorax.

22 points needed to pass skill evaluation ____/26 Points: Pass / Fail Competency Level (If this was learner-led, mark “S”)

Initials: 1. Instructor:______2. Instructor: ______

Comments:

GLEMSA/DU Skill Sheet Name ______

Shortness of Breath Leader Team

 Chest pain?  Have you been sick lately? Running a fever?  Nausea or have you vomited?  Smoker? COPD?  Trauma to the chest?  Anxiety problems? [This area is worth a total of 5 pts]  Productive cough?  Alcohol or illicit drugs?”?”  Risk factors for P.E.  “Any history of surgeries?” Physical Exam 11. Lung sounds. (AF) 12. Palpate abdomen. 13. Distal extremities for edema and JVD. 14. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 15. Position, Oxygen and IV(AF) 16. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

standard questioning / assessment needs to occur prior to administration(AF) 17. Moved patient appropriately 18. Provided effective radio report to hospital(AF) Affective 19. Uses proper non-verbal communication(AF) 20. Uses patient’s name and gives Empathy statements(AF) 21. Communicated thoughts/rationale of clinical impression and treatment plan to patient 22. Looks confident, makes the patient feel at ease. (AF) Total needed to pass: 38 Total ____ / 44

Instructors name (printed) Pass / Fail

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Leader Team Chest pain

First 60 seconds 1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 4. Good Introduction Basic History 5. History Allergies,  Medical Hx, Medications 6. Onset: “what were you doing when it started?” 7. Provocation/palliation: “does anything make it better or worse?” 8. Quality: “Can you describe the pain?” 9. Region/radiation: “Can you point to the pain and does it go anywhere?” 10. Severity: “can you put it on a scale from 1 – 10?” 11. Time: “When did it start and has it been constant?” 12. Follow up questions: “What do you think it is?” “Have you ever had pain like this before?” Differential Diagnosis

13. Organized and thorough assessment and integrated findings to expand the assessment

 Short of breath?”  Sick lately? Running a fever?  Nausea / Vomiting  Have you had any problems with your bowel/Stools?”  Trauma to the chest?”  Any history of surgeries  Risk factors for cardiac  Changes in your diet [This area is worth a total of 5 pts]  History of GERD or GI problems  Risk factors for P.E Physical Exam 14. Lung sounds. 15. Palpate abdomen. 16. Distal extremities for edema and JVD. 17. Compare pulses in both radials to assess for thoracic aneurysm. 18. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate. Management 19. Position, Oxygen and IV 20. Aspirin, confirms no problem with aspirin and that there is no risk for internal bleeding 21. Nitroglycerine, confirms no ED meds and advises patient how the SL route works 22. Morphine, “sells” the medication to the patient. 23. Provided effective radio report to hospital Affective 24. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements 25. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 42 Total ____ / 50

50Instructors name (printed) Pass / Fail

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Leader Team Stroke

MENDS Exam 9. Visual Fields (checks all four quadrants) 10. Horizontal Gaze (moves eyes back and forth)

11. Sensory feels touch in each extremity (eyes closed) 12. Coordination (finger to nose and heel to shin) Differential Diagnosis 13. Organized and thorough assessment and integrated findings to expand the assessment

 Any complaint of a headache or stiff neck  Been sick lately?  Running a fever? Feeling run down / tired?  Risk factors for cerebral embolism  Nausea or have you vomited  Risk factors for aneurysm (HTN)  Trauma to the head? [This area is worth a total of 5 pts]  Hx of seizures?  Medication, alcohol or illicit drugs Physical Exam 14. Check blood sugar 15. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate. 16. Repeat Cincinnati Stroke Scale Management 17. Position, Oxygen and IV 18. Proper IV fluid and/or drug administration 19. Moved Patient appropriately 20. Provided effective radio report to hospital Affective 21. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements 22. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 38 Total ____ / 44

Instructors name (printed) Pass / Fail

Initials

Comment 23

GLEMSA/DU Skill Sheet Name ______

Leader Team Altered Mental Status

Palpate Abdomen, Any Signs of Trauma (with a Good Introduction) Basic History 5. History Allergies,  Medical Hx, Medications 6. Onset: “what were you doing when it started?” 7. Time: “When were they last seen normal?” Differential Diagnosis 8. Organized and thorough assessment and integrated findings to expand the assessment  Been sick lately?  Any complaint of a headache or stiff neck  Risk factors for cerebral embolism  Running a fever? Feeling run down / tired?  Risk factors for aneurysm (HTN)  Nausea or have you vomited  Trauma?  Trauma to the head? [This area is worth a total of 5 pts]  Hx of seizures?  Medication, alcohol or illicit drugs  Problems with bowel or bladder?  Depression or Psychiatric Hx Physical Exam 9. Lung sounds 10. Inspect and Palpate Abdomen 11. Check blood sugar 12. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate. Management 13. Position, Manage ABCs 14. Oxygen and IV 15. Proper IV fluid and/or drug administration 16. Moved Patient appropriately 17. Provided effective radio report to hospital Affective 18. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements 19. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 32 Total ____ / 38

Instructors name (printed) Pass / Fail Initials

Comment

GLEMSA/DU Skill Sheet Name ______

Leader Team Abdominal Pain

13. Organized and thorough assessment and integrated findings to expand the assessment

 Short of breath?”  Sick lately? Running a fever?  Nausea / Vomiting  Have you had any problems with your Bowel/Stools?”  Trauma to the Abdomen?”  Any history of surgeries  Risk factors for cardiac  Changes in your diet [This area is worth a total of 5 pts]  History of GERD or GI problems  Risk of pregnancy and the menstrual cycle Physical Exam 14. Lung sounds. 15. Inspect and Palpate abdomen. 16. Distal extremities for edema and JVD. 17. Compare pulses in both Feet to assess for aortic aneurysm. 18. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate. Management 19. Position, Oxygen and IV 20. Proper fluid and/or drug administration 21. Moved patient appropriately 22. Provided effective radio report to hospital Affective 23. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements 24. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 40 Total ____ / 48

Instructors name (printed) Pass / Fail Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Leader Team Childbirth - Normal

First 60 seconds 1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 4. Good Introduction 5. Tell me more about your complaint why you called 911 Questions Regarding the Urgency of Childbirth 6. How far along are you? 7. Water Broke? Or mucous plug? Any bleeding? If they saw the amniotic fluid was it clear 8. Tell me about the contractions 9. Do you feel the need to push or have a B. M. 10. Questions for  Para  Gravida Questions Regarding Possible Complications 11. Previous complications with child birth 12. Have you been seeing your doctor? Who is your doctor? And have you been taking meds? 13. Use of drugs or ETOH during Pregnancy? 14. Hx of  Gestational Diabetes?  Twins?  C-section?  Placenta previa 15. History Allergies,  Medical Hx, Medications Management 16. Position and Oxygen possible IV if time / # of people permit 17. Check for crowning and prolapsed cord 18. Check to see if amniotic sac in the way and fix it if it is intact. If amniotic fluid is present is it clear

(looking for meconium) 19. Place hand against baby’s head and allow for gentle delivery 20. Suction  Mouth and then  Nose 21. Check for nuchal cord and fix it if there is a problem 22. Pull the anterior shoulder downward to clear the mother's symphysis pubis (as needed) 23. Deliver baby and suction again and begin drying off the baby 24. Tie/clamp the umbilical cord in two places and cut the cord when appropriate 25. Dry, warm, position, and suction as needed 26. Continue with appropriate neonatal resuscitation (as needed) 27. 1 minute and 5 minute APGAR 28. Note time of birth 29. Package mom up and assess for delivery of the placenta (lengthening of the cord) 30. Assess for excessive post-partum bleeding and treat appropriately 31. Inspect and Palpate abdomen. Total needed to pass: 52 Total ____ / 61

Instructors name (printed) Pass / Fail

Initials

Comments: 26

GLEMSA/DU Skill Sheet Name ______

Leader Team Childbirth - Abnormal

First 60 seconds 1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 4. Good Introduction 5. Tell me more about your complaint why you called 911 Questions Regarding the Urgency of Childbirth 6. How far along are you? 7. Water Broke? Or mucous plug? Any bleeding? If they saw the amniotic fluid was it clear 8. Tell me about the contractions 9. Do you feel the need to push or have a B. M. 10. Questions for  Para  Gravida Questions Regarding Possible Complications 11. Previous complications with child birth 12. Have you been seeing your doctor? Who is your doctor? And have you been taking meds? 13. Use of drugs or ETOH during Pregnancy? 14. Hx of  Gestational Diabetes?  Twins?  C-section?  Placenta previa 15. History Allergies,  Medical Hx, Medications Management 16. Position and Oxygen possible IV if time / # of people permit 17. Check for crowning and prolapsed cord 18. Check to see if amniotic sac in the way and fix it if it is intact. If amniotic fluid is present is it

clear (looking for meconium) Abnormal Delivery This area is worth 5 points Breech Prolapsed Cord Multiple births Continues with delivery Checks for pulsation of the cord Provides airway for neonate if birth Pushes baby’s head up/off cord Knows that cord should still be cut

is prolonged Immediate transport Second delivery may be breech Proper positioning

Total needed to pass: 40 Total ____ / 23

Instructors name (printed) Pass / Fail

Initials

GLEMSA/DU Skill Sheet Name ______

General Medical Complaint Leader Team

First 60 seconds 1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) (AF) 2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) (AF) 3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) (AF) 4. Good Introduction Basic History 5. History Allergies,  Medical Hx, Medications (AF) 6. Onset: “what were you doing when it started?” 7. Provocation/palliation: “does anything make it better or worse?” 8. Time: “When did it start and has it been constant?” 9. Follow up questions: “What do you think it is?” “Been short of breath like this before?” Differential Diagnosis 10. Organized and thorough assessment and integrated findings to expand the assessment  Nausea or have you vomited?  Recent Trauma?  Running a fever?  Sickness? Fever? Productive cough?  Smoker?  Risk factors for P.E.  Anxiety/psychiatric problems?  Bowels/ Stool been normal?  Alcohol or illicit drugs?  Bladder/ Urine been normal?  Any history of surgeries?  Physical Exam 11. Lung sounds. (AF) 12. Palpate abdomen. 13. Blood sugar check 14. Temperature 15. Distal extremities for edema and JVD. 16. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 17. Position, Oxygen and IV(AF) 18. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

standard questioning / assessment needs to occur prior to administration(AF) 19. Moved patient appropriately 20. Provided effective radio report to hospital(AF) Affective 21. Uses proper non-verbal communication(AF) 22. Uses patient’s name and gives Empathy statements(AF) 23. Communicated thoughts/rationale of clinical impression and treatment plan to patient 24. Looks confident, makes the patient feel at ease. (AF) Total needed to pass: 40 Total ___ / 48 Instructors name (printed) Pass / Fail

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Date Date Date Orthopedic Injuries

Joint or Long bone fracture (J=Joint and L= Long bone) Upper or Lower extremity (U=Upper and L=Lower)

Traction Splint (T)

1. “Scene is safe and standard precautions”

2. Asks about general impression of patient (anxiety, position, age, LOC etc)

3. Completes Initial assessment (ABCs and mental status)

4. Asks questions regarding M.O.I.

5. Directs application of manual stabilization of the joint / extremity

6. Removes all clothes from around injury (verbalized when appropriate)

7. Assess PMS (actually checks not verbalized) Examiner: “PMS is normal.” 8. Selects proper splinting material

9. Immobilizes the bone above and below the injury

10. Reassess PMS (actually checks not verbalized) Examiner: “PMS is still normal.” 11. Talks to the patient throughout the scenario

12. Gains a SAMPLE history

13. Gives the patient on statement of empathy regarding situation QUESTIONS 14. Name 6 of the principles of splinting.

15. What would you do to care for an open fracture

16. Later, patient complains of numbness and tingling. What do you do? CRITICAL CRITERIA Did not support the joint during immobilization    Did not properly immobilize the joint    Did not check PMS before or after the skill   

Total needed to Pass 26 Points: ___/32 ___/32 ___/32 Pass / Fail:

1. Instructor: ______2. Instructor: ______Initials: 3. Instructor ______

GLEMSA/DU Skill Sheet Name ______

Date: Date: Bleeding Control and Shock Management

Start: Time

1. Takes, or verbalizes, body substance isolation precautions (AF) 2. Initial Assessment (General Impression and ABCs) 3. Asks about MOI as approaching patient (AF) 4. Has someone hold C-spine (if the MOI suggests c-spine injury) 5. Applies direct pressure to the wound with gloved hand (no delay) (AF) “The wound continues to bleed”. 6. Applies tourniquet 7. Dresses and bandages wound “The patient is now showing signs and symptoms of Shock”. 8. States the need for rapid transport to hospital 9. Properly positions the patient (trendelenberg) 10. Administers high concentration oxygen (AF) 11. Initiates steps to prevent heat loss from the patient (AF) 12. Completes secondary survey (head-to-toe) 13. Talks to patient (SAMPLE and empathy statement) 14. Takes vital signs 15. Initiates transport and establishes 1 or 2 IV during transport 16. Knows proper fluid bolus for controlled and uncontrolled bleeding (AF) 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   Total needed to pass: 18 Points: AF= Auto Fail or Critical Criteria Pass / Fail: ____/32 ____/32

Initials:

GLEMSA/DU Skill Sheet Name ______

Patient Management-Trauma Date Date 1. Scene safety and standard precautions (AF) 2. Asks specific questions about mechanism of injury (MOI) (height, weapons, speed, etc) 3. Determines the # of patients, and requests additional help if necessary 4. Considers stabilization of spine (AF) Initial Assessment / Primary Survey 1. Verbalizes general impression of the patient (major bleeding, position, acuity, age & sex etc) 2. Determines responsiveness/level of consciousness 3. If patient is awake, ask about chief complaint and MOI (“what happened?”) Spontaneous Breathing 4. A Any noises with respiration (AF) Impending airway problem (facial trauma or epistaxis) Breathing rate and tidal volume (AF) 5. B Sign of adequate breathing (AF) If there is any MOI or signs of difficult breathing – check neck and chest (AF) Pulse check Skin color and capillary refill (AF) 6. C Ensure control of any major bleeding (AF) Checks for major internal bleeding (quick check of abdomen, pelvis and femurs) (AF) 7. Initiates appropriate oxygen / ventilatory therapy (AF) 8. Identifies priority patients/makes transport decision (AF) Detailed Physical Examination / Secondary Survey 9. Head Assesses the head / face (eyes, ears, nose, mouth) Posterior sweep 10. Neck Anterior  JVD  Trachea midline  obvious trauma  Expose  Inspect  Palpates  checks Lung Sounds 11. Chest Have patient take a breath while holding rib cage 12. Abdomen  Expose  Inspect  Palpate 13. Back Checks back immediately when necessary (MOI suggests injury) 14. Pelvis DCAP BTLS TIC Genital sweep (priapism, wetness, blood) 15. Femurs DCAP BTLS TIC Legs – DCAP, BTLS, TIC, Check PMS) 16. Extremities Arms – DCAP, BTLS, TIC, Check PMS) 17. Vital signs:  Pulse  Blood Pressure  Resp. 18. A.M.P.L.E.  Allergies  Medications  History Last meal Management 19. Manages primary and secondary njuries appropriately (AF) 20. Radio Report:  MOI Assessment Treatment Clear and Concise 35 points needed to pass skill evaluation Points: ____/40 ____/40

AF= Auto Fail or Critical Criteria Pass / Fail: Initials:

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Preparatory Module Affective Evaluation Demographics Name Class Date

Evaluation Statements 1. Professionalism in the classroom Competent  Not yet competent 

Showing consideration to fellow students and the instructor by being quiet and participating in discussion at the appropriate times. Responding appropriately to questions. Does not have a problem turning pagers or phones off prior to class. Seems eager to learn. Comments:

2. Self-Motivation Competent  Not yet competent  Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence; accepting constructive feedback in a positive manner; taking advantage of learning opportunities Comments:

3. Appearance and Personal Hygiene Competent  Not yet competent  Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming. Comments:

4. Self-Confidence and Communication Competent  Not yet competent  Able to communicate thoughts, feelings, and rationale when questioned by the instructor or other students. Uses proper tone and volume of speech when discussing material. Speaks clearly; writing legibly; listening actively; adjusting communication strategies to various situations Comments:

5. Time Management Competent  Not yet competent  Consistent punctuality; completing tasks and assignments on time. Absenteeism and Tardiness Comments:

6. Respect Competent  Not yet competent  Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession. Comments:

Student’s Comments

Signature of Student Date Signature of Primary Instructor Date

GLEMSA/DU Skill Sheet Name ______

Cardiology Module Skills and Scenarios

GLEMSA/DU Skill Sheet Name ______

Date Date Laryngoscopic Intubation – Adult

1. Takes Standard Precautions (AF) (gloves and face shield or goggles)

2. Begins with Manual airway and BVM ventilations (AF)

3. Appropriately places adjunct airway maneuvers. (AF)

4. Ventilates with 100% oxygen. (AF)

5. Assembles and checks equipment. Light should be bright white and tight (AF) 6. Places patient’s head in the sniffing position (look over the fence, then drop the head back) (AF) 7. Blade is inserted slowly /carefully on the right side of the patient’s mouth and then the tongue is swept to the left. (AF) 8. Student verbalizes care to stay off teeth and be careful not to pinch tongue. Student pays close attention to insertion of blade. (AF) 9. Lifts laryngoscope forward to displace jaw without putting pressure on teeth. (do not touch the teeth or pinch the tongue) (AF) 10. Suctions the hypopharynx as necessary (most likely verbalized) 11. Lifts jaw at 45o angle to the ground, exposing glottis. (lift up and away without using teeth as a fulcrum) (AF) 12. Directly visualizes vocal cords, passes ETT through the glottic opening until distal cuff disappears beyond vocal cords. 13. Inflates distal cuff with 5-10 ml of air (until pilot balloon is firms)

14. Immediately used EDD

15. Attaches BVM with ETCO2 detector to ETT. 16. Checks for proper tube placement; equal bilateral breath sounds, symmetrical rise and fall of chest. (--) Epigastric sounds (AF) 17. Secures ETT with tape or commercial device. Does not let go of the tube until the tube is secured 29 points needed to pass skill evaluation Points: __/34 __/ 34 Pass / Fail Competency Level (If this was learner-led, mark “S”) 1. Instructor: ______2. Instructor: ______Initials:

GLEMSA/DU Skill Sheet Name ______

Ventilatory Management – Adult Date Date 1. Takes or verbalizes “Standard Precautions” AF 2. Opens the airway manually. Ventilates the patient within 30 seconds. AF 3. Ventilates patient at a rate of 8-12/minute with appropriate volumes 4. Attaches oxygen to bag-valve-mask device and connects to high flow oxygen 5. Asks about 1) compliance, 2) lung sounds, 3) SaO2 and 4) patient responsiveness “No gag reflex is present and patient accepts adjunct.” 6. Properly measures and inserts basic airway adjunct and continues to ventilate. “Compliance is normal, pulse @ 100 bpm, L.S. are clear and equal and that SpO2 is 85%....It is time to intubate the patient.” 7. Directs assistant to pre-oxygenate patient and selects proper equipment for intubation 8. Checks equipment for: Stylet positioned properly. Cuff does not leak (leaves syringe on

bulb), laryngoscope operational with bulb tight (white, bright & tight) 9. Have evaluator remove OPA, prepare the ETCO2, and count out loud to 30 Remove OPA and move out of the way when candidate is prepared to intubate 10. Positions head properly (sniffing position or hyperextension) AF 11. Inserts blade carefully 1) avoids pinching the lip, 2) slow approach to the proper position 12. Elevates mandible with proper technique. 13. Introduces ET tube and advances to proper depth, verbalizes: “The ETT is passing

through the vocal cords.” Inflates cuff to proper pressure and disconnects syringe. AF 14. Acknowledges depth of the ETT at the teeth and then again after tube is secured. AF 15. Ventilates (or directs ventilation of) patient within 30 seconds. AF 16. Confirms placement- listens bilaterally over each lung and over epigastrium. 17. Does not let go of the ETT until it is secured. 18. Knows alternate methods for checking placement (ETCO2, pulse oximetry, esophageal

detector, misting) “You see secretions in the tube and hear gurgling” 19. Pre-oxygenates patient. AF 20. Inserts catheter down ETT with no suction. Insert catheter until resistance is met and

withdraws. Applies suction while withdrawing the catheter. No longer then 5 seconds 21. Directs ventilation of the patient while suctioning water to flush catheter. Repeat as

necessary. Knows this procedure is supposed to be sterile Critical Criteria Failure to ventilate properly (depth, rate, O2) more than a 30 second delay at any time.   Uses laryngoscope as a fulcrum during intubation attempt or applies pressure to teeth.   Unable to state two additional methods of confirming/monitoring tube placement   Verbalizes (or through body language) lack of skill practice or confidence in the procedure.   36 points needed to pass skill evaluation Points: __/42 __/ 42 Pass / Fail Competency Level (If this was learner-led, mark “S”) 1. Instructor:______2. Instructor: ______Initials:

GLEMSA/DU Skill Sheet Name ______

Ventilatory Management-Pediatric Date Date 1. Takes or verbalizes “Standard Precautions” AF 2. Opens the airway and places pad under torso for proper sniffing position. AF 3. Begins ventilations at the proper rate and depth (12 to 20 breaths/min) 4. Elevates tongue, inserts simple adjunct (oropharyngeal). 5. Verbalizes suction should be available and to suction first if there is gurgling. “No gag reflex is present and patient accepts adjunct.” 6. Ventilates patient immediately with bag-valve-mask device (May add O2). 7. Candidate should ask about 1) chest rise w/ ventilation, 2) lung sounds, and 3) SpO2 “Ventilation is being performed without difficulty and that pulse oximetry indicates the patient ’s blood oxygen saturation is 88%” 8. Attaches oxygen to bag-valve-mask device and connects to high flow oxygen. After 30 seconds, “Breath sounds are present, equal bilaterally and it is time to intubate the patient.” 9. Directs assistant to pre-oxygenate patient and selects proper equipment for intubation. 10. Checks equipment for: stylette positioned properly, cuff is checked if the tube has a cuff.

laryngoscope operational with bulb tight (white, bright & tight). 11. Asks the evaluator to remove OPA, Prepare the ETCO2 detector, and count out loud to 30 Remove OPA and move out of the way when candidate is prepared to intubate 12. Positions head properly (sniffing position or hyperextension). AF 13. Inserts blade carefully 1) avoids pinching the lip, 2) slow approach to the proper position. 14. Elevates mandible with proper technique. Any amount of pressure on teeth or fulcruming

motion with Laryngoscope is an auto fail. AF 15. Introduces ET tube and advances to proper depth, “The ETT is passing through the vocal

cords.” Inflates cuff to proper pressure (if there is a cuff) and disconnects syringe. 16. Ventilates (or directs ventilation of) patient within 30 seconds. AF 17. Acknowledges depth of the ETT at the teeth and then again after tube is secured AF 18. Confirms placement listens bilaterally over each lung and over epigastrium. “What would you expect to hear?” 19. Knows answers to above question. 20. Secures Tube. Does not let go of the tube until it is secured. “Please demonstrate an additional method of verifying tube placement.” 21. Knows alternate methods for checking placement. (ETCO2, pulse oximetry, misting) Critical Criteria Failure to ventilate for a period of 30 seconds (including the beginning)   Failure ventilate properly [depth (chest rise), rate (12-20 bpm), O2 at the appropriate time].   Failure to provide good basic airway with towel roll under shoulders.   Uses teeth as a fulcrum during intubation attempt.   Verbalizes (or through body language) lack of skill practice or confidence in the procedure.   Poor technique that could result in trauma or missed intubations.   36 points needed to pass skill evaluation Points: __/42 __/ 42 Pass / Fail Competency Level (If this was learner-led, mark “S”) 1. Instructor:______2. Instructor: ______Initials:

GLEMSA/DU Skill Sheet Name ______

During this task assessment the student will be given a scenario where the patient is dead when they arrive or the patient is alive and goes into arrest soon after arrival.

Date Date Date Defibrillation

1. Confirms that the patient does not have “signs of life”

2. Assures adequate CPR if appropriate

3. Appropriately applies defibrillation pads 4. Charges defibrillator to appropriate level (verbalize level and sets

monitor to a level between 2 ad 10 joules)

5. I am clear…you are clear…everyone is clear….

6. Pushes shock button while watching over patient

7. Immediately starts CPR without trying to interpret rhythm

8. Knows the only rhythms that we always defibrillate

Passing score is = 13 Total ____ /16 ____ /16 ____ /16

Pass / Fail

Skill Level (If this was learner-led, mark “S” for student)

Initials of Evaluator

GLEMSA/DU Skill Sheet Name ______

During this task assessment the student will be given a scenario where the patient is in an unstable wide complex (V.T.) or unstable narrow complex (SVT).

Date Date Date Cardioversion 1. Confirms that the patient is unstable by the presence of one of the following: Low B/P, AMS, significant CP or SOB with Pulm. edema 2. Places defib/pacer pads on patient appropriately 3. Knows that if time permits an IV can be started and consider sedation

(2.5 of versed and 5 mg of M.S.)

4. Explains procedure to patient

5. Pushes synch and observes monitor for proper synch 6. Charges defibrillator to appropriate level (verbalize level and sets

monitor to a level between 2 ad 10 joules) 7. Knows that the AHA calls for the following Joules:  SVT: 50 joules

 Ventricular Tachycardia: as low as 100 joules  Atrial Fibrillation .: 120 joules biphasic

8. I am clear…you are clear…everyone is clear….

9. Pushes shock button while watching over patient (holds button)

10. Immediately evaluates rhythm for 3 seconds of asystole

11. Knows: a short period of asystole = cardioversion was successful. 12. Knows that if the shock was not successful the joules should be

“increased in a step wise fashion”

13. Checks for a pulse 14. Knows that when the patient is in a narrow complex rhythm the

medication after cardioversion would be a Ca++ Channel blocker 15. Knows that when the patient is in a wide complex rhythm the

medication after would be a procainamide, amiodarone, or lidocaine. Passing score is = 25 Total ____ /30 ____ /30 ____ /30

Pass / Fail

Skill Level (If this was learner-led, mark “S” for student)

Initials of Evaluator

GLEMSA/DU Skill Sheet Name ______

During this task assessment the student will be given a scenario where the patient is in a symptomatic and unstable bradycardia (sinus, junctional, or a block).

Date Date Date Transcutaneous Pacing 1. Confirms that the patient is in a symptomatic bradycardia by the

presence of one of a Low B/P or AMS 2. Knows that if time permits an IV can be started and consider sedation

(2.5 of versed and 5 mg of M.S.)

3. Explains procedure to patient

4. Pushes “Pacer” button

5. Observes the PPM screen comes up and assures that the rate is 70 or 80

6. Increases the milliamps slowly

7. Talks to patient about the uncomfortable nature of pacing

8. Observes for electrical capture

9. When there is electrical capture checks for mechanical capture (pulse) 10. Knows that if the B/P is still low (below 90 systolic) that the patient

should get a fluid bolus followed by a dopamine drip Passing score is = 13 Total ___ /20 ___ /20 ___ /20

Pass / Fail

Skill Level (If this was learner-led, mark “S” for student)

Initials of Evaluator

GLEMSA/DU Skill Sheet Name ______

Date Date Date Dynamic Cardiology Points

Start Time:

Takes or verbalizes standard precautions * 1 Asks about a general impression of the patient (from doorway) 1 Checks level of responsiveness 1 Checks ABCs (or CAB if patient appears to have no signs of life) 1 Attaches ECG monitor and/or applies pacer/defibrillation pads 1 Correctly interprets initial rhythm 2 Appropriately manages initial rhythm 2 Notes change in rhythm 1 Checks patient condition to include pulse and, if appropriate, BP 2 Correctly interprets second rhythm 2 Appropriately manages second rhythm 2 Notes change in rhythm 1 Checks patient condition to include pulse and, if appropriate, BP 1 Correctly interprets third rhythm 2 Appropriately manages third rhythm 2 Notes change in rhythm 1 Checks patient condition to include pulse and, if appropriate, BP 2 Correctly interprets fourth rhythm 2 Appropriately manages fourth rhythm 2 End Time: 29 1. Failure to deliver shock in a timely and safe manner. 2. Failure to order start or resume of CPR when appropriate. 3. Failure to order correct management of airway and oxygenation 4. Orders administration of an inappropriate drug or dosage.     ______5. Inappropriate use of pacing, cardioversion or defibrillation. 6. Misinterpretation of the any one of the rhythms. 7. Does not appear confident or hesitates too often. Student need 25 points to pass Points: 29 ___/29 ___/29 ___/29

Pass/Fail:

Initials:

GLEMSA/DU Skill Sheet Name ______

1. Date 2. Date 3. Date 4. Date Static Cardiology

Start Time: Interpretation: 1. ______3. ______1 1 1 1 2. ______4. ______Patient Care Plan: 1. ______2. ______2 2 2 2 3. ______4. ______Interpretation: 1. ______3. ______1 1 1 1 2. ______4. ______Patient Care Plan: 1. ______2. ______2 2 2 2 3. ______4. ______Interpretation: 1. ______3. ______1 1 1 1 2. ______4. ______Patient Care Plan: 1. ______2. ______2 2 2 2 3. ______4. ______

Interpretation: 1. ______3. ______1 1 1 1 2. ______4. ______

Patient Care Plan: 1. ______2. ______2 2 2 2 3. ______4. ______

End Time: 1. Failure to interpret one of the rhythm.     2. Orders inappropriate/wrong drug or drug dosage.

3. Does not follow current ACLS guidelines. ______4. Does not appear confident or hesitates too often. Student needs 10 points to pass Points: ____/12 ____/12 ____/12 ____/12 Pass/Fail:

Initials:

GLEMSA/DU Skill Sheet Name ______

In this station the student is presented with an IV that has already been initiated with a scenario that will require an IV Drip Medication. The administration of the medication will involve drawing up a medication from a vial/ampule and adding it to an IV bag. Then administering the IV drip medication. The station has a four (4) minute time limit.

Intravenous Drip Medications Date Date Date Date 1. Continuing to take /verbalizes “Standard Precautions.” (AF) 2. Assures IV is running with no signs of infiltration. 3. Asks patient about allergies and medications. 4. Checks selected medication: (student needs all 3 to get credit)

5.  proper medication  Expiration date  concentration. (AF) 6. Checks selected IV bag: (student needs all 3 to get credit)

 proper medication  Expiration date  concentration. (AF) 7. Calculates the volume of the medication to be injected into the bag. (AF) 8. Uses the correct syringe. 9. Verbalizes a second check of medication and IV fluid (all 3) (AF)

 proper med.  Expiration date  concentration 10. States “open sharp” when appropriate. (AF) 11. Assures aseptic technique when drawing up medication. 12. Prepares syringe with the appropriate amount of the medication. 13. Uses a safe practice while drawing up medication (no recapping needles) 14. Assures aseptic technique when placing medication into IV bag. Mixes

IV bag and spike the bag with minidrip (60) administration set 15. Documents the concentration of the drug in the IV bag on the IV bag 16. Verbalizes a third check of medication and IV fluid (all 3)

 proper medication  Expiration date  concentration 17. Hooks up the medication administration set to the mainline 18. The student should use a needleless system/technique if possible 19. Stops mainline IV flow (roller clamp). 20. Administers medication at appropriate IV drip rate. 21. Secures medication line to mainline near insertion site (one piece of tape). 22. Disposes of all material in proper container(s). (AF) 23. Verbalizes that the patent should be observed for the effect of the med. 24. Labels medication line near the main line with piece of tape. 25. Documents who, what, when, how, how much, and any changes. Failure to establish an IV drip within 4-minute time limit.     Contaminates equipment without correcting situation.     The student does not complete three (3) checks     Failure to dispose/verbalize disposal of needle in proper container.     Student needs 43 points to pass Points: ___/50 ___/50 ___/50 ___/50 AF= Auto Fail or Critical Criteria Pass/Fail: Initials:

GLEMSA/DU Skill Sheet Name ______

Date Date ACLS - Bradycardia

1. Takes or verbalizes Standard Precautions * 2. Asks about a General Impression of the patient (from doorway) 3. Checks Level of Responsiveness

4. Checks /Maintains ABCs (or CAB if patient appears to have no signs of life)

5. Good Introduction if appropriate and Positions patient 6. Attaches ECG Monitor and/or applies pacer/defibrillation pads

14. Transcutaneous Pacing patient as appropriate

15. Reassessment and continual Monitoring 16. Moved patient appropriately

17. Provides proper analgesia and sedation if required/appropriate ACLS Care ACLS 18. Knows that if there is capture with pacing and the patent continues to have low

B/P dopamine is indicated. 19. Provided effective radio report to hospital 20. Uses proper non-verbal communication. Uses patient’s name and gives

Empathy statements 1. Failure to deliver shock in a timely and safe manner. 2. Failure to order start or resume of CPR when appropriate. 3. Failure to order correct management of airway and oxygenation   4. Orders administration of an inappropriate drug or dosage. ______5. Inappropriate use of pacing, cardioversion or defibrillation. 6. Misinterpretation of the rhythm. 7. Does not appear confident or hesitates too often. Student need 34 points to pass Points: ___/40 ___/40

Pass/Fail:

Initials:

GLEMSA/DU Skill Sheet Name ______

Date Date ACLS - Tachycardia

1. Takes or verbalizes Standard Precautions * 2. Asks about a General Impression of the patient (from doorway) 3. Checks Level of Responsiveness

4. Checks /Maintains ABCs (or CAB if patient appears to have no signs of life)

5. Good Introduction if appropriate and Positions patient 6. Attaches ECG Monitor and/or applies pacer/defibrillation pads

7. Obtains Vital Signs and appropriate Physical Exam and monitoring devices Basic Care Basic 8. Correctly Interprets Initial rhythm 9. Patient History (SAMPLE and possibly OPQRST) 10. Oxygen via appropriate administration (N.C, NRB, BVM) 11. Starts an IV / IO and gives appropriate fluid bolus 12. Vagal Maneuvers 13. Adenosine 6 mg fast IV push, followed by 12 mg 14. Ca++ Channel blocker - SVT Cardizem .25mg/kg IV push Verapamil 2.5 – 5.0 mg followed by 5.0 – 10 mg 15. Ventricular antidysrhythmic Lidocaine 1.0 – 1.5 mf/kg followed by ½ dose and lidocaine drip

Pracainamide 20 -50 mg/min followed by procainamide drip Amiodarone 150 mg over 10 minutes. Repeat if needed 16. Synchronized Cardioversion at appropriate level 50-100 joules - SVT 100 Joules – Monomorphic VT ACLS Care ACLS 120 Joules – Atrial Fibrillation Defibrillation (asynchronized) for Torsades de Pointes 17. Reassessment and continual Monitoring Moved patient appropriately 18. Provides proper analgesia and sedation if required/appropriate 19. Knows that if there is capture with pacing and the patent continues to have low

B/P dopamine is indicated. 20. Provided effective radio report to hospital

1. Failure to deliver shock in a timely and safe manner. 2. Failure to order start or resume of CPR when appropriate. 3. Failure to order correct management of airway and oxygenation   4. Orders administration of an inappropriate drug or dosage. ______5. Inappropriate use of pacing, cardioversion or defibrillation. 6. Misinterpretation of the rhythm. 7. Does not appear confident or hesitates too often. Student need 34 points to pass Points: ___/40 ___/40

Pass/Fail:

Initials:

GLEMSA/DU Skill Sheet Name ______

Date Date ACLS – Cardiac Arrest

1. Takes or verbalizes Standard Precautions * 2. Asks about a General Impression of the patient (from doorway) 3. Checks Level of Responsiveness

4. Checks /Maintains ABCs (or CAB if patient appears to have no signs of life)

5. If witnessed arrest – prioritizes defibrillation

If unwitnessed arrest – prioritizes compressions 6. Starts CPR in reasonable amount of time

Basic Care Basic 7. Attaches ECG Monitor and/or applies pacer/defibrillation pads 8. Provides Basic Airway that evolves to an adjunct and Advanced Airway 9. Starts an IV / IO and gives appropriate fluid bolus 10. Patient History from bystanders/family. What happened and down time.

Possibly SAMPLE 11. Defibrillation appropriate level every 2 minutes (if appropriate) 12. Epinephrine 1.0 mg every 3-5 minutes IVP (if appropriate) 13. Ventricular antidysrhythmic (if appropriate) Amiodarone 300 mg. followed by 150 mg

Lidocaine 1.0 – 1.5 mf/kg followed by ½ dose

Procainamide 100 mg every 5 minutes 14. Considers H’s and T’s 15. Switches out person doing compressions every 2-4 minutes

ACLS Care ACLS 16. Used capnography to maintain ALS airway and look for ROSC 17. Provides proper post arrest care (IV fluids, ventilation, possible drugs)

18. Moved Patient appropriately

19. Provided effective radio report to hospital

1. Failure to deliver shock in a timely and safe manner. 2. Failure to order start or resume of CPR when appropriate. 3. Failure to order correct management of airway and oxygenation   4. Orders administration of an inappropriate drug or dosage. ______5. Misinterpretation of the rhythm. 6. Does not appear confident or hesitates too often. Student need 32 points to pass Points: ___/38 ___/38

Pass/Fail:

Initials:

GLEMSA/DU Skill Sheet Name ______

Date Date Date 12-Lead ECG

1. Explains procedure to patient

2. Prepares the patient (shaving and cleansing as needed)

3. Places limb leads on the limbs

4. Places precordial leads at their appropriate locations: 5. Ensures the patient is sitting or lying still, breathing normally and not

talking

6. Obtains 12-lead ECG recording

7. Examines tracing for acceptable quality

8. Interprets 12-lead ECG to local standard and reports findings as needed 9. Voices repeating 12-lead ECG every 5 – 10 minutes in high risk patients

and post- treatment 10. Addresses modesty/privacy of the patient by keeping them covered

where appropriate Passing score is = 13 Total ___ /20 ___ /20 ___ /20

Pass / Fail

Skill Level (If this was learner-led, mark “S” for student)

Initials of Evaluator

GLEMSA/DU Skill Sheet Name ______

Shortness of Breath Leader Team

Instructors name (printed) Pass / Fail

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Leader Team Chest pain

13. Organized and thorough assessment and integrated findings to expand the assessment

50Instructors name (printed) Pass / Fail

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Cardiology Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Cardiology Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Cardiology Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Cardiology Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Cardiology Module Affective Evaluation Demographics Name Class Date

Evaluation Statements 1. Professionalism in the classroom Competent  Not yet competent 

3. Appearance and Personal Hygiene Competent  Not yet competent  Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming. Comments:

5. Time Management Competent  Not yet competent  Consistent punctuality; completing tasks and assignments on time. Absenteeism and Tardiness Comments:

6. Respect Competent  Not yet competent  Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession. Comments:

Student’s Comments

Signature of Student Date Signature of Primary Instructor Date

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Skills and Scenarios

GLEMSA/DU Skill Sheet Name ______

During this exercise the student should visualize the scene as a clinic or for a home health care setting. The student will be completing a thorough patient physical exam in order to relay that information to a provider. Completing a thorough patient physical exam such as this should take 15 to 20 minutes. The patient will most likely have a general illness of some sort and not require immediate intervention/ transportation. Track the time!

Date Date Date Comprehensive Adult Physical Exam

Initial General Impression Appearance 1. Speaks when approached 2. Facial expression / Anxiety 3. Skin color 4. Eye contact 5. Weight-estimated/translated to kg 6. Work of breathing 7. Posture, ease of movement Level of Consciousness/Mental Status 8. Person Place and Time Speech 9. Rate and Volume 10. Articulation and Fluency Memory 11. Short term (give the patient 3-4 objects to remember) 12. Long term (ask about something in the past) Vital signs 13. Blood pressure, Pulse, Respirations, Temperature, and Pulse Oximetry Secondary physical examination Skin / Integumentary 14. Colors-flushed, jaundiced, pallor, cyanotic 15. Moisture-dryness, sweating, oiliness 16. Temperature-hot or cool to touch -Take a temperature 17. Skin Turgor 18. Lesions-types, location, arrangement 19. Nails-condition, cleanliness, growth (discoloration , clubbing) Head and neck 20. Hair (falling out, greasy, dirty) 21. Scalp (flaking, dandruff, dirty) 22. Skull (intact) 23. Face (bones intact, acne, symmetry) 24. Have patient clinch teeth together and assess /palpate TMJ to check for symmetry

(CN V)

GLEMSA/DU Skill Sheet Name ______

25. Test the sensory aspect of CN V by having patient close their eyes and see if they can tell the difference between a paperclip and Q-tip when placed on forehead, cheek and mandible (the three branches of the trigeminal nerve) 26. Have the patient smile big, showing their front teeth. Then have them raise their eyebrows and puff out their cheeks Have them close both eyes tightly so you cannot open them. (checking symmetry) (CN VII) Eyes 27. Acuity-vision is clear and free of disturbance (CN II) 28. Symmetry (looking for drooping on one side (CN VII) 29. Appearance-color, iris clear 30. Pupils-size, reaction to light 31. Extraocular movements-up, down, both sides (CN III, IV, VI) Ears 32. External ear 33. Ear canal (otoscope looking at tympanic membrane) 34. Hearing-present/absent (CN VIII) Nose 35. Deformity 36. Air movement

37. Ability to smell (C.N. I) Mouth 38. Opens willingly Jaw tension 39. Mucosal color and Moisture Under the tongue 40. Teeth intact 41. Open wide and say: “AHH” Check uvula and malampati score (CN IX, X) Neck 42. Trachea-midline 43. Jugular veins-appearance with patient position Chest 44. Chest wall movement-expansion 45. Skin color-closed wounds 46. Open wounds 47. Presence/absence of pain 48. Auscultation-anterior and posterior 49. Heart Sounds Abdomen 50. Color, closed wounds, Scars 51. Open wounds 52. Size, symmetry, shape, Distention 53. Auscultation 54. Palpation-quadrants, masses, tenderness, rigidity

GLEMSA/DU Skill Sheet Name ______

Back 55. Color, closed wounds, Scars 56. Open wounds 57. Size, symmetry, shape 58. Palpation- tenderness along spine Pelvis 59. Stability 60. Male genitalia - Wounds, rashes, external lesions, Drainage 61. Female genitalia - Wounds, rashes, external lesions, Drainage, Bleeding Legs and Feet 62. Symmetry and Deformity 63. Range of motion 64. Skin color, Closed wounds, Open wounds 65. Pulses movement, strength and sensation Arms and Hands 66. Symmetry and Deformity 67. Range of motion 68. Skin color, Closed wounds, Open wounds 69. Pulses movement, strength and sensation Affective 70. Accepts evaluation and criticism professionally 71. Shows willingness to learn 72. Interacts with simulated patient and other personnel in professional manner,

i.e. uses appropriate name, explains procedures, maintains modesty You need to get 122 points /144 /144 /144 Time: 1. Evaluator ______ Student  instructor 2. Evaluator ______ Student  instructor Pass / Fail: 3. Evaluator ______ Student  instructor Initials

Comments 1.

GLEMSA/DU Skill Sheet Name ______

Date Date Date Comprehensive Patient History

1. Good introduction and positioning 2. Age, Weight, Sex 3. Reliability (do you trust the person providing the history) 4. Why did you call us? 5. Onset: “What were you doing when this started?” “Was it gradual or sudden?” 6. Provocation: “What brought this on?” “Does anything make it better or worse?” 7. Quality: “Please describe the pain” “has this changed since it began?” 8. Region and Radiation: “Point to where the pain is.” “Does the pain radiate?” 9. Severity: “Scale from 1-10” 10. Timing: “When did this begin?” 11. Setting Is there anything unique to place or events with this episode? 12. Treatments “Have you taken anything to treat this problem?” 13. Pertinent negatives Notes any signs or symptoms not present Does the provider consider a differential diagnosis and ask question to rule out illness/injuries 14. Converges Moves history from broad to focused to field impression. Does the provider as the associated symptoms questions to help confirm the diagnosis? Past Medical History 15. What does the patient say about his/her health? 16. Patient nutritional status. “How have you been eating?” 17. How has you bowel and bladder (bathroom habits been)? 18. Have you been sleeping well? 19. Female: “Tell me about your menstrual cycle” Award points for males 20. Female: “Is there any chance that you are pregnant?” Award points for males 21. “Do you have any habitual activities, such as drugs, alcohol or tobacco use?” Current Medications 22. “What prescribed medications do you currently take?” 23. “What over-the-counter medication or home remedies do you currently take?” 24. “When did you take your last does of medications?” 25. “Do you take all your medications as directed?” Adult Illnesses 26. “What other similar episodes were present?” 27. “Is this an acute or chronic illness?” 28. “What medical care do you currently receive for this illness?” 29. “What medical care do you currently receive for other illnesses?” 30. Allergies “Do you have any allergies to any medications, foods or other things?” 31. Operations What previous surgeries have you had?” 32. Environmental “Have you been living / working at a place with normal temps?”

GLEMSA/DU Skill Sheet Name ______

33. Family History Questions patient about pertinent family medical history 34. Psychological History Asks appropriate history questions based upon presentation Verbal report 35. Completes succinct report 36. Identifies pertinent findings (positives) and pertinent negatives 37. Organizes report in logical sequence (paints an appropriate picture for the patient Affective 38. Makes the patient feel comfortable 39. Uses good eye contact 40. Establishes and maintains proper distance 41. Uses techniques that show interest in the patient 42. Professional appearance 43. Takes notes of findings during history 44. Preferably uses open-ended questions 45. Follows patient lead to converge questions 46. Uses reflection to gain patient confidence 47. Shows empathy in a professional manner

Failure to take or verbalize appropriate PPE precautions    Failure to complete an appropriate history    Failure to obtain information for the proper assessment, diagnosis and management    You need to get 80 points /94 /94 /94 1. Evaluator Name ______ Student  instructor Time: Pass / 2. Evaluator Name ______ Student  instructor Fail: 3. Evaluator Name ______ Student  instructor Initials Comments

GLEMSA/DU Skill Sheet Name ______

Team Leader Evaluation – Scenario

Scenario Description Age Group • Adult • Geriatric • Pediatric Age ______Date Complaint/Problem ______

SCENE MANAGEMENT 1. Directs Team Members well (timely, prioritized) 2. Maintains accountability for team’s actions/outcomes 3. Demonstrates confidence, compassion, maturity and command presence 4. Maintains situational awareness 5. Addresses safety concerns and is safety conscious at all times (scene hazards, agitated bystanders, sharps handling, etc.) FLEXIBILITY 6. Adapts treatment plan and sequence as information becomes available, listens to teammates 7. Reconciles incongruent information (reassesses, asks again, engages family or medical record to confirm information, checks him or herself if delegated information doesn't fit presentation) COMMUNICATION 8. Uses closed-loop communication 9. Communicates accurately and concisely while listening and encouraging feedback 10. Advises patient of thoughts, feelings, rationale. Keeps everyone involved in treatment plan 11. Utilizes appreciative inquiry (speaking directly and respectfully, asks if others see anything else

that should be considered, solicits input and feedback from Team Members) AFFECT 12. Establishes basic rapport with the patient and interacts professionally with all on scene PATIENT ASSESSMENT AND MANAGEMENT CATEGORY 13. Addresses spinal stabilization, airway, ventilation, oxygenation, circulation and hemorrhage management early in scenario 14. Determines chief complaint, mechanism of injury, associated symptoms 15. Able to obtain an accurate history of present illness (HPI) using SAMPLE 16. Receives, processes, verifies and prioritizes information 17. Obtains vital signs and completes an appropriate physical exam 18. Creates an appropriate list of differential diagnoses 19. Makes accurate clinical judgments about patient acuity 20. Develops treatment plan and implements appropriate treatment 1. Failure to address safety concerns  2. Failure to function as a competent EMT  3. Failure to initiate care and create a reasonable treatment plan  4. Exhibits unacceptable affect with patient or other personnel  Student need 34 points to pass Points: ___/40 Pass/Fail: Evaluator Name ______ Student  instructor Initials:

Comments on Reverse side

GLEMSA/DU Skill Sheet Name ______

Team Member Evaluation – Scenario

Scenario Description Age Group • Adult • Geriatric • Pediatric Age ______Date Complaint/Problem ______

FOLLOWERSHIP 1. Able to follow orders /instructions 2. Maintains situational awareness COMMUNICATION 3. Uses closed-loop communication 4. Clarifies unclear or unsafe order/instructions 5. Immediately suggests corrective action is a harmful intervention is ordered/performed. 6. Advises leader of thoughts, feelings, rationale when appropriate 7. Does not ask patient questions without the “permission” from leader. 8. Communicates clearly with team leader and others on scene AFFECT 9. Demonstrates confidence, compassion and maturity 10. Does not try to “take over” the scene. PATIENT ASSESSMENT AND MANAGEMENT CATEGORY 11. Performs tasks in a timely manner 12. Performs skills in an acceptable manner  Basic Airway (NPA, OPA)  I.V. Start  Defibrillation  Splinting  Supraglottic Airway  Medication Admin  Cardioversion  Dressing and Bandage  Oral Intubation  I.O. Start  Pacing  KED  Nasal Intubation  IM or SQ injection  12-Lead  Backboard  BVM Ventilation  Nebulizer

 Surgical/Needle Cric  Intranasal 13. Reports progress on skills as appropriate 14. Anticipates the needs of the Team Leader 15. Able to help Team Leader when asked about thoughts on assessment/management 1. Failure to address safety concerns  2. Failure to function as a competent EMT  3. Failure to follow instructions to support a reasonable treatment plan  4. Exhibits unacceptable affect with patient or other personnel  Student need 18 points to pass Points: ___/24 Pass/Fail: Evaluator Name ______ Student  instructor Initials:

Comments on Reverse side

GLEMSA/DU Skill Sheet Name ______

Shortness of Breath Leader Team

First 60 seconds 23. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) (AF) 24. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) (AF) 25. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) (AF) 26. Good Introduction Basic History 27. History Allergies,  Medical Hx, Medications (AF) 28. Onset: “what were you doing when it started?” 29. Provocation/palliation: “does anything make it better or worse?” 30. Time: “When did it start and has it been constant?” 31. Follow up questions: “What do you think it is?” “Been short of breath like this before?” Differential Diagnosis 32. Organized and thorough assessment and integrated findings to expand the assessment

 Chest pain?  Have you been sick lately? Running a fever?  Nausea or have you vomited?  Smoker? COPD?  Trauma to the chest?  Anxiety problems? [This area is worth a total of 5 pts]  Productive cough?  Alcohol or illicit drugs?”?”  Risk factors for P.E.  “Any history of surgeries?” Physical Exam 33. Lung sounds. (AF) 34. Palpate abdomen. 35. Distal extremities for edema and JVD. 36. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 37. Position, Oxygen and IV(AF) 38. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

standard questioning / assessment needs to occur prior to administration(AF) 39. Moved patient appropriately 40. Provided effective radio report to hospital(AF) Affective 41. Uses proper non-verbal communication(AF) 42. Uses patient’s name and gives Empathy statements(AF) 43. Communicated thoughts/rationale of clinical impression and treatment plan to patient 44. Looks confident, makes the patient feel at ease. (AF) Total needed to pass: 38 Total ____ / 44

Instructors name (printed) Pass / Fail

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Leader Team Chest pain

First 60 seconds 26. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 27. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 28. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 29. Good Introduction Basic History 30. History Allergies,  Medical Hx, Medications 31. Onset: “what were you doing when it started?” 32. Provocation/palliation: “does anything make it better or worse?” 33. Quality: “Can you describe the pain?” 34. Region/radiation: “Can you point to the pain and does it go anywhere?” 35. Severity: “can you put it on a scale from 1 – 10?” 36. Time: “When did it start and has it been constant?” 37. Follow up questions: “What do you think it is?” “Have you ever had pain like this before?” Differential Diagnosis

38. Organized and thorough assessment and integrated findings to expand the assessment

 Short of breath?”  Sick lately? Running a fever?  Nausea / Vomiting  Have you had any problems with your bowel/Stools?”  Trauma to the chest?”  Any history of surgeries  Risk factors for cardiac  Changes in your diet [This area is worth a total of 5 pts]  History of GERD or GI problems  Risk factors for P.E Physical Exam 39. Lung sounds. 40. Palpate abdomen. 41. Distal extremities for edema and JVD. 42. Compare pulses in both radials to assess for thoracic aneurysm. 43. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate. Management 44. Position, Oxygen and IV 45. Aspirin, confirms no problem with aspirin and that there is no risk for internal bleeding 46. Nitroglycerine, confirms no ED meds and advises patient how the SL route works 47. Morphine, “sells” the medication to the patient. 48. Provided effective radio report to hospital Affective 49. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements 50. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 42 Total ____ / 50

50Instructors name (printed) Pass / Fail

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Leader Team Stroke

First 60 seconds 23. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 24. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 25. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 26. Good Introduction Basic History History Allergies,  Medical Hx, Medications 27. Onset: “what were you doing when it started?” 28. Time: “When were they last seen normal?” 29. Follow up questions: “What do you think it is?” “Has this happened before?” Cincinnati Stroke Scale 30. Speech: “you can’t teach….”,  Facial Droop,  Arm Drift (eyes closed)

MENDS Exam 31. Visual Fields (checks all four quadrants) 32. Horizontal Gaze (moves eyes back and forth)

33. Sensory feels touch in each extremity (eyes closed) 34. Coordination (finger to nose and heel to shin) Differential Diagnosis 35. Organized and thorough assessment and integrated findings to expand the assessment

 Any complaint of a headache or stiff neck  Been sick lately?  Running a fever? Feeling run down / tired?  Risk factors for cerebral embolism  Nausea or have you vomited  Risk factors for aneurysm (HTN)  Trauma to the head? [This area is worth a total of 5 pts]  Hx of seizures?  Medication, alcohol or illicit drugs Physical Exam 36. Check blood sugar 37. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate. 38. Repeat Cincinnati Stroke Scale Management 39. Position, Oxygen and IV 40. Proper IV fluid and/or drug administration 41. Moved Patient appropriately 42. Provided effective radio report to hospital Affective 43. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements 44. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 38 Total ____ / 44

Instructors name (printed) Pass / Fail

Initials

Comment 75

GLEMSA/DU Skill Sheet Name ______

Leader Team Altered Mental Status

First 60 seconds 20. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 21. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 22. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 23. Rapids Medical Assessment (quick head to toe looking for life threats) Pupils, JVD, Lung Sounds,

Palpate Abdomen, Any Signs of Trauma (with a Good Introduction) Basic History 24. History Allergies,  Medical Hx, Medications 25. Onset: “what were you doing when it started?” 26. Time: “When were they last seen normal?” Differential Diagnosis 27. Organized and thorough assessment and integrated findings to expand the assessment  Been sick lately?  Any complaint of a headache or stiff neck  Risk factors for cerebral embolism  Running a fever? Feeling run down / tired?  Risk factors for aneurysm (HTN)  Nausea or have you vomited  Trauma?  Trauma to the head? [This area is worth a total of 5 pts]  Hx of seizures?  Medication, alcohol or illicit drugs  Problems with bowel or bladder?  Depression or Psychiatric Hx Physical Exam 28. Lung sounds 29. Inspect and Palpate Abdomen 30. Check blood sugar 31. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate. Management 32. Position, Manage ABCs 33. Oxygen and IV 34. Proper IV fluid and/or drug administration 35. Moved Patient appropriately 36. Provided effective radio report to hospital Affective 37. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements 38. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 32 Total ____ / 38

Instructors name (printed) Pass / Fail Initials

Comment

GLEMSA/DU Skill Sheet Name ______

Leader Team Abdominal Pain

First 60 seconds 25. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 26. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 27. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 28. Good Introduction Basic History 29. History Allergies,  Medical Hx, Medications 30. Onset: “what were you doing when it started?” 31. Provocation/palliation: “does anything make it better or worse?” 32. Quality: “Can you describe the pain?” 33. Region/radiation: “Can you point to the pain and does it go anywhere?” 34. Severity: “can you put it on a scale from 1 – 10?” 35. Time: “When did it start and has it been constant?” 36. Follow up questions: “What do you think it is?” “Have you ever had pain like this before?” Differential Diagnosis

37. Organized and thorough assessment and integrated findings to expand the assessment

 Short of breath?”  Sick lately? Running a fever?  Nausea / Vomiting  Have you had any problems with your Bowel/Stools?”  Trauma to the Abdomen?”  Any history of surgeries  Risk factors for cardiac  Changes in your diet [This area is worth a total of 5 pts]  History of GERD or GI problems  Risk of pregnancy and the menstrual cycle Physical Exam 38. Lung sounds. 39. Inspect and Palpate abdomen. 40. Distal extremities for edema and JVD. 41. Compare pulses in both Feet to assess for aortic aneurysm. 42. EKG, Pulse Oximetry, and capnography (as appropriate). 12 lead or 15 lead if appropriate. Management 43. Position, Oxygen and IV 44. Proper fluid and/or drug administration 45. Moved patient appropriately 46. Provided effective radio report to hospital Affective 47. Uses proper non-verbal communication. Uses patient’s name and gives Empathy statements 48. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 40 Total ____ / 48

Instructors name (printed) Pass / Fail Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Anaphylaxis Leader Team

 Nausea or have you vomited?  Recent Trauma?  Anxiety/psychiatric problems?  Sickness? Fever? Productive cough?  Alcohol or illicit drugs?  Risk factors for P.E.

Physical Exam 10. Lung sounds. (AF) 11. Check trunk for Urticaria 12. Blood sugar check 13. Any problems with upper airway (hoarseness, difficulty in swallowing) 14. Distal extremities for edema 15. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 16. Position, Oxygen and IV(AF) 17. Early us of drugs in an appropriate (prioritized and timely) way. 18. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Module Affective Evaluation Demographics Name Class Date

Evaluation Statements 1. Professionalism in the classroom Competent  Not yet competent 

3. Appearance and Personal Hygiene Competent  Not yet competent  Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming. Comments:

5. Time Management Competent  Not yet competent  Consistent punctuality; completing tasks and assignments on time. Absenteeism and Tardiness Comments:

6. Respect Competent  Not yet competent  Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession. Comments:

Student’s Comments

Signature of Student Date Signature of Primary Instructor Date

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies I Skills and Scenarios

GLEMSA/DU Skill Sheet Name ______

Leader Team Childbirth - Normal

First 60 seconds 32. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 33. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 34. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 35. Good Introduction 36. Tell me more about your complaint why you called 911 Questions Regarding the Urgency of Childbirth 37. How far along are you? 38. Water Broke? Or mucous plug? Any bleeding? If they saw the amniotic fluid was it clear 39. Tell me about the contractions 40. Do you feel the need to push or have a B. M. 41. Questions for  Para  Gravida Questions Regarding Possible Complications 42. Previous complications with child birth 43. Have you been seeing your doctor? Who is your doctor? And have you been taking meds? 44. Use of drugs or ETOH during Pregnancy? 45. Hx of  Gestational Diabetes?  Twins?  C-section?  Placenta previa 46. History Allergies,  Medical Hx, Medications Management 47. Position and Oxygen possible IV if time / # of people permit 48. Check for crowning and prolapsed cord 49. Check to see if amniotic sac in the way and fix it if it is intact. If amniotic fluid is present is it clear

(looking for meconium) 50. Place hand against baby’s head and allow for gentle delivery 51. Suction  Mouth and then  Nose 52. Check for nuchal cord and fix it if there is a problem 53. Pull the anterior shoulder downward to clear the mother's symphysis pubis (as needed) 54. Deliver baby and suction again and begin drying off the baby 55. Tie/clamp the umbilical cord in two places and cut the cord when appropriate 56. Dry, warm, position, and suction as needed 57. Continue with appropriate neonatal resuscitation (as needed) 58. 1 minute and 5 minute APGAR 59. Note time of birth 60. Package mom up and assess for delivery of the placenta (lengthening of the cord) 61. Assess for excessive post-partum bleeding and treat appropriately 62. Inspect and Palpate abdomen. Total needed to pass: 52 Total ____ / 61

Instructors name (printed) Pass / Fail

Initials

Comments: 87

GLEMSA/DU Skill Sheet Name ______

Leader Team Childbirth - Abnormal

First 60 seconds 19. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) 20. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) 21. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) 22. Good Introduction 23. Tell me more about your complaint why you called 911 Questions Regarding the Urgency of Childbirth 24. How far along are you? 25. Water Broke? Or mucous plug? Any bleeding? If they saw the amniotic fluid was it clear 26. Tell me about the contractions 27. Do you feel the need to push or have a B. M. 28. Questions for  Para  Gravida Questions Regarding Possible Complications 29. Previous complications with child birth 30. Have you been seeing your doctor? Who is your doctor? And have you been taking meds? 31. Use of drugs or ETOH during Pregnancy? 32. Hx of  Gestational Diabetes?  Twins?  C-section?  Placenta previa 33. History Allergies,  Medical Hx, Medications Management 34. Position and Oxygen possible IV if time / # of people permit 35. Check for crowning and prolapsed cord 36. Check to see if amniotic sac in the way and fix it if it is intact. If amniotic fluid is present is it

is prolonged Immediate transport Second delivery may be breech Proper positioning ____ / Total needed to pass: 40 Total 23 Instructors name (printed) Pass / Fail

Initials

GLEMSA/DU Skill Sheet Name ______

Leader Team General Medical Complaint

First 60 seconds 25. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) (AF) 26. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) (AF) 27. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) (AF) 28. Good Introduction Basic History 29. History Allergies,  Medical Hx, Medications (AF) 30. Onset: “what were you doing when it started?” 31. Provocation/palliation: “does anything make it better or worse?” 32. Time: “When did it start and has it been constant?” 33. Follow up questions: “What do you think it is?” “Been short of breath like this before?” Differential Diagnosis 34. Organized and thorough assessment and integrated findings to expand the assessment  Nausea or have you vomited?  Recent Trauma?  Running a fever?  Sickness? Fever? Productive cough?  Smoker?  Risk factors for P.E.  Anxiety/psychiatric problems?  Bowels/ Stool been normal?  Alcohol or illicit drugs?  Bladder/ Urine been normal?  Any history of surgeries?  Physical Exam 35. Lung sounds. (AF) 36. Palpate abdomen. 37. Blood sugar check 38. Temperature 39. Distal extremities for edema and JVD. 40. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 41. Position, Oxygen and IV(AF) 42. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

standard questioning / assessment needs to occur prior to administration(AF) 43. Moved patient appropriately 44. Provided effective radio report to hospital(AF) Affective 45. Uses proper non-verbal communication(AF) 46. Uses patient’s name and gives Empathy statements(AF) 47. Communicated thoughts/rationale of clinical impression and treatment plan to patient 48. Looks confident, makes the patient feel at ease. (AF) Total needed to pass: 40 Total ___ / 48 Instructors name (printed) Pass / Fail

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Leader Team Overdose - Prescription

First 60 seconds 1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) (AF) 2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) (AF) 3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) (AF) 4. Good Introduction Basic Toxicology 1. What was taken? 2. How much was taken? 3. When was it taken? 4. Accurate weight of the patient Basic History 5. History Allergies,  Medical Hx, Medications 6. Tell me more about the poisoning / exposure 7. Is there anything else that was ingested / injected / taken? 8. Follow up questions: “Has this happened before?” Differential Diagnosis 9. Organized and thorough assessment and integrated findings to expand the assessment  Nausea or have you vomited?  Abdominal Pain? Chest pain?  Drugs or Alcohol?  Shortness of Breath?  Psychiatric/suicidal in the past? Physical Exam 10. Lung sounds and check skin (rash) 11. Pupils check and H-pattern test 12. Blood sugar check and Temperature 13. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 14. Proper Decontamination !! Position, Oxygen and IV(AF) 15. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

standard questioning / assessment needs to occur prior to administration(AF) Opiates Ca++ blocker Aspirin Beta blockers TCA APAP  BVM  Calcium  NaHCO3  Glucogon  NaHCO3  Mucomyst  Narcan  Glucogon (at E.R.) (at E.R.) (at E.R.) Affective 16. Uses proper non-verbal communication(AF) 17. Uses patient’s name and gives Empathy statements(AF) 18. Communicated thoughts/rationale of clinical impression and treatment plan to patient 19. Looks confident, makes the patient feel at ease. (AF) Total needed to pass: 34 Total ___ / 40 Instructors name (printed) Pass / Fail

Initials

GLEMSA/DU Skill Sheet Name ______

Leader Team Toxic Exposure

First 60 seconds 1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) (AF) 2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) (AF) 3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) (AF) 4. Good Introduction Basic Toxicology 5. What was the toxic substance? Asks about MSDSs or Placards / Labels 6. Assessment of how the long the patient was exposed and concentration of substance 7. When did the exposure occur? 8. Accurate weight of the patient Basic History 5. History Allergies,  Medical Hx, Medications 6. Tell me more about the poisoning / exposure 7. Is there anything else that was ingested / injected / taken? 8. Follow up questions: “Has this happened before?” Differential Diagnosis 9. Organized and thorough assessment and integrated findings to expand the assessment  Nausea or have you vomited?  Abdominal Pain? Chest pain?  Illicit drug or alcohol?  Shortness of Breath?  Psychiatric/suicidal in the past? Physical Exam 10. Lung sounds. (AF) 11. Pupils check and H-pattern test 12. Blood sugar check and Temperature 13. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 14. Position, Oxygen and IV(AF) 15. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

standard questioning / assessment needs to occur prior to administration(AF) Cyanide Organophophate CO Corrosives Hydrocarbons  Amyl nitrite  Atropine  Oxygen  No vomiting  No vomiting +  Na nitrite  2-PAM  Hyperbaric chamber  Pulm edema  Pulm edema  Na+ thiosulfate  EKG !  EKG !  Or Cyanokit Affective 16. Uses proper non-verbal communication(AF) 17. Uses patient’s name and gives Empathy statements(AF) 18. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 34 Total ___ / 40 Instructors name (printed) Pass / Fail

Initials

GLEMSA/DU Skill Sheet Name ______

Leader Team Overdose – Illicit Drugs

First 60 seconds 1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) (AF) 2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) (AF) 3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) (AF) 4. Good Introduction Basic Toxicology 9. What was taken? 10. How much was taken? 11. When was it taken? 12. Is there anything else that was ingested / injected / taken? Basic History 5. History Allergies,  Medical Hx, Medications 6. Tell me more about the poisoning / exposure 7. Is there anything else that was ingested / injected / taken? 8. Follow up questions: “Has this happened before?” Differential Diagnosis 9. Organized and thorough assessment and integrated findings to expand the assessment  Nausea or have you vomited?  Abdominal Pain? Chest pain? Shortness of Breath?  Drugs or Alcohol?  Psychiatric/suicidal in the past? Physical Exam 10. Lung sounds and check skin (rash) 11. Pupils check and H-pattern test 12. Blood sugar check and Temperature 13. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 14. Proper Decontamination !! Position, Oxygen and IV(AF) 15. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

standard questioning / assessment needs to occur prior to administration(AF) CNS stimulant Opiates CNS depressant Hallucinogen Methanol MDMA / X  EKG!  Narcan  BVM assist  Safety #1  ETOH  BVM support  Benzo is OK  Seizure  Calm / quiet  NaHCO3  hyperthermia  hyperthrmia precautions Affective 16. Uses proper non-verbal communication(AF) 17. Uses patient’s name and gives Empathy statements(AF) 18. Communicated thoughts/rationale of clinical impression and treatment plan to patient Total needed to pass: 33 Total ___ / 38 Instructors name (printed) Pass / Fail

Initials

GLEMSA/DU Skill Sheet Name ______

Leader Team Abdominal Pain

13. Organized and thorough assessment and integrated findings to expand the assessment

Instructors name (printed) Pass / Fail Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Leader Team Behavioral Emergency

First 60 seconds 1. Assess the scene and take deliberate actions to stay safe. Standard precautions (gloves) (AF) 2. As I approach the patient, what do I see (stable/unstable, age, anxiety, position) (AF) 3. Initial Assessment (quick assessment of ABCs and AVPU, and ABCs) (AF) 4. Good Introduction Basic History 5. History Allergies,  Medical Hx, Medications (AF) 6. Onset: “what were you doing when it started?” 7. Provocation/palliation: “does anything make it better or worse?” 8. Time: “When did it start and has it been constant?” 9. Follow up questions: “What do you think it is?” “Been short of breath like this before?” Differential Diagnosis 10. Organized and thorough assessment and integrated findings to expand the assessment  Nausea or have you vomited?  Running a fever?  Recent Trauma?  Smoker?  Sickness? Fever? Productive cough?  Anxiety/psychiatric problems?  Bowels/ Stool been normal?  Alcohol or illicit drugs?  Bladder/ Urine been normal?  Any history of surgeries?  Physical Exam 11. Lung sounds. (AF) 12. Palpate abdomen. 13. Blood sugar check 14. Temperature 15. Distal extremities for edema and JVD. 16. EKG, Pulse Oximetry, and capnography and 12-lead (as appropriate). (AF) Management 17. Position, Oxygen and IV(AF) 18. Proper fluid and/or drug administration. The drug and drug dose has to be appropriate and the

Initials

Comments:

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies II Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies II Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies II Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies II Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies II Module Testing (NREMT)

GLEMSA/DU Skill Sheet Name ______

Medical Emergencies II Module Affective Evaluation Demographics Name Class Date

Evaluation Statements 1. Professionalism in the classroom Competent  Not yet competent 

3. Appearance and Personal Hygiene Competent  Not yet competent  Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming. Comments:

5. Time Management Competent  Not yet competent  Consistent punctuality; completing tasks and assignments on time. Absenteeism and Tardiness Comments:

6. Respect Competent  Not yet competent  Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession. Comments:

Student’s Comments

Signature of Student Date Signature of Primary Instructor Date

100

GLEMSA/DU Skill Sheet Name ______

Trauma Module Skills and Scenarios

101

GLEMSA/DU Skill Sheet Name ______

Date Date Date Orthopedic Injuries

Joint or Long bone fracture (J=Joint and L= Long bone) Upper or Lower extremity (U=Upper and L=Lower)

Traction Splint (T)

17. “Scene is safe and standard precautions”

18. Asks about general impression of patient (anxiety, position, age, LOC etc)

19. Completes Initial assessment (ABCs and mental status)

20. Asks questions regarding M.O.I.

21. Directs application of manual stabilization of the joint / extremity

22. Removes all clothes from around injury (verbalized when appropriate)

23. Assess PMS (actually checks not verbalized) Examiner: “PMS is normal.” 24. Selects proper splinting material

25. Immobilizes the bone above and below the injury

26. Reassess PMS (actually checks not verbalized) Examiner: “PMS is still normal.” 27. Talks to the patient throughout the scenario

28. Gains a SAMPLE history

29. Gives the patient on statement of empathy regarding situation QUESTIONS 30. Name 6 of the principles of splinting.

31. What would you do to care for an open fracture

32. Later, patient complains of numbness and tingling. What do you do? CRITICAL CRITERIA Did not support the joint during immobilization    Did not properly immobilize the joint    Did not check PMS before or after the skill   

Total needed to Pass 26 Points: ___/32 ___/32 ___/32 Pass / Fail:

1. Instructor: ______2. Instructor: ______Initials: 3. Instructor ______

102

GLEMSA/DU Skill Sheet Name ______

Date: Date: Bleeding Control and Shock Management

Start: Time

17. Takes, or verbalizes, body substance isolation precautions (AF) 18. Initial Assessment (General Impression and ABCs) 19. Asks about MOI as approaching patient (AF) 20. Has someone hold C-spine (if the MOI suggests c-spine injury) 21. Applies direct pressure to the wound with gloved hand (no delay) (AF) “The wound continues to bleed”. 22. Applies tourniquet 23. Dresses and bandages wound “The patient is now showing signs and symptoms of Shock”. 24. States the need for rapid transport to hospital 25. Properly positions the patient (trendelenberg) 26. Administers high concentration oxygen (AF) 27. Initiates steps to prevent heat loss from the patient (AF) 28. Completes secondary survey (head-to-toe) 29. Talks to patient (SAMPLE and empathy statement) 30. Takes vital signs 31. Initiates transport and establishes 1 or 2 IV during transport 32. Knows proper fluid bolus for controlled and uncontrolled bleeding (AF) 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   Total needed to pass: 18 Points: AF= Auto Fail or Critical Criteria Pass / Fail: ____/32 ____/32

Initials:

103

GLEMSA/DU Skill Sheet Name ______

Patient Management-Trauma Date Date MOI  Blunt Injury Penetrating Injury Burns Hemorrhagic Shock 1. Scene safety and standard precautions (AF) 2. Asks specific questions about mechanism of injury (MOI) (height, weapons, speed, etc) 3. Determines the # of patients, and requests additional help if necessary 4. Considers stabilization of spine (AF) Initial Assessment / Primary Survey 1. Verbalizes general impression of the patient (major bleeding, position, acuity, age & sex etc) 2. Determines LOC and asks about chief complaint and MOI (“what happened?”) Spontaneous Breathing 3. A Any noises with respiration (AF) Impending airway problem (facial trauma or epistaxis) Breathing rate and tidal volume (AF) 4. B Sign of adequate breathing (AF) If there is any MOI or signs of difficult breathing – check neck and chest (AF) Pulse check Skin color and capillary refill (AF) 5. C Ensure control of any major bleeding (AF) Checks for major internal bleeding (quick check of abdomen, pelvis and femurs) (AF) 6. Initiates appropriate oxygen / ventilatory therapy (AF) 7. Identifies priority patients/makes transport decision (AF) Detailed Physical Examination / Secondary Survey 8. Head Assesses the head / face (eyes, ears, nose, mouth) Posterior sweep 9. Neck Anterior  JVD  Trachea midline  obvious trauma  Expose  Inspect  Palpates  checks Lung Sounds 10. Chest Have patient take a breath while holding rib cage 11. Abdomen  Expose  Inspect  Palpate 12. Back Checks back immediately when necessary (MOI suggests injury) 13. Pelvis DCAP BTLS TIC Genital sweep (priapism, wetness, blood) 14. Femurs DCAP BTLS TIC Legs – DCAP, BTLS, TIC, Check PMS) 15. Extremities Arms – DCAP, BTLS, TIC, Check PMS) 16. Vital signs:  Pulse  Blood Pressure  Resp. 17. A.M.P.L.E.  Allergies  Medications  History Last meal Management 18. Manages primary and secondary njuries appropriately (AF) 19. Radio Report:  MOI Assessment Treatment Clear and Concise 35 points needed to pass skill evaluation Points: ____/40 ____/40

AF= Auto Fail or Critical Criteria Pass / Fail: Initials:

104

GLEMSA/DU Skill Sheet Name ______

Date Date Needle Decompression 1. Assembles Equipment:  16-14 gauge IV catheter, 2.75 – 3.0” (peds can be 2”)  10 mL syringe  4x4s  antiseptic solution  Tape

2. Palpates the chest locating the second intercostal space on the midclavicular line

3. Properly cleanses the insertion site with appropriate solution 4. Reconfirms the site of insertion and directs the needle over the top of the rib on the midclavicular line 5. Listens for a rush of air or watches for plunger in syringe to withdraw and aspirates air

6. Removes needle/syringe leaving only the catheter in place

7. Disposes of the needle in proper container

8. Stabilizes the catheter hub with 4x4s and tape 9. Reassesses adequacy of ventilation, lung sounds, blood pressure and pulse for improvement in patient condition

Passing score is = 15 Total ___ /18 ___ /18

Pass / Fail

Initials of Evaluator

105

GLEMSA/DU Skill Sheet Name ______

Date Date Needle Cricothyrotomy 1. Assembles Equipment:  Oxygen source capable of 50 PSI  Oxygen Tubing  Manual Jet ventilato device (“Y” connector or push button)  Large bore IV catheter  10 -20 mL syringe  3.0 mm ETT adaptor 2. Places the patient supine and hyperextends the head/neck (neutral position if cervical spine injury is suspected)

3. Palpates neck locating the cricothyroid membrane

4. Cleanse the insertion site with appropriate solution 5. Stabilizes site and inserts needle through cricothyroid membrane at midline directing at a 45° angle caudally

6. Aspirates syringe to confirm proper placement in trachea

7. Advances catheter while stabilizing needle

8. Disposes of the needle in proper container 9. Attaches ventilation device and begins ventilation (1 sec for inflation, 2 sec for exhalation using jet ventilator, manually triggered ventilation device, BVM)

10. Secures catheter 11. Continues ventilation while observing for possible complications (subcutaneous emphysema, hemorrhage, hypoventilation, equipment failure, catheter kink) Passing score is = 18 Total ___ /22 ___ /22

Pass / Fail

Initials of Evaluator

106

GLEMSA/DU Skill Sheet Name ______

Date Date Nasal Intubation

1. Takes Standard Precautions (AF) (gloves and face shield or goggles)

2. Begins with Manual airway and BVM ventilations (AF)

3. Places adjunct airway maneuvers (NPA with Lidocaine use Neosynephrine (AF)

4. Ventilates with 100% oxygen. (AF)

5. Assembles and checks equipment.  Suction, ETT tube(s), Capnography, 10 cc syringe, water soluble jelly 6. Positions head – start with neutral, but nose, chin and sternum should be aligned

7. Inserts ET tube into selected nostril and guides it along the septum 8. Pauses to assure that tip of ET tube is positioned just superior to the vocal cords (visualizes misting in the tube, hears audible breath sounds from ET tube) 9. Instructs patient to take a deep breath ( or cough and then wait for breath) while passing ET tube through vocal cords 10. Inflates cuff to proper pressure and immediately removes syringe 11. If tube is not directed through the first attempt the head/neck can be flexed or extended and step 9 reapeated 12. Assists patient ventilations and confirms proper tube placement by auscultation bilaterally over lungs and over epigastrium; observes for misting in tube; listens for audible breath sounds from proximal end of ET tube; and assures that patient is aphonic (unable to make noises with their vocal cords) 13. Verifies proper tube placement by secondary confirmation such as capnography, capnometry, EDD or colorimetric device 14. Secures ET tube 15. Assists patient ventilations patient at proper rate and volume while observing capnography/capnometry and pulse oximeter 25 points needed to pass skill evaluation Points: __/30 __/ 30 Pass / Fail Competency Level (If this was learner-led, mark “S”) 1. Instructor: ______2. Instructor: ______Initials:

107

GLEMSA/DU Skill Sheet Name ______

Date Date Trauma Patient Intubation

1. Takes Standard Precautions (AF) (gloves and face shield or goggles)

2. Assures someone is holding manual C-Spine (neutral position)

3. Begins with Manual airway and BVM ventilations (AF)

4. Appropriately places adjunct airway maneuvers. (AF)

5. Ventilates with 100% oxygen. (AF)

6. Assembles and checks equipment. Light should be bright white and tight (AF) 7. Assures the team member holding C-spine continues to hold head and neck in neutral position (AF) 8. Understands this is a difficult intubation and a Bougie stylet may help 9. Blade is inserted slowly /carefully on the right side of the patient’s mouth and then the tongue is swept to the left. (AF) 10. Student verbalizes care to stay off teeth and be careful not to pinch tongue. Student pays close attention to insertion of blade. (AF) 11. Lifts laryngoscope forward to displace jaw without putting pressure on teeth. (do not touch the teeth or pinch the tongue) (AF) 12. Suctions the hypopharynx as necessary (most likely verbalized) 13. Lifts jaw at 45o angle to the ground, exposing glottis. (lift up and away without using teeth as a fulcrum) (AF) 14. Directly visualizes vocal cords, passes ETT through the glottic opening until distal cuff disappears beyond vocal cords. 15. Inflates distal cuff with 5-10 ml of air (until pilot balloon is firms)

16. Immediately used EDD

17. Attaches BVM with ETCO2 detector to ETT. 18. Checks for proper tube placement; equal bilateral breath sounds, symmetrical rise and fall of chest. (--) Epigastric sounds (AF) 19. Secures ETT with tape or commercial device. Does not let go of the tube until the tube is secured 31 points needed to pass skill evaluation Points: __/38 __/ 38 Pass / Fail Competency Level (If this was learner-led, mark “S”) 1. Instructor: ______2. Instructor: ______Initials:

108

GLEMSA/DU Skill Sheet Name ______

Trauma Module Testing (NREMT)

109

GLEMSA/DU Skill Sheet Name ______

Trauma Module Testing (NREMT)

110

GLEMSA/DU Skill Sheet Name ______

Trauma Module Testing (NREMT)

111

GLEMSA/DU Skill Sheet Name ______

Trauma Module Testing (NREMT)

112

GLEMSA/DU Skill Sheet Name ______

Trauma Module Testing (NREMT)

113

GLEMSA/DU Skill Sheet Name ______

Trauma Module Testing (NREMT)

114

GLEMSA/DU Skill Sheet Name ______

Trauma Module Affective Evaluation Demographics Name Class Date

Evaluation Statements 1. Professionalism in the classroom Competent  Not yet competent 

3. Appearance and Personal Hygiene Competent  Not yet competent  Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming. Comments:

5. Time Management Competent  Not yet competent  Consistent punctuality; completing tasks and assignments on time. Absenteeism and Tardiness Comments:

6. Respect Competent  Not yet competent  Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession. Comments:

Student’s Comments

Signature of Student Date Signature of Primary Instructor Date

115

GLEMSA/DU Skill Sheet Name ______

Operations and Review Module Skills and Scenarios

116

GLEMSA/DU Skill Sheet Name ______

Operations and Review Module Testing (NREMT)

117

GLEMSA/DU Skill Sheet Name ______

Operations and Review Module Testing (NREMT)

118

GLEMSA/DU Skill Sheet Name ______

Operations and Review Module Testing (NREMT)

119

GLEMSA/DU Skill Sheet Name ______

Operations and Review Module Testing (NREMT)

120

GLEMSA/DU Skill Sheet Name ______

Cardiology Module Testing (NREMT)

121

GLEMSA/DU Skill Sheet Name ______

Cardiology Module Testing (NREMT)

122

GLEMSA/DU Skill Sheet Name ______

Operations and Review Module Testing (NREMT)

123

GLEMSA/DU Skill Sheet Name ______

Operations and Review Module Testing (NREMT)

124

GLEMSA/DU Skill Sheet Name ______

Operations and Review Module Testing (NREMT)

125

GLEMSA/DU Skill Sheet Name ______

Affective Evaluation Demographics Name Class Date

Evaluation Statements 1. Professionalism in the classroom Competent  Not yet competent 

3. Appearance and Personal Hygiene Competent  Not yet competent  Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming. Comments:

5. Time Management Competent  Not yet competent  Consistent punctuality; completing tasks and assignments on time. Absenteeism and Tardiness Comments:

6. Respect Competent  Not yet competent  Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession. Comments:

Student’s Comments

Signature of Student Date Signature of Primary Instructor Date

126

GLEMSA/DU Skill Sheet Name ______

127