Fayetteville Technical Community College

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1 Fayetteville Technical Community College Detailed Assessment Report Emergency and Protective Services- Emergency Medical Technician (Paramedic) As of: 8/20/ :24 PM EST Mission / Purpose The purpose of the Emergency Medical Technician-Paramedic Program of Fayetteville Technical Community College, Continuing Education Department, is to establish and maintain qualified faculty, facilities, and staff to educate our students and provide the citizens of this state with competent, service-oriented Emergency Medical Technician - Paramedics. The program is designed to meet and achieve the educational and career goals of our students as they train to become assets in healthcare. Upon graduation, the program will have prepared the student for success in the North Carolina State and National Registry licensure exam. Student Learning Outcomes/Objectives, with Any Associations and Related Measures, Targets, Reporting Findings, and Action Plans SLO 1: Critical Thinking Students must be able to gather, interpret, and utilize available information in order to make accurate treatment decisions while caring for sick or injured patients. Relevant Associations: General Education/Core Curriculum Associations 2 Use critical thinking to analyze problems and make logical decisions. 4 Demonstrate quantitative competencies. InstitutionalGoals Associations 4 Focus on workforce preparedness to support economic development. Related Measures M 1: Critical Thinking What: Students must be able to gather, interpret, and utilize available information in order to make accurate treatment decisions while caring for sick or injured patients. Why: In order to demonstrate competency and workforce preparedness. How: 80% of the students must pass a minimum of three scenarios on their first attempt during the Technical Scope of Practice Testing during the assessment cycle.. Who: EMS instructors, paramedic level, will utilize the National Registry Skills Grade Sheets for each of the scenarios. When: Students will demonstrate their proficiency in critical thinking when they pass the scenario based Scope of Practice exam and skills. Source of Evidence: Performance (recital, exhibit, science project) Connected Documents Evaluation Form Dynamic Cardiology Evaluation Form Oral Station A Evaluation Form Oral Station B Evaluation Form Patient Assessment Trauma Evaluation Form Static Cardiology Evaluation Skill Forms for Evaluating Patient Assessment Skills Skill Check List for Pharmacology Skills and Performance Evaluation Skill Evaluation Check Forms for Evaluating Respiratory Skills Target: 80% of the students will pass on their first attempt in six scenarios for patient care in cardiology, trauma, respiratory emergencies, altered mental status to include pediatric and adult scenarios. Reporting Finding ( ) - Target: Met With 65 students being tested, 100% were successful in demonstrating the ability to detect, analyze, and treat any medical or traumatic emergency within any age group or gender of patients. Our instructors' competency and student knowledge again revealed another successful year. Connected Document Examination Results Reporting Finding ( ) - Target: Met This year we continued to strive for successful evaluation of our paramedic students in the National Registry and NC State practical skills exam. Our paramedic interns registered a 100% pass rate in 12/12 stations examined. Reporting Finding ( ) - Target: Met 100% of all Paramedic students were successful in demonstrating the ability to analyze a given a simulated emergency situation and determine the appropriate emergency medical care to be given to the patient. The end of course evaluation demonstrated 100% success with 48 students being tested using the National Registry Paramedic Practical Exam. No remediation was necessary due to the success on first attempt. Reporting Finding ( ) - Target: Met 100 Percent of all Paramedic students were successful and demonstrated ability to analyze a given emrgency situation and determine appropriate care to be administered to the patient. End of course evaluation at the National Registry Paramedic Practical Exam demonstrated 100% success with 20 students

2 testing. No remediation was needed due to success on first attempt. Reporting Finding ( ) - Target: Met Assessment summary for Lab demonstration in the EMT-P Program demonstrated that 20 students test and passed the North Carolina Office of EMS State and the National Registry Paramedic Exam with 100% Pass rate. No remediation was needed due to success on first attempt. SLO 2: Technical Competence and Readiness Students are required to be technically sound at all skill levels in preparation to enter the work force. Relevant Associations: General Education/Core Curriculum Associations 1 Communicate effectively using the conventions of American Standard English in professional and academic environments. 2 Use critical thinking to analyze problems and make logical decisions. 4 Demonstrate quantitative competencies. InstitutionalGoals Associations 4 Focus on workforce preparedness to support economic development. StrategicObjectives Associations FTCC 44 Enhance outreach to business/industry to understand and define existing and future workforce training needs. Related Measures M 2: Technical Competence and Readiness What: Students must be technically competent in order to practice at the EMT-Paramedic level. Why: To provide the EMS workforce with qualified and competent Paramedics. How: This measure will be assessed by standardized examinations utilizing the National Registry skills requirements and also the North Carolina Office of Emergency Medical Services skills. The results will be retrieved from the National Registry website and the North Carolina Office of Emergency Services. When: At the end of the assessment cycle, with results available through the National Registry Web Site and North Carolina Office of EMS web site within five days of the skills and written exams. Who: The Lead Instructor for the course. Source of Evidence: Certification or licensure exam, national or state Target: 80% of students will successfully pass the NC State OEMS Paramedic Exam on their first attempt. 70% of students will successfully pass the National Registry Paramedic written exam on their first attempt. Reporting Finding ( ) - Target: Met Of the 65 students graduating our program, the pass rate for the NCOEMS state exam of 94% reveals another considerable improvement and an envious percentage across the state. Due to the fact that a number of students were military and only tested National Registry, our pass rate was 89% on that exam, still higher than the national average of 66%. Connected Document Examination Results Reporting Finding ( ) - Target: Met Of the 26 paramedic interns that completed our courses, 24 successfully passed the NC state written exam on the first attempt, which leaves a pass rate of 90%, one of the highest in the state. Reporting Finding ( ) - Target: Met Of the 20 Paramedic students that completed this course successfully and elected to take the North Carolina Office of EMS State certification exam, 18 passed on their first attempt, resulting in a 90% pass rate of all first time test takers. Outcomes and objectives met with no remediation or changes in program required at this time. Reporting Finding ( ) - Target: Met 100 Percent of the Paramedic Students that completed the program with success tested with the North Carolina Office of EMS State Paramedic Exam. 20 Paramedic Students tested and 20 Paramedic Students passed first attempt, which resulted in 100 percent Pass Rate. Outcomes and Objectives met with no remediation or changes in program required. Reporting Finding ( ) - Target: Met Success of the NC State OEMS EMT-Paramedic Test resulted in 20 student attempting the test on first attempt with all 20 students successfully passing the exam with 100% pass rate for the year. No remediation was noted due to 100% pass rate on first attempt. SLO 3: Professional Communication Students must be able to communicate utilizing professional language and written skills while interacting with other healthcare professionals and the general public. Relevant Associations: General Education/Core Curriculum Associations 1 Communicate effectively using the conventions of American Standard English in professional and academic environments. 2 Use critical thinking to analyze problems and make logical decisions. 4 Demonstrate quantitative competencies. InstitutionalGoals Associations 4 Focus on workforce preparedness to support economic development.

3 Related Measures M 3: Professional Communication What: Students must be able to communicate utilizing professional language and written skills while interacting with other healthcare professionals and the general public. Why: In order to understand the needs of public, explain treatments and procedures to patients, and engage other healthcare professionals in continuing that care. How: By learning medical terminology, role-playing, scenarios, writing patient care reports, understanding disabilities and seeking other forms of non-conventional communication when necessary. When: Throughout the entire assessment cycle, during both didactic and clinical hours. Who: The Lead Instructor for the course. Source of Evidence: Performance (recital, exhibit, science project) Connected Documents Evaluation Form Bleeding Control and Shock Managment Evaluation Form Intravenous Therapy Evaluation Form Pediatric IO Evaluation Form Pediatric Ventilatory Management Evaluation Form Spinal Immobilization Seated Evaluation Form Spinal Immobilization Supine Evaluation Form Supraglottice Airway Device Evaluation Form Ventilatory Management Adult Patient Assessment Skills Evaluation Sheets Skill Evaluation Form for Immobilization with Traction Splint Target: 90% of students will receive satisfactory evaluations during clinical rotations. Reporting Finding ( ) - Target: Met An overview of our students' performance during clinical rotations revealed a 100% compliance by our students in professional communication. The fact that they were often invited and welcomed by the staff in the various hospital specialties and EMS systems reflects upon the reputation of our department and our students in the clinical settings. Connected Document Examination Results Reporting Finding ( ) - Target: Met 100% of our paramedic interns received a "successful" or "above successful" rating on their clinical hours which consisted of Cape Fear Valley Health Systems, (ED, ICU, NICU, L&D, Newborn Nursery, Peds, Cath Lab) also several EMS systems to include, Cape Fear Valley, Moore County, Harnett County, Robeson County, Med I, and Lumberton Rescue. No remediation was required due their success in the various clinical settings. Reporting Finding ( ) - Target: Met 100 percent of all paramedic students received a "satisfactory" or "above average" evaluation from evaluators and preceptors during clinical rotations as Cape Fear Valley Medical Center (Emergency Room, Operating Room, Intensive Care Units, Ambulance Service and Specialty Care Transport units. No remediation or changes made in program due to overall clinical success indicators and evaluations. Reporting Finding ( ) - Target: Met 100 percent of all students recieved a satisfactory or above average evaluation during clinical rotations at Hospital ( Emergency Room, Operating Room, Intensive Care Units, Ambulance Service, and Specilaty care transport units). No remediation or changes made in program due to success. Reporting Finding ( ) - Target: Met Through clinical rotations in hospital and local ambulance services the students were able to successfully master their skills while the different local ambulance services had the ability to evaluate the students themselves. Before the end of the class all 20 students had interviews to be hired based on the facts if they pass their NC OEMS State Paramedic Exam and National Registry Paramedic Exam. Another element that attracted the various ambulance services was that each student during their Paramedic class obtained specialty certifications ( Advanced Cardiac Life Support, Pediatric Advanced Cardiac Life Support and Advanced International Trauma Life Support). Out of 20 students all obtained employeement during the first 30 days after completing the Paramedic Class. 100% hired and all various agencies were 100% satified with student performance. SLO 4: Global Awareness Students will research various cultures and give an oral presentation on that culture to understand the effects of cultural differences on a patient care. Relevant Associations: General Education/Core Curriculum Associations 3 Demonstrate socialization skills that support cultural awareness and a global perspective. 4 Demonstrate quantitative competencies. InstitutionalGoals Associations 2 Establish a culture of quality customer service. Related Measures M 4: Global Awareness Project What: Each student will familiarize themselves with a culture and give a presentation on the specific cultural practices that could impact patient care and treatment. Why: So students gain a better understanding of the many different cultures they may encounter in the EMS field. How: Students will be able to utilize all open source material, and even interview cultural members, due to the vast number of cultures in our own area. When: This project will be completed during the assessment cycle. Who: The Lead Instructor for the course will monitor each student's project and evaluate the presentation based on a departmental rubric. Source of Evidence: Written assignment(s), usually scored by a rubric Connected Document Cultural Rubric

4 Cultural Rubric Target: Each student, or 100% of the class must identify a specific culture, relate the religious practices, family composition, daily life-style, diet, and beliefs that a Paramedic might encounter while in the field of EMS and how these cultural differences could impact patient communication, treatment, and transport. Reporting Finding ( ) - Target: Partially Met Even though cultural differences are discussed and covered within the course, it is noted that not all instructors emphasize this requirement. Due to the fact that so many of our students and instructors are culturally diversified themselves, it is apparent that more emphasis should be placed on how to manage this topic and how it relates to the EMS field. This could possibly be done partially through more role playing scenarios which emphasize the patient's cultural background as well as their illness or injury. Connected Document Course Syllabus Related Action Plans (by Established cycle, then alpha): For full information, see the Details of Action Plans section of this report. Standardized Syllabus with Designeated Rubric Established in Cycle: Our action plan will consist of a standardized syllabus for each paramedic course, regardless of the instructor, to include a ru... SLO 5: Computer Literacy Each student will be able to demonstrate computer literacy in preparedness for workplace readiness. Relevant Associations: General Education/Core Curriculum Associations 1 Communicate effectively using the conventions of American Standard English in professional and academic environments. 5 Demonstrate computer literacy. InstitutionalGoals Associations 4 Focus on workforce preparedness to support economic development. Related Measures M 5: Computer Literacy What: Each student will demonstrate computer literacy. Why: To demonstrate the ability to operate computers and software in the workplace as well as prepare for computer-based certification testing, and continued education. How: Student will write term papers, utilizing English, grammar, spelling and formats as well as completing online assignments and tests. When: Throughout the assessment cycle. Who: Grading will be completed by the Lead Instructor with the use of an approved rubric. Source of Evidence: Written assignment(s), usually scored by a rubric Connected Document Computer Literacy Matrix Target: 90% of the students will correctly format their papers and complete online writing and testing assignments. Reporting Finding ( ) - Target: Met We have established a requirement that all paramedic courses be listed online through Blackboard to include submission of reports and assignments through Blackboard. This requirement has proven to be an effective method of communication for the instructors as well as the students and provided an additional avenue to improve writing, reading, vocabulary, and exam skills. The students have access to their grades and assignments on a daily basis and instructors are able to add or subtract information without the traditional classroom. Due to the fact that the students are reunited with some basic computer and literacy skills, it makes them more valuable in the job market as professional paramedics where peers will be reviewing these skills daily. We report that 92% are computer literate upon graduation from our program. Connected Document Computer Literacy Details of Action Plans for This Cycle (by Established cycle, then alpha) Standardized Syllabus with Designeated Rubric Our action plan will consist of a standardized syllabus for each paramedic course, regardless of the instructor, to include a rubric for the cultural assignment. Established in Cycle: Implementation Status: Planned Priority: High Relationships (Measure Outcome/Objective): Measure: Global Awareness Project Outcome/Objective: Global Awareness Implementation Description: Implementation will begin August Responsible Person/Group: Joyce Pettengill Additional Resources: None Analysis Questions and Analysis Answers What were the strengths of your assessment process? During our present assessment process, our department has established designated dates and specific instructors for

5 practice and review of the course requirements in order to provide each student with the group and individual reinforcement they require prior to written and practical skills exams. What were the weaknesses of your assessment process? During some of our assessments, a distinct time factor became very relevant in reference to a few of the skills stations. We noted that due to the varying lengths of the stations, (some are five, ten, and fifteen minutes each), that students were not moving through the process in a timely and efficient manner. What was learned as a result of your assessment process? With some our assessments demonstrating a significant time lapse for the students, we recognized the need to add additional personnel and additional stations to keep the flow moving at a reasonable rate without taxing the skills examiners or the students. Dependent upon the quantity of students requiring testing, the department has added as many as three examiners for the same skill in order to provide a smooth transition from skill to skill for the students. The department also recognized the need to train additional personnel to handle the Director's and Coordinator's responsibilities should one or both be unable to attend on that specific assessment date. How will what was learned impact the direction and emphasis of your academic or support unit? This awareness has prompted our department to separate each skill individually. Therefore, an examiner only evaluates one skill per student at a time. With the addition of more examiners, equipment, and space we have been able to overcome the backlog that often occurred during this process, which in turn, left students anxious and examiners weary. The students now are able to move through the process in a more relaxed atmosphere with confidence, resulting in better evaluations overall for all of the participants. We feel that our department has developed a stronger process of assessment which reflects the integrity and notoriety of our program and our graduates throughout the state and nation. Annual Report Section Responses Program Review (Academic Units) Non-curricular programs are not required to have program reviews. Advisory Comm. Minutes (Academic Units) Non-curricular programs are not required to have advisory committee meeting minutes. End Of Year Reports (VPs, AVPs, Deans) End of Year Report ( ) and Strategic Plan ( ). Connected Documents End of Year Report ( ) Strategic Plan ( )

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11 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-1 Percussion Task: Perform percussion. Performance Observations: The candidate shall be able to correctly perform percussion. Candidate Directive: Properly perform percussion. No. Task Steps First Test Retest P F P F 1. Place your hand lightly against the surface to be examined. 2. Hyperextend the middle finger and apply firm pressure. 3. Strike the middle finger with one or two fingertips of the other hand. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

12 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-2 Assessing the Head Task: Assess the head. Performance Observations: The candidate shall be able to correctly assess the head. Candidate Directive: Properly assess the head. No. Task Steps First Test Retest P F P F 1. Visually inspect the head, looking for any obvious DCAP-BTLS. 2. Palpate the top and back of the head to locate any subtle abnormalities. 3. Part the hair in several places to examine the condition of the scalp. 4. Palpate the structure of the face noting any DCAP-BTLS. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

13 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-3 Examining the Eye Task: Examine the eye. Performance Observations: The candidate shall be able to correctly examine the eye. Candidate Directive: Properly examine the eye. No. Task Steps First Test Retest 1. Examine the exterior portion of the eye. 2. Measure visual acuity by having the patient count the number of fingers you are holding up at varying distances. 3. Test the pupils for their reaction to light. 4. Test for cranial nerve function by asking the patient to follow your fingers in a Z or H pattern. 5. Inspect the eyelids, lashes, and tear ducts. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

14 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-4 Eye Examination With an Ophthalmoscope Task: Examine the eye with an ophthalmoscope. Performance Observations: The candidate shall be able to correctly examine the eye with an ophthalmoscope. Candidate Directive: Properly examine the eye with an ophthalmoscope. No. Task Steps First Test Retest 1. Ask the patient to look straight ahead and focus on a distant object. 2. Use your right hand and eye to examine the patient s right eye; use your left hand and eye to examine the patient s left eye. 3. Place the scope to your eye and look into the patient s pupil from 10 to 20 away at a 45º angle to the eye. 4. Inspect for the size, color, and clarity of the disk. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

15 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-5 Examining the Ear With an Otoscope Task: Examine the ear with an otoscope. Performance Observations: The candidate shall be able to correctly examine the ear with an otoscope. Candidate Directive: Properly examine the ear with an otoscope. No. Task Steps First Test Retest 1. Place your hand firmly against the patient s head and gently grasp the patient s auricle. 2. Turn on the otoscope and insert the speculum into the ear. 3. Inspect the canal for any lesions or discharge. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

16 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-6 Examining the Neck Task: Examine the neck. Performance Observations: The candidate shall be able to correctly examine the neck. Candidate Directive: Properly examine the neck. No. Task Steps First Test Retest 1. If trauma is suspected, take precautions to protect the cervical spine. 2. Palpate the neck to find any structural abnormalities or subcutaneous air, and to ensure the trachea is midline. Begin at the suprasternal notch and work your way toward the head. 3. Assess the lymph nodes. 4. Assess the jugular veins for distention. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

17 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-7 Examining the Chest Task: Examine the chest. Performance Observations: The candidate shall be able to correctly examine the chest. Candidate Directive: Properly examine the chest. No. Task Steps First Test Retest P F P F 1. Inspect the chest for any obvious DCAP-BTLS. 2. Note the shape of the chest. 3. Auscultate the lung fields, noting any abnormal lung sounds. 4. Percuss the chest to detect any abnormalities. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

18 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-8 Auscultation of Heart Sounds Task: Auscultate heart sounds. Performance Observations: The candidate shall be able to correctly auscultate heart sounds. Candidate Directive: Properly auscultate heart sounds. No. Task Steps First Test Retest 1. Place the patient in a position that will bring the heart closer to the left anterior chest wall, such as sitting up and leaning slightly forward. 2. Place your stethoscope at the fifth intercostal space over the apex of the heart. 3. Ask the patient to breathe normally and hold the breath on inhalation. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date _ Candidate Date Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

19 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 13-9 Examining the Abdomen Task: Examine the abdomen. Performance Observations: The candidate shall be able to correctly examine the abdomen. Candidate Directive: Properly examine the abdomen. No. Task Steps First Test Retest 1. Inspect the abdomen for any DCAP-BTLS. 2. Auscultate the abdomen for bowel sounds. 3. Palpate the four quadrants of the abdomen in a systematic pattern, beginning with the quadrant farthest from the patient s complaint. 4. Note any tenderness or rigidity. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

20 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Examining the Musculoskeletal System Task: Examine the musculoskeletal system. Performance Observations: The candidate shall be able to correctly examine the musculoskeletal system. Candidate Directive: Properly examine the musculoskeletal system. No. Task Steps First Test Retest 1. Inspect the skin overlying the muscles, bones, and joints for soft-tissue damage. 2. Check for adequate distal pulse, motor, and sensation to each extremity. 3. Ask the patient flex and extend the joints of the fingers, hands, and wrist to establish range of motion. 4. Ask the patient to turn the hand from the palm-down position to the palm-up position and back again. 5. Inspect and palpate the shoulders. 6. Inspect and palpate the bony structures. 7. Ask the patient to point and bend the toes to establish range of motion. 8. Ask the patient to rotate the ankle, checking for pain or restricted range of motion. 9. Inspect and palpate the knee joints and patella. Ask the patient to bend and straighten both to establish range of motion. 10. Check for structural integrity of the pelvis by applying gentle pressure to the iliac crests and pushing in and then down. 11. Ask the patient to lift both legs, bending at the hip and then turning the legs inward and outward. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

21 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Examining the Peripheral Vascular System Task: Examine the peripheral vascular system. Performance Observations: The candidate shall be able to correctly examine the peripheral vascular system. Candidate Directive: Properly examine the peripheral vascular system. No. Task Steps First Test Retest 1. Note any abnormalities in the radial pulse, skin color, or condition. 2. If abnormalities are noted in the distal pulse, work your way proximally checking these pulse points and noting your findings. 3. Palpate the epitrochlear and brachial nodes of the lymphatic system, noting any swelling or tenderness. 4. Examine the lower extremities, noting any abnormalities in the size and symmetry of the legs. 5. Inspect the skin color and condition, noting any abnormal venous patterns or enlargement. 6. Check distal pulses. 7. Palpate the inguinal nodes for swelling or tenderness. 8. Evaluate for pitting edema in the legs and feet. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

22 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Examining the Spine Task: Examine the spine. Performance Observations: The candidate shall be able to correctly examine the spine. Candidate Directive: Properly examine the spine. No. Task Steps First Test Retest 1. Inspect the cervical, thoracic, and lumbar curves for any abnormalities. 2. Evaluate the heights of the shoulders and the iliac crests. 3. Palpate the posterior portion of the cervical spine, noting any point tenderness or structural abnormalities. 4. In the nontrauma patient, and in the absence of reported pain, ask the patient to move the head forward, backward, and from side to side. 5. Palpate each vertebra with the thumbs. 6. In the absence of pain or trauma, ask the patient to bend at the waist in each direction to establish the range of motion. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

23 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Examining the Nervous System Task: Examine the nervous system. Performance Observations: The candidate shall be able to correctly examine the nervous system. Candidate Directive: Properly examine the nervous system. No. Task Steps First Test Retest 1. Evaluate cranial nerve function. 2. Evaluate the patient s neuromuscular status by checking muscle strength against resistance. 3. Evaluate the patient s coordination by performing the finger-to-nose test using alternating hands. 4. If appropriate, test the patient s gait and balance by having the patient walk heel-to-toe or perform the heel-to-shin stance. 5. Perform the pronator drift test by asking the patient to close his or her eyes and hold both arms out in front of the body. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

24 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Evaluation of Deep Tendon Reflexes Task: Evaluate deep tendon reflexes. Performance Observations: The candidate shall be able to correctly evaluate deep tendon reflexes. Candidate Directive: Properly evaluate deep tendon reflexes. No. Task Steps First Test Retest 1. Place the patient in the sitting position. 2. Flex the patient s arm to a 45º angle at the elbow. Locate the biceps tendon in the antecubital fossa. Place your thumb over the tendon, with your fingers behind the elbow. Strike your thumb with the reflex hammer, noting the flexion of the elbow. 3. With the patient s arm remaining at a 45º angle, rest the patient s forearm on your arm with the hand slightly pronated. Strike the patient s brachioradialis tendon proximal to the wrist, noting the flexion of the elbow. 4. Flex the patient s arm at the elbow 90º and rest his or her hand against the body. Locate and strike the triceps tendon, noting contraction of the triceps or extension of the elbow. 5. Flex the patient s knee to 90º, allowing the leg to dangle. Support the upper leg with your hand, and strike the patellar tendon just below the patella. 5. With the patient s leg in the same position, hold the heel of the patient s foot in your hand. Strike the Achilles tendon. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

25 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-1 Spiking the Bag Task: Spike an IV bag. Performance Observations: The candidate shall be able to correctly spike an IV bag. Candidate Directive: Properly spike an IV bag. No. Task Steps First Test Retest 1. Pull on the rubber pigtail on the end of the IV bag to remove it. Remove the protective cover from the piercing spike. 2. Slide the spike into the IV bag until you see fluid enter the drip chamber. 3. Allow the solution to run freely through the drip chamber and into the tubing to prime the line and flush the air out of the tubing. 4. Twist the protective cover of the opposite end of the IV tubing to allow air to escape. Do not remove this cover yet. Let the fluid flow until air bubbles are removed from the line before turning the roller clamp wheel to stop the flow. 5. Check the drip chamber; it should be only half-filled. If the fluid level is too low, squeeze the chamber until it fills; if the chamber is too full, invert the bag and the chamber and squeeze the chamber to empty the fluid back into the bag. Hang the bag in an appropriate location. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

26 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-2 Obtaining Vascular Access Task: Obtain vascular access. Performance Observations: The candidate shall be able to correctly obtain vascular access. Candidate Directive: Properly obtain vascular access. No. Task Steps First Test Retest 1. Fill the drip chamber by squeezing it. 2. Flush or bleed the tubing to remove any air bubbles by opening the roller clamp. 3. Tear the tape before venipuncture, or have a commercial device available. 4. Apply gloves before making contact with the patient. Palpate a suitable vein. 5. Apply the constricting band above the intended IV site. 6. Clean the area using aseptic technique. Use an alcohol pad to cleanse in a circular motion from the inside out. Use a second alcohol pad to wipe straight down the center. 7. Choose the appropriately sized catheter, and examine it for any imperfections. 8. Insert the catheter at an angle of approximately 45º with the bevel up while applying distal traction with the other hand. 9. Observe for flashback as blood enters the catheter. 10. Occlude the catheter to prevent blood leaking while removing the stylet. 11. Immediately dispose of all sharps in the proper container. 12. Attach the prepared IV line. 13. Remove the constricting band. 14. Open the IV line to ensure fluid is flowing and the IV is patent. Observe for swelling or infiltration around the IV site. 15. Secure the catheter with tape or a commercial device. 16. Secure the IV tubing and adjust the flow rate while monitoring the patient. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

27 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-3 Determining Whether an IV Is Viable Task: Determine whether an IV is viable. Performance Observations: The candidate shall be able to correctly determine whether an IV is viable. Candidate Directive: Properly determine whether an IV is viable. No. Task Steps First Test Retest 1. Select and assemble a sterile 10-mL syringe and large-gauge needle. 2. Select an injection port near the IV site, and swab it with an alcohol wipe. Depress the plunger of the syringe, and insert the syringe into the port. 3. Pinch the line between the IV site and the port, and pull back on the plunger to draw clean IV fluid from the bag. 4. Once the syringe is full, leave it in place, switch your hand from the tubing between the port and the IV site to between the port and the IV bag, and pinch the line. Gently apply pressure to the plunger to disrupt the occlusion and reestablish flow. Ensure that the line is free and the rate is sufficient. If the occlusion does not dislodge, discontinue the IV and reestablish it in the opposite extremity or at a proximal location on the same extremity. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

28 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-4 IO Infusion Task: Perform an IO infusion. Performance Observations: The candidate shall be able to correctly perform an IO infusion. Candidate Directive: Properly perform an IO infusion. No. Task Steps First Test Retest 1. Check selected IV fluid for proper fluid, clarity, and expiration date. Select the appropriate equipment, including an IO needle, syringe, saline, and extension tubing. Select the proper administration set. Connect the administration set to the bag. Prepare the administration set, syringe, and extension tubing. 2. Take BSI precautions. 3. Identify the proper anatomic site for IO puncture. 4. Cleanse the site appropriately. Stabilize the tibia, and insert the needle at a 90º angle, advancing it with a twisting motion until a pop is felt. 5. Unscrew the cap, and remove the stylet from the needle. 6. Attach the syringe and extension set to the IO needle. Pull back on the syringe to aspirate blood and particles of bone marrow to ensure proper placement. Slowly inject saline to ensure proper placement of the needle. Watch for extravasation, and stop the infusion immediately if it is noted. Connect the administration set, and adjust the flow rate as appropriate. 7. Secure the needle with tape, and support it with bulky dressing. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

29 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-5 Administering Medication via the Gastric Tube Task: Administer medication via the gastric tube. Performance Observations: The candidate shall be able to correctly administer medication via the gastric tube. Candidate Directive: Properly administer medication via the gastric tube. No. Task Steps First Test Retest 1. Attach a 60-mL syringe to the proximal end of the gastric tube, and slowly inject air into the tube while auscultating over the epigastrium to confirm proper placement. For further confirmation of correct tube placement, aspirate with the syringe and observe for gastric contents. 2. Inject 30 to 60 ml of normal saline into the gastric tube to irrigate the tube. 3. Inject the appropriate amount of medication into the gastric tube. 4. Flush the gastric tube with 30 to 60 ml of normal saline to ensure dispersal of the drug into the stomach. 5. Clamp off the proximal end of the gastric tube; do not reattach the tube to suction. Monitor the patient for adverse reactions, and repeat the medication dose if indicated. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

30 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-6 Drawing Medication From an Ampule Task: Draw medication from an ampule. Performance Observations: The candidate shall be able to correctly draw medication from an ampule. Candidate Directive: Properly draw medication from an ampule. No. Task Steps First Test Retest 1. Gently tap the stem of the ampule to shake medication into the base. 2. Grip the neck of the ampule using a 4 x 4 gauze pad, and snap the neck off. 3. Without touching the outer sides of the ampule, insert the needle into the medication in the ampule, and draw the solution into the syringe. 4. Holding the syringe with the needle pointing up, gently tap the barrel to loosen air trapped inside. 5. Gently press on the plunger to dispel any air bubbles, and recap the needle using the one-handed method. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

31 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-7 Drawing Medication From a Vial Task: Draw medication from a vial. Performance Observations: The candidate shall be able to correctly draw medication from a vial. Candidate Directive: Properly draw medication from a vial. No. Task Steps First Test Retest 1. Check the medication and its expiration date. 2. Determine the amount of medication needed, and draw that amount of air into the syringe. 3. Invert the vial, and insert the needle through the rubber stopper. Expel the air in the syringe into the vial, and then withdraw the amount of medication needed. 4. Withdraw the needle, and expel any air in the syringe. 5. Recap the needle using the one-handed method. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

32 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-8 Administering Medication via the Subcutaneous Route Task: Administer medication via the subcutaneous route. Performance Observations: The candidate shall be able to correctly administer medication via the subcutaneous route. Candidate Directive: Properly administer medication via the subcutaneous route. No. Task Steps First Test Retest 1. Check the medication to ensure that it is the correct one, that it is not discolored, and that the expiration date has not passed. 2. Assemble and check the equipment. Draw up the correct dose of medication. 3. Using aseptic technique, cleanse the injection area. 4. Pinch the skin surrounding the area, and insert the needle at a 45º angle. Pull back on the plunger to aspirate for blood. If there is no blood, inject the medication, remove the needle, and hold pressure over the area. Immediately dispose of the needle and syringe in the sharps container. 5. To disperse the medication, rub the area in a circular motion. Monitor the patient s condition. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

33 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-9 Administering Medication via the Intramuscular Route Task: Administer medication via the intramuscular route. Performance Observations: The candidate shall be able to correctly administer medication via the intramuscular route. Candidate Directive: Properly administer medication via the intramuscular route. No. Task Steps First Test Retest 1. Check the medication to ensure that it is the correct one, that it is not discolored, and that its expiration date has not passed. 2. Assemble and check the equipment. Draw up the correct dose of medication. 3. Using aseptic technique, cleanse the injection area. 4. Stretch the skin over the area, and insert the needle at a 90º angle. Pull back on the plunger to aspirate for blood. If there is no blood, inject the medication and remove the needle. Immediately dispose of the needle and syringe in the sharps container. 5. To disperse the medication, rub the area in a circular motion. Monitor the patient s condition. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

34 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-10 Administering Medication via the Intravenous Bolus Route Task: Administer medication via the intravenous bolus route. Performance Observations: The candidate shall be able to correctly administer medication via the intravenous bolus route. Candidate Directive: Properly administer medication via the intravenous bolus route. No. Task Steps First Test Retest 1. Assemble and check the equipment. Cleanse the injection port, or remove the protective cap if using the needleless system. 2. Insert the needle into the port, and pinch off the IV tubing proximal to the administration port. Administer the correct dose at the appropriate rate. 3. Unclamp the IV line to flush the medication into the vein, allowing it to run briefly wide open, or flush with a 20-mL bolus of normal saline. Readjust the IV flow rate to the original setting, and monitor the patient s condition. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

35 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-11 Administering Medication via the IO Route Task: Administer medication via the IO route. Performance Observations: The candidate shall be able to correctly administer medication via the IO route. Candidate Directive: Properly administer medications via the IO route. No. Task Steps First Test Retest 1. Check the medication to ensure that it is the correct one, that it is not discolored, and that the expiration date has not passed. Assemble the equipment, and draw up the medication. Draw up 20-mL of normal saline for a flush. 2. Cleanse the injection port, or remove the protective cap if using the needleless system. 3. Insert the needle into the port, and pinch off the IV tubing proximal to the administration port. Administer the correct dose at the proper push rate. 4. Unclamp the IV line to flush medication into the vein, allowing it to run briefly wide open, or flush with a 20-mL bolus of normal saline. Readjust the IV flow rate to the original setting, and monitor the patient s condition. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

36 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-12 Administering Medication via the Sublingual Route Task: Administer medication via the sublingual route. Performance Observations: The candidate shall be able to correctly administer medication via the sublingual route. Candidate Directive: Properly administer medication via the sublingual route. No. Task Steps First Test Retest 1. Check the medication for drug type and expiration date, and determine the appropriate amount for the correct dose. Have the patient rinse his or her mouth with a little water if the mucous membranes are dry. 2. Explain the procedure to the patient, and ask the patient to lift his or her tongue. Place the tablet or spray the dose underneath the tongue, or have the patient do so. Advise the patient not to chew or swallow the tablet, but to let it dissolve slowly. Monitor the patient, and document the medication given, the route, administration time, and the response of the patient. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

37 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 8-13 Administering a Medication via Small-Volume Nebulizer Task: Administer a medication via small-volume nebulizer. Performance Observations: The candidate shall be able to correctly administer a medication via small-volume nebulizer. Candidate Directive: Properly administer a medication via small-volume nebulizer. No. Task Steps First Test Retest 1. Check the medication and the expiration date. 2. Add premixed medication to the bowl of the nebulizer. 3. Connect the T piece with the mouthpiece to the top of the bowl, connect it to the oxygen tubing, and set the flowmeter at 6 L/min. 4. Instruct the patient to breathe as deeply as possible and hold his or her breath for 3 to 5 seconds before exhaling. Monitor the patient for effects. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

38 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-1 Performing Pulse Oximetry Task: Perform pulse oximetry. Performance Observations: The candidate shall be able to correctly perform pulse oximetry. Candidate Directive: Properly perform pulse oximetry. No. Task Steps First Test Retest 1. Clean the patient s finger and place his or her finger in the pulse oximeter probe. Turn on the pulse oximeter and note the LED display of the SaO Palpate the radial pulse to ensure that it correlates with the LED display on the pulse oximeter. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

39 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-2 Peak Expiratory Flow Measurement Task: Measure peak expiratory flow. Performance Observations: The candidate shall be able to correctly measure peak expiratory flow. Candidate Directive: Properly measure peak expiratory flow. No. Task Steps First Test Retest 1. Assemble the flowmeter and make sure it reads zero. 2. Ask the patient to take a deep breath, place the mouthpiece in his or her mouth, and ask the patient to exhale as forcefully as possible. Make sure no air leaks around the device or comes from the patient s nose. 3. Perform the test three times, and take the best rate of the three readings P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

40 3 SECTION 1 Preparing to be an EMT-B Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-3 Head Tilt Chin Lift Maneuver Task: Perform the head tilt chin lift maneuver. Performance Observations: The candidate shall be able to correctly perform a head tilt-chin lift maneuver. Candidate Directive: Properly perform a head tilt chin lift maneuver. No. Task Steps First Test Retest 1. Position yourself at the side of the supine patient. 2. Place your hand closest to the patient s head on the forehead. 3. With your other hand, place two fingers on the underside of the patient s chin. 4. Simultaneously apply backward and downward pressure to the patient s forehead and lift the jaw straight up. Do not depress the soft tissue below the chin. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

41 4 SECTION 1 Preparing to be an EMT-B Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-4 Jaw-Thrust Maneuver Task: Perform the jaw-thrust maneuver. Performance Observations: The candidate shall be able to correctly perform a jaw-thrust maneuver. Candidate Directive: Properly perform a jaw-thrust maneuver. No. Task Steps First Test Retest 1. Position yourself at the top of the patient s head. 2. Place the meaty portion of the base of your thumbs on the zygomatic arches, and hook the tips of your index fingers under the angle of the mandible, in the indent below each ear. 3. While holding the patient s head still, displace the jaw upward and open the patient s mouth with your thumb tips. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

42 5 SECTION 1 Preparing to be an EMT-B Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-5 Jaw-Thrust Maneuver With Head Tilt Task: Perform the jaw-thrust maneuver with head tilt. Performance Observations: The candidate shall be able to correctly perform a jaw-thrust maneuver with head tilt. Candidate Directive: Properly perform a jaw-thrust maneuver with head tilt. No. Task Steps First Test Retest 1. Position yourself at the top of the patient s head. 2. Place the meaty portion of the base of your thumbs on the zygomatic arches, and hook the tips of your index fingers under the angle of the mandible, in the middle indent below each ear. 3. Displace the jaw upward and tilt the head back. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

43 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-6 Tongue-Jaw Lift Maneuver Task: Perform the tongue-jaw lift maneuver. Performance Observations: The candidate shall be able to correctly perform a tongue-jaw lift maneuver. Candidate Directive: Properly perform a tongue-jaw lift maneuver. No. Task Steps First Test Retest 1. Position yourself at the patient s side 2. Place the hand closest to the patient s head on the forehead. 3. With your other hand, reach into the patient s mouth and hook your first knuckle under the incisors or gum line. While holding the patient s head and maintaining the hand on the forehead, lift the jaw straight up. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

44 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-7 Managing Severe Airway Obstruction in a Conscious Adult or Child Task: Manage a severe airway obstruction in a conscious adult or child. Performance Observations: The candidate shall be able to correctly manage a severe airway obstruction in a conscious adult or child. Candidate Directive: Properly manage a severe airway obstruction in a conscious adult or child. No. Task Steps First Test Retest 1. Determine whether the patient is choking by asking, Are you choking? If the patient nods yes, then help is needed. 2. Perform the Heimlich maneuver until the object is expelled or the patient becomes unresponsive. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

45 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-8 Managing Severe Airway Obstruction in an Unconscious Adult or Child Task: Manage a severe airway obstruction in an unconscious adult or child. Performance Observations: The candidate shall be able to correctly manage a severe airway obstruction in an unconscious adult or child. Candidate Directive: Properly manage a severe airway obstruction in an unconscious adult or child. No. Task Steps First Test Retest 1. Open the airway and look in the mouth. If you see the object, carefully remove it from the patient s mouth. 2. Attempt to ventilate the patient. If unsuccessful, reopen the airway and again attempt ventilation. 3. Perform chest compressions. 4. Open the airway and look in the mouth. If you see the object, carefully remove it from the patient s mouth. Repeat steps 2 through 4 until successful or until help arrives. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

46 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill 11-9 Managing Severe Airway Obstruction in a Conscious Infant Task: Manage a severe airway obstruction in a conscious infant. Performance Observations: The candidate shall be able to correctly manage a severe airway obstruction in a conscious infant. Candidate Directive: Properly manage a severe airway obstruction in a conscious infant. No. Task Steps First Test Retest 1. Perform five back blows (slaps) 2. Perform five chest thrusts. Repeat steps 1 and 2 until the object is expelled or the infant becomes unresponsive. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

47 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Managing Severe Airway Obstruction in an Unconscious Infant Task: Manage a severe airway obstruction in an unconscious infant. Performance Observations: The candidate shall be able to correctly manage a severe airway obstruction in a conscious infant. Candidate Directive: Properly manage a severe airway obstruction in an unconscious infant. No. Task Steps First Test Retest 1. Open the infant s airway and look in the mouth. If you see the object, carefully remove it from the infant s mouth. 2. Attempt to ventilate. If unsuccessful, reopen the airway and again attempt ventilation. 3. Perform chest compressions. 4. Open the infant s airway and look in the mouth. If you see the object, carefully remove it from the infant s mouth. Repeat steps 2 through 4 until successful or until help arrives. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

48 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Removal of an Upper Airway Obstruction with Magill Forceps Task: Remove an upper airway obstruction with Magill forceps. Performance Observations: The candidate shall be able to correctly remove an upper airway obstruction with Magill forceps. Candidate Directive: Properly remove an upper airway obstruction with Magill forceps. No. Task Steps First Test Retest 1. With the patient s head in the sniffing position, open the patient s mouth and insert the laryngoscope blade. 2. Visualize the obstruction, and retrieve the object with the Magill forceps. 3. Remove the object with the Magill forceps. 4. Attempt to ventilate the patient. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

49 12 SECTION 1 Preparing to be an EMT-B Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Suctioning a Patient s Airway Task: Suction a patient s airway. Performance Observations: The candidate shall be able to correctly suction a patient s airway. Candidate Directive: Properly suction a patient s airway. No. Task Steps First Test Retest 1. Make sure the suctioning unit is properly assembled, and turn on the suction unit. 2. Measure the catheter from the corner of the mouth to the earlobe. 3. Open the patient s mouth, and insert the catheter to the predetermined depth without suctioning. 4. Apply suction in a circular motion as you withdraw the catheter. Do not suction an adult for more than 15 seconds. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

50 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Inserting an Oral Airway Task: Insert an oral airway. Performance Observations: The candidate shall be able to correctly insert an oral airway. Candidate Directive: Properly insert an oral airway. No. Task Steps First Test Retest 1. Determine the size of the airway by measuring the distance from the patient s earlobe to the corner of the mouth. 2. Open the patient s mouth with the crossfinger technique or tongue-jaw lift. Hold the airway upside down with your other hand. Insert the airway with the tip facing the roof of the mouth and slide it in until it touches the roof of the mouth. 3. Rotate the airway 180º flipping it over the tongue. Insert the airway until the flange rests on the patient s lips. In this position, the airway will hold the tongue away from the posterior pharynx. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

51 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Inserting an Oral Airway With a 90º Rotation Task: Insert an oral airway with a 90º rotation. Performance Observations: The candidate shall be able to correctly insert an oral airway with a 90º rotation. Candidate Directive: Properly insert an oral airway with a 90º rotation. No. Task Steps First Test Retest 1. Depress the tongue with a tongue blade so the tongue remains forward. 2. Insert the oral airway sideways from the corner of the mouth, until the reaches the lips. 3. Rotate the oral airway 90º, and remove the tongue blade as you exert gentle backward pressure on the oral airway until the flange rests securely in place against the lips. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

52 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Inserting a Nasal Airway Task: Insert a nasal airway. Performance Observations: The candidate shall be able to correctly insert a nasal airway. Candidate Directive: Properly insert a nasal airway. No. Task Steps First Test Retest 1. Determine the size of the airway by measuring the distance from the tip of the nose to the patient s earlobe. Coat the tip with a water-soluble lubricant. 2. Insert the lubricated airway into the larger nostril, with the curvature following the floor of the nose and the bevel facing the septum. 3. Gently advance the airway. If using the left nostril, insert the nasal airway until it meets with resistance, then rotate the airway 180º into position. This rotation is not required if you are using the right nostril. 4. Continue until the flange rests against the nostril. If you feel any resistance or obstruction, remove the airway and insert it into the other nostril. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

53 16 SECTION 1 Preparing to be an EMT-B Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Placing an Oxygen Cylinder Into Service Task: Place an oxygen cylinder into service. Performance Observations: The candidate shall be able to correctly place an oxygen cylinder into service. Candidate Directive: Properly place an oxygen cylinder into service. No. Task Steps First Test Retest 1. Using an oxygen wrench, turn the valve counterclockwise to crack the cylinder. 2. Attach the regulator/flowmeter to the valve stem using the two pin-indexing holes, and make sure that the O-ring is in place over the larger hole. 3. Align the regulator so that the pins fit snugly into the correct holes on the valve stem and hand-tighten the regulator. 4. Attach the oxygen connective tubing to the flowmeter. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

54 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Mouth-to-Mask Ventilation Task: Perform mouth-to-mask ventilation. Performance Observations: The candidate shall be able to correctly perform mouth-to-mask ventilation. Candidate Directive: Properly perform mouth-to-mask ventilation. No. Task Steps First Test Retest 1. Once the patient s head is properly positioned, place the mask on the patient s face. Seal the mask to the face using both hands. 2. Exhale into the open port of the one-way valve for 1 second as you watch for visible chest rise. 3. Watch for the patient s chest to fall during exhalation. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

55 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill One-Person Bag-Mask Ventilation Task: Perform one-person bag-mask ventilation. Performance Observations: The candidate shall be able to correctly perform one person bag-mask ventilation. Candidate Directive: Properly perform one-person bag-mask ventilation. No. Task Steps First Test Retest 1. Choose the proper mask size to seat the mask from the bridge of the nose to the chin. 2. Position the mask on the patient s face and ensure an adequate seal. 3. Open the patient s airway and hold the mask in place with one hand as you squeeze the bag with the other hand. Allow the bag to reinflate slowly and completely. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

56 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Two-Person Bag-Mask Ventilation Task: Perform two-person bag-mask ventilation. Performance Observations: The candidate shall be able to correctly perform two-person bag-mask ventilation. Candidate Directive: Properly perform two-person bag-mask ventilation. No. Task Steps First Test Retest 1. The first paramedic maintains the mask seal by the most appropriate method. 2. The second paramedic squeezes the bag completely over 1 second to provide visible chest rise. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

57 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Three-Person Bag-Mask Ventilation Task: Perform three-person bag-mask ventilation. Performance Observations: The candidate shall be able to correctly perform three-person bag-mask ventilation. Candidate Directive: Properly perform three-person bag-mask ventilation. No. Task Steps First Test Retest P F P F 1. The first paramedic maintains a mask seal by the most appropriate method. 2. The second paramedic squeezes the bag over 1 second to achieve visible chest rise. 3. The third paramedic applies cricoid pressure. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

58 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Flow-Restricted, Oxygen-Powered Ventilation for Apneic Patients Task: Perform flow-restricted, oxygen-powered ventilation for an apneic patient. Performance Observations: The candidate shall be able to correctly perform flow-restricted, oxygen-powered ventilation for an apneic patient. Candidate Directive: Properly perform flow-restricted, oxygen-powered ventilation for an apneic patient. No. Task Steps First Test Retest 1. Choose the proper mask size to seat the mask from the bridge of the nose to the chin. 2. Position the mask on the patient s face by the most appropriate method. 3. Open the patient s airway and hold the mask with one hand. 4. Press the ventilation button until you achieve visible chest rise. 5. Allow the patient to exhale passively. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

59 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Flow-Restricted, Oxygen-Powered Ventilation Device for Conscious, Spontaneously Breathing Patients Task: Use a flow-restricted, oxygen-powered ventilation device for a conscious, spontaneously breathing patient. Performance Observations: The candidate shall be able to correctly use a flow-restricted, oxygen-powered ventilation device for a conscious, spontaneously breathing patient. Candidate Directive: Properly use a flow-restricted, oxygen-powered ventilation device for a conscious, spontaneously breathing patient. No. Task Steps First Test Retest 1. Prepare your equipment. 2. Whenever possible, have the patient hold the mask to his or her own face to maintain a good seal. 3. When the patient inhales, the negative pressure created will trigger the valve within the FROPVD and deliver 100% oxygen. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

60 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Cricoid Pressure (Sellick Maneuver) Task: Perform the Sellick maneuver. Performance Observations: The candidate shall be able to correctly perform the Sellick maneuver. Candidate Directive: Properly perform the Sellick maneuver. No. Task Steps First Test Retest P F P F 1. Visualize the cricoid cartilage. 2. Palpate to confirm its location. 3. Apply firm pressure with your thumb and index finger on either side of the midline. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

61 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Nasogastric Tube Insertion in a Conscious Patient Task: Insert a nasogastric tube in a conscious patient. Performance Observations: The candidate shall be able to correctly insert a nasogastric tube in a conscious patient. Candidate Directive: Properly insert a nasogastric tube in a conscious patient. No. Task Steps First Test Retest 1. Explain the procedure to the patient, and oxygenate the patient if necessary. Ensure that the patient s head is in a neutral position and suppress the gag reflex with a topical anesthetic spray. 2. Constrict the blood vessels in the nares with a topical alpha agonist. 3. Measure the tube for the correct depth of insertion (nose to ear to xiphoid process). 4. Lubricate the tube with a water-soluble gel. 5. Advance the tube gently along the nasal floor. 6. Encourage the patient to swallow or drink to facilitate passage of the tube. 7. Advance the tube into the stomach. 8. Confirm proper placement: auscultate over the epigastrium while injecting 30 to 50 ml of air and/or observe for gastric contents in the tube. There should be no reflux around the tube. 9. Apply suction to the tube to aspirate the gastric contents, and secure the tube in place. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

62 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Orogastric Tube Insertion Task: Insert an orogastric tube. Performance Observations: The candidate shall be able to correctly insert an orogastric tube. Candidate Directive: Properly insert an orogastric tube. No. Task Steps First Test Retest 1. Position the patient s head in a neutral or flexed position. 2. Measure the tube for the correct depth of insertion (mouth to ear to xiphoid process). 3. Lubricate the tube with a water-soluble gel. 4. Introduce the tube at the midline, and advance it gently into the oropharynx. 5. Advance the tube into the stomach. 6. Confirm proper placement: auscultate over the epigastrium while injecting 30 to 50 ml of air and/or observe for gastric contents in the tube. There should be no reflux around the tube. 7. Apply suction to the tube to aspirate the stomach contents, and secure the tube in place. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

63 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Using Colorimetric Capnography for Carbon Dioxide Detection Task: Use colorimetric capnography for carbon dioxide detection. Performance Observations: The candidate shall be able to correctly use colorimetric capnography for carbon dioxide detection. Candidate Directive: Properly use colorimetric capnography for carbon dioxide. No. Task Steps First Test Retest 1. Detach the ventilation device from the ET tube. 2. Attach an in-line capnographer or capnometer to the proximal adaptor of the ET tube. 3. Reattach the ventilation device to the ET tube, and resume ventilations. 4. Monitor the capnographer or capnometer for appropriate reading (appropriate color change or digital reading). P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

64 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Securing an Endotracheal Tube With Tape Task: Secure an endotracheal tube with tape. Performance Observations: The candidate shall be able to correctly secure an endotracheal tube with tape. Candidate Directive: Properly secure an endotracheal tube with tape. No. Task Steps First Test Retest 1. Note the centimeter marking on the tube at the level of the patient s teeth. 2. Remove the bag-mask device from the ET tube. 3. Move the ET tube to the corner of the patient s mouth. 4. Encircle the ET tube with tape, and secure the tape to the patient s maxilla (using tincture of benzoin to facilitate tape adhesion). 5. Reattach the bag-mask device, and auscultate again over the apices and bases of the lungs and over the epigastrium. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

65 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Securing an Endotracheal Tube With a Commercial Device Task: Secure an endotracheal tube with a commercial device. Performance Observations: The candidate shall be able to correctly secure an endotracheal tube with a commercial device. Candidate Directive: Properly secure an endotracheal tube with a commercial device. No. Task Steps First Test Retest 1. Note the centimeter marking on the tube at the level of the patient s teeth. 2. Remove the bag-mask device from the ET tube. 3. Position the ET tube in the center of the patient s mouth. 4. Place the commercial device over the ET tube and secure. Tighten the screw and fasten the strap to secure. 5. Reattach the bag-mask device, and auscultate again over the apices and bases of the lungs and over the epigastrium. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

66 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Intubation of the Trachea Using Direct Laryngoscopy Task: Intubate the trachea using direct laryngoscopy. Performance Observations: The candidate shall be able to correctly intubate the trachea using direct laryngoscopy. Candidate Directive: Properly intubate the trachea using direct laryngoscopy. No. Task Steps First Test Retest 1. Use BSI precautions (gloves and face shield). 2. Preoxygenate the patient for 2 to 3 minutes with a bag-mask device and 100% oxygen. 3. Check, prepare, and assemble your equipment. 4. Place the patient s head in the sniffing position. 5. Insert the blade into the right side of the patient s mouth, and displace the tongue to the left. 6. Gently lift the long axis of the laryngoscope handle until you can visualize the glottic opening and the vocal cords. 7. Insert the ET tube through the right corner of the mouth, and visualize its entry between the vocal cords. 8. Remove the laryngoscope from the patient s mouth. 9. Remove the stylet from the ET tube. P F P F 10. Inflate the distal cuff of the ET tube with 5 to 10 ml of air, and detach the syringe from the inflation port. (continued) 2008 Jones and Bartlett Publishers, Inc.

67 Skill Drill Intubation of the Trachea Using Direct Laryngoscopy (continued) 11. Attach the end-tidal carbon dioxide detector to the ET tube. 12. Attach the bag-mask device, ventilate, and auscultate over the apices and bases of both lungs and over the epigastrium. 13. Secure the ET tube. 14. Place a bite block in the patient s mouth. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

68 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Blind Nasotracheal Intubation Task: Perform a blind nasotracheal intubation. Performance Observations: The candidate shall be able to correctly perform a blind nasotracheal intubation. Candidate Directive: Properly perform a blind nasotracheal intubation. No. Task Steps First Test Retest 1. Use BSI precautions (gloves and face shield). 2. Preoxygenate the patient whenever possible with a bag-mask device and 100% oxygen. 3. Check, prepare, and assemble your equipment. 4. Place the patient s head in a neutral position. 5. Pre-form the ET tube by bending it in a circle. 6. Lubricate the tip of the tube with a water-soluble gel. 7. Gently insert the ET tube into the most compliant nostril with the bevel facing toward the nasal septum and advance the tube along the nasal floor. 8. Advance the ET tube through the vocal cords as the patient inhales. The BAAM device can be helpful in this step. 9. Inflate the distal cuff with 5 to 10 ml of air and detach the syringe. 10. Attach an end-tidal carbon dioxide detector to the ET tube. 11. Attach the bag-mask device, ventilate, and auscultate over the apices and bases of both lungs and over the epigastrium. 12. Secure the ET tube. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

69 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Digital Intubation Task: Perform a digital intubation. Performance Observations: The candidate shall be able to correctly perform a digital intubation. Candidate Directive: Properly perform a digital intubation. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield) 2. Preoxygenate the patient for 2 to 3 minutes with a bag-mask device and 100% oxygen. 3. Check, prepare, and assemble your equipment. 4. Bend the ET tube by placing a slight curve at its distal end (like a hockey stick). 5. Place the patient s head in a neutral position. 6. Place a bite block in between the patient s molars to prevent the patient from biting your fingers. 7. Insert your left middle and index fingers into the patient s mouth and shift the patient s tongue forward as you advance your fingers toward the larynx. 8. Palpate and lift the epiglottis with your left middle finger. 9. Advance the tube with your right hand and guide it in between the vocal cords with your left index finger. 10. Remove the stylet from the ET tube. 11. Inflate the distal cuff of the ET tube with 5 to 10 ml of air and detach the syringe. P F P F 12. Attach the ETCO 2 detector to the ET tube. (continued) 2008 Jones and Bartlett Publishers, Inc.

70 Skill Drill Digital Intubation (continued) 13. Attach the bag-mask device, ventilate, and auscultate over the apices and bases of both lungs and over the epigastrium. 14. Secure the ET tube. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

71 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Transillumination Intubation Task: Perform a transillumination intubation. Performance Observations: The candidate shall be able to correctly perform a transillumination intubation. Candidate Directive: Properly perform a transillumination intubation. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield). 2. Preoxygenate the patient for 2 to 3 minutes with a bag-mask device and 100% oxygen. 3. Check, prepare, and assemble your equipment. 4. Insert the lighted stylet into the ET tube. 5. Bend the ET tube by placing a slight curve at its distal end (like a hockey stick) and turn on the lighted stylet. 6. Lift the patient s tongue and mandible anteriorly. 7. Insert the ET tube into the midline of the patient s mouth and slowly advance toward the larynx. 8. Observe for a tightly-circumscribed light at the midline of the neck and advance the ET tube 2 to 4 cm farther. 9. Remove the stylet from the ET tube. 10. Inflate the distal cuff of the ET tube with 5 to 10 ml of air and detach the syringe. P F P F (continued) 2008 Jones and Bartlett Publishers, Inc.

72 Skill Drill Transillumination Intubation (continued) 11. Attach the ETCO 2 detector to the ET tube. 12. Attach the bag-mask device, ventilate, and auscultate over the apices and bases of both lungs and over the epigastrium. 13. Secure the ET tube and recheck breath sounds. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

73 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Performing Tracheobronchial Suctioning Task: Perform tracheobronchial suctioning. Performance Observations: The candidate shall be able to correctly perform tracheobronchial suctioning. Candidate Directive: Properly perform a tracheobronchial suctioning. No. Task Steps First Test Retest 1. Check, prepare, and assemble your equipment. 2. Lubricate the suction catheter. 3. Preoxygenate the patient. 4. Detach the bag-mask device and inject 3 to 5 ml of sterile water down the ET tube. 5. Gently insert the catheter into the ET tube until resistance is felt. 6. Suction in a rotating motion while withdrawing the catheter. Monitor the patient s cardiac rhythm and oxygen saturation during the procedure. 7. Reattach the bag-mask device and resume ventilation and oxygenation. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

74 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Performing Extubation Task: Perform an extubation. Performance Observations: The candidate shall be able to correctly perform an extubation. Candidate Directive: Properly perform an extubation. No. Task Steps First Test Retest P F P F 1. Hyperoxygenate the patient. 2. Ensure that ventilation and suction equipment are immediately available. 3. Confirm patient responsiveness. 4. Lean the patient forward. 5. Suction the oropharynx. 6. Deflate the distal cuff of the ET tube. 7. Remove the ET tube as the patient coughs or begins to exhale. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

75 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Performing Pediatric Endotracheal Intubation Task: Perform a pediatric endotracheal intubation. Performance Observations: The candidate shall be able to correctly perform a pediatric endotracheal intubation. Candidate Directive: Properly perform a pediatric endotracheal intubation. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield). 2. Check, prepare, and assemble your equipment. 3. Manually open the child s airway and insert an adjunct if needed. 4. Preoxygenate the child with a bag-mask device and 100% oxygen for at least 30 seconds. 5. Insert the laryngoscope in the right side of the mouth and sweep the tongue to the left. Lift the tongue with firm, gentle pressure. Avoid using the teeth or gums as a fulcrum. 6. Identify the vocal cords. If the cords are not yet visible, instruct your partner to apply cricoid pressure. 7. Introduce the ET tube in the right corner of the child s mouth. 8. Pass the ET tube through the vocal cords to approximately 2 to 3 cm below the vocal cords. Inflate the cuff if a cuffed tube is used. 9. Attach an ETCO 2 detector. 10. Attach the bag-mask device, and auscultate for equal breath sounds over each lateral chest wall high in the axillae. Ensure absence of breath sounds over the epigastrium. 11. Secure the ET tube, noting the placement of the distance marker at the child s teeth or gums and reconfirm tube placement. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

76 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Insertion of the PtL Task: Insert a PtL. Performance Observations: The candidate shall be able to correctly insert a PtL. Candidate Directive: Properly insert a PtL. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield). 2. Preoxygenate the patient with a bag-mask device and 100% oxygen. 3. Place the patient s head in a neutral position. 4. Open the patient s mouth with the tongue-jaw lift maneuver, and insert the PtL in the midline of the patient s mouth. 5. Inflate the proximal and distal cuffs. 6. Ventilate the patient through the pharyngeal (green) tube first. If the chest rises, continue to ventilate through the green tube. 7. If the chest does not rise, remove the stylet from the clear tube and ventilate through the clear tube. 8. Confirm placement by auscultating for breath sounds over the lungs and gastric sounds over the abdomen. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

77 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Insertion of the Combitube Task: Insert a Combitube. Performance Observations: The candidate shall be able to correctly insert a Combitube. Candidate Directive: Properly insert a Combitube. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield). 2. Preoxygenate the patient with a bag-mask device and 100% oxygen. 3. Gather your equipment. 4. Place the patient s head in a neutral position. 5. Open the patient s mouth with the tongue-jaw lift maneuver, and insert the Combitube in the midline of the patient s mouth. Insert the tube until the incisors lie between the two reference marks. 6. Inflate the pharyngeal cuff with 100 ml of air. 7. Inflate the distal cuff with 15 ml of air. 8. Ventilate the patient through the pharyngeal (blue) tube first. Chest rise indicates esophageal placement of distal tip; continue to ventilate. 9. No chest rise indicates tracheal placement; switch ports and ventilate. 10. Confirm placement by auscultating for breath sounds over the lungs and gastric sounds over the abdomen P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

78 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill LMA Insertion Task: Insert a LMA. Performance Observations: The candidate shall be able to correctly insert a LMA. Candidate Directive: Properly insert a LMA. No. Task Steps First Test Retest 1. Check the cuff of the LMA by inflating it with 50% more air than is required for that size airway. Then deflate the cuff completely. 2. Lubricate the base of the device. 3. Preoxygenate the patient with a bag-mask device and 100% oxygen. Ventilation should not be interrupted for more than 30 seconds to accomplish LMA placement. Place the patient s head in the sniffing position. 4. Insert your finger between the cuff and the tube. Place the index finger of your dominant hand in the notch between the tube and the cuff. Open the patient s mouth. 5. Insert the LMA along the roof of the mouth. Use your finger to push the airway against the hard palate. 6. Inflate the cuff with the amount of air indicated for that size airway. 7. Attach the bag-mask device and begin to ventilate the patient. Confirm chest rise and the presence of breath sounds. Continuously and closely monitor the patient. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

79 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Performing an Open Cricothyrotomy Task: Perform an open cricothyrotomy. Performance Observations: The candidate shall be able to correctly perform an open cricothyrotomy. Candidate Directive: Properly perform an open cricothyrotomy. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield). 2. Check, assemble, and prepare the equipment. 3. With the patient s head in a neutral position, palpate for and locate the cricothyroid membrane. 4. Cleanse the area with an iodine-containing solution. 5. Stabilize the larynx and make a 1- to 2-cm vertical incision over the cricothyroid membrane. 6. Puncture the cricothyroid membrane and make a horizontal cut 1 cm in each direction from the midline. 7. Spread the incision apart with curved hemostats. 8. Insert the tube into the trachea. 9. Inflate the distal cuff of the tube. 10. Attach an ETCO 2 detector in between the tube and the bag-mask device. 11. Ventilate the patient and confirm correct tube placement by auscultating the apices and bases of both lungs and over the epigastrium. 12. Secure the tube with a commercial device or tape. Reconfirm correct tube placement and resume ventilations at the appropriate rate. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: _ Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

80 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Performing Needle Cricothyrotomy and Translaryngeal Catheter Ventilation Task: Perform needle cricothyrotomy and translaryngeal catheter ventilation. Performance Observations: The candidate shall be able to correctly perform needle cricothyrotomy and translaryngeal catheter ventilation. Candidate Directive: Properly perform needle cricothyrotomy and translaryngeal catheter ventilation. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield). 2. Attach a 14- to 16-gauge IV catheter to a 10-mL syringe containing approximately 3 ml of sterile saline or water. 3. With the patient s head in a neutral position, palpate for and locate the cricothyroid membrane. 4. Cleanse the area with an iodine-containing solution. 5. Stabilize the larynx and insert the needle into the cricothyroid membrane at a 45º angle towards the feet. 6. Aspirate with the syringe to determine correct catheter placement. 7. Slide the catheter off of the needle until the hub of the catheter is flush with the patient s skin. 8. Place the syringe and needle in a puncture-proof container. 9. Connect one end of the oxygen tubing to the catheter and the other end to the jet ventilator. P F P F 10. Open the release valve on the jet ventilator and adjust the pressure accordingly to provide adequate chest rise. (continued) 2008 Jones and Bartlett Publishers, Inc.

81 Skill Drill Performing Needle Cricothyrotomy and Translaryngeal Catheter Ventilation (continued) 11. Auscultate the apices and bases of both lungs and over the epigastrium to confirm correct catheter placement. 12. Secure the catheter with a 4 X 4 gauze pad and tape. Continue ventilations while frequently reassessing for adequate ventilations and any potential complications. Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

82 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Suctioning of a Stoma Task: Suction a stoma. Performance Observations: The candidate shall be able to correctly suction a stoma. Candidate Directive: Properly suction a stoma. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield). 2. Preoxygenate the patient with a bag-mask device and 100% oxygen. 3. Inject 3 ml of saline through the stoma and into the trachea. 4. Instruct the patient to exhale, and insert the catheter (without providing suction) until resistance is felt (no more than 12 cm). 5. Suction while withdrawing the catheter as you instruct the patient to cough or exhale. 6. Resume oxygenating the patient with a bag-mask device and 100% oxygen. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

83 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Mouth-to-Stoma Ventilation (Using a Resuscitation Mask) Task: Perform mouth-to-stoma ventilation. Performance Observations: The candidate shall be able to correctly perform mouth-to-stoma ventilation. Candidate Directive: Properly perform mouth-to-stoma ventilation. No. Task Steps First Test Retest 1. Position the patient s head in a neutral position with the shoulders slightly elevated. 2. Locate and expose the stoma site. 3. Place the resuscitation mask (pediatric mask preferred) over the stoma, and ensure an adequate seal. 4. Maintain the patient s neutral head position, and ventilate the patient by exhaling directly into the resuscitation mask. Assess the patient for adequate ventilation by observing his or her chest rise and feeling for air leaks around the mask. 5. If air leakage is evident, seal the patient s mouth and nose and ventilate. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

84 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Bag-Mask Device-to-Stoma Ventilation Task: Perform bag-mask device-to-stoma ventilation. Performance Observations: The candidate shall be able to correctly perform bag-mask device-to-stoma ventilation. Candidate Directive: Properly perform bag-mask device-to-stoma ventilation. No. Task Steps First Test Retest 1. With the patient s head in a neutral position, locate and expose the stoma. 2. Place the bag-mask device over the stoma, and ensure an adequate seal. 3. Ventilate the patient by squeezing the bag-mask device, and assess for adequate ventilation by observing chest rise. 4. Auscultate over the lungs to confirm adequate ventilation. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

85 Nancy Caroline s Emergency Care in the Streets, Sixth Edition Candidate: AAOS Date: ID#: Skill Drill Replacing a Dislodged Tracheostomy Tube Task: Replace a dislodged tracheostomy tube. Performance Observations: The candidate shall be able to correctly replace a dislodged tracheostomy tube. Candidate Directive: Properly replace a dislodged tracheostomy tube. No. Task Steps First Test Retest 1. Take BSI precautions (gloves and face shield). 2. Lubricate the same-sized tracheostomy tube or an ET tube (at least 5.0 mm). 3. Instruct the patient to exhale, and gently insert the tube approximately 1 to 2 cm beyond the balloon cuff. 4. Inflate the balloon cuff. 5. Ensure that the patient is comfortable, and confirm patency and proper placement of the tube by listening for air movement from the tube and noting the patient s clinical status. Ensure that a false lumen was not created. 6. Auscultate the lungs to confirm correct tube placement. P F P F Retest Approved By: Retest Evaluation: Evaluator Comments: Candidate Comments: Evaluator Date Candidate Date _ Retest Evaluator Date Retest Candidate Date 2008 Jones and Bartlett Publishers, Inc.

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102 CULTURAL RUBRIC CONTENT EXCELLENT POINTS PROFICIENT POINTS ACCEPTABLE POINTS LIMITED 31-1 POINTS NOT ATTEMPTED 0 The content is exceptionally clear and focused. The main ideas are relevant, thoughtfully selected and supported strongly to exceed the assignment objectives. Content exceeds the required length. The content is clear and focused. The reader is able to understand the ideas. Details are relevant but often general. Content meets minimum required length. The reader can understand the main points, although they may be overly broad or overly limited. Details are much the same, too general or too limited, maybe off-topic. Content meets 75% of the minimum required length. The main ideas and purpose are unclear or underdeveloped. Content includes irrelevant details that just clutter the content. Content meets 50% or less of the minimum required length. No assignment was submitted. ORGANIZATION EXCELLENT POINTS PROFICIENT POINTS ACCEPTABLE POINTS LIMITED 11-1 POINTS NOT ATTEMPTED 0 The organization displays and enhances the central idea while supporting the development of the topic. The structure and order are strong allowing for effortless reading, smooth transitions, and sequential formations. The content tends to draw the reader in and brings them to closure. An attempt was made to organize the content, but still lacks the consistency required. The content lacks a clear structure. Occasionally, a device is noticeable, but the content is difficult to read, thus requiring the reader to reread portions. The content lacks coherence and organization is disjointed. After reading, the reader is confused and the main points are obscure. No assignment was submitted.

103 GRAMMAR AND STYLE EXCELLENT POINTS PROFICIENT POINTS ACCEPTABLE POINTS LIMITED 11-1 POINTS NOT ATTEMPTED 0 The text demonstrates an exceptionally strong control of Standard Written English with punctuation, spelling capitalization, paragraph breaks, and grammar. The errors are minor and do not hinder the readability. The test demonstrates control of Standard Written English with punctuation, spelling capitalization, paragraph breaks, and grammar. The noticeable errors are minor and do not hinder the readability. The test demonstrates limited control of Standard Written English with punctuation, spelling capitalization, paragraph breaks, and grammar. The noticeable errors do somewhat hinder the readability. The test demonstrates limited control of Standard Written English with punctuation, spelling capitalization, paragraph breaks, and grammar. The errors are very noticeable and do hinder the readability. No assignment was submitted. RESOURCES AND REFERENCES EXCELLENT POINTS PROFICIENT POINTS ACCEPTABLE POINTS LIMITED 11-1 POINTS NOT ATTEMPTED 0 The sources are properly acknowledged and cited. The source material includes an appropriate list and contains all of the sources cited within the content. Correct quotation integration is utilized and the sources are at the appropriate academic level. The sources are identified and cited, but the format is inconsistent. This is cause to attribute the wrong content to an author or an incomplete list. The majority of the sources are at the appropriate academic level. The sources are partially identified which reflects an inconsistent format and missing citations. Multiple sources are not at the appropriate academic level. An attempt is made to acknowledge the sources, but the format is very inconsistent. The writer has struggled to identify all their components and the academic level is inappropriate. No assignment was submitted. No attempt was made to incorporate the sources or citations. Content + Organization + Grammar/Style + Resources/References = Final Score

104 Fayetteville Technical Community College Hybrid Intermediate - Paramedic Course Continuing Education Department April 9 - December 11, 2014 EMS 56143/ Wednesdays 8:00-5:00 EMS 56144/ Thursdays 8:00-5:00 Cliffdale Park Room 208 Lead Instructor: Joyce Pettengill Week Part Date A/B Content Instructor Hours WEEK 1 A Registration, Policies & Procedures, Orientation Pettengill 20 Apr Volume I Ch 10 Basic Human Physiology Ch 11 Principles of Pathophysiology Ch 12 Medical Terminology WEEK 2 A Exam 1 Wed Apr 16 (Ch 10,11, 12) Pettengill 20 Apr Volume I Ch 20 Airway Anatomy and Physiology Ch 21 The Algorithmic Approach to Airway Ch 22 Non-Intubating Airway Management Ch 23 Intubating Airway Management Ch 24 Medication Intubation Ch 25 Ventilation Thurs Apr 17 B Lab Pettengill 8 WEEK 3 A Exam 2 Wed Apr 23 (Ch 20-25) Pettengill 16 Apr Volume I Ch 26 Medication Administration Ch 27 IV Access Ch 28 Blood Products and Transfusions WEEK 4 A Exam 3 Wed Apr 30 (Ch 26-28) Pettengill 20 Apr 30 - May 6 Ch 29 Introduction to Pharmacology Ch 30 Pharmacology Interventions Cardio Ch 31 Pharmacology for Medical Thurs May 1 B Lab Pettengill 8 WEEK 5 A Exam 4 Wed May 7 (Ch 29-31) Pettengill 20 May 7-13 Volume I Ch 32 Principles of Electrocardiology Ch 33 The Monitoring ECG Ch 34 Diagnostic ECG 12-Lead WEEK 6 Exam 5 Wed May 14 EKG Strips Pettengill 20 May Volume I Ch 32 Principles of Electrocardiology Ch 33 The Monitoring ECG Ch 34 Diagnostic ECG 12-Lead Thurs May 15 B Lab Pettengill 8

105 WEEK 7 A Exam 6 Wed May 21 EKG Strips Multiple Choice Pettengill 20 May Volume II Ch 1 Diagnostic ECG 12-Lead Ch 2 Acute Coronary Syndrome Ch 3 Heart Failure Ch 4 Error of Automaticity Ch 5 Errors of Conduction Tachycardia Ch 6 Errors of Conduction Bradycardia Ch 7 Cardiac Resuscitation WEEK 8 A Volume II Ch 1 Diagnostic ECG 12-Lead Pettengill 20 May 28-June 3 Ch 2 Acute Coronary Syndrome Ch 3 Heart Failure Ch 4 Error of Automaticity Ch 5 Errors of Conduction Tachycardia Ch 6 Errors of Conduction Bradycardia Ch 7 Cardiac Resuscitation Thurs May 29 B Lab ACLS Pettengill 8 WEEK 9 A ACLS Wed June 4 ACLS Continued Pettengill 20 June 4-10 Volume II Ch 1 Diagnostic ECG 12-Lead Ch 2 Acute Coronary Syndrome Ch 3 Heart Failure Ch 4 Error of Automaticity Ch 5 Errors of Conduction Tachycardia Ch 6 Errors of Conduction Bradycardia Ch 7 Cardiac Resuscitation Thurs June 12 B ED Clinical Rotations Begin! 12 Sat June 14 B Lab National Registry Skills Evaluation Pettengill 8 WEEK 10 A Exam 7 Wed Jan 11 (Ch 1-7) Pettengill 16 Jun Volume I Ch 1 Roles and Responsibilities Ch 2 Introduction to EMS Systems Ch 3 Workforce Safety and Wellness Ch 4 Research and EMS WEEK 11 A Exam 8 Wed June 18 (Ch 1-4) Pettengill 16 June Volume I Ch 5 Ethics and the Parmedic Ch 6 The Law and Paramedics Ch 7 Public Health and the Paramedic Ch 8 Illness and Injury Prevention Ch 9 Lifespan Development WEEK 12 A Exam 9 Wed Jun 25 (Ch 5-9) Pettengill 20 June 25 - July 1 Volume I Ch 13 Scene Size-up, Primary Assessment Ch 14 Therapeutic Communications Ch 15 History Taking Ch 16 Physical Exam/Secondary Assmnt Ch 17 Clinical Decision Making/Teamwork Ch 18 Communications Ch 19 Documentation

106 WEEK 13 A Exam 10 Wed July 2 (Ch 13-19) Pettengill 16 July 2 - July 8 Volume II Ch 8 Disorders of Oxygenation Ch 9 Disorders of Ventilation WEEK 14 A Exam 11 Wed July 9 (Ch 8, 9 ) Pettengill 16 July 9-15 Ch 10 Disorders of the Brain Function Ch 11 Disorders of Cerebral Circulation Ch 12 Disorders of Peripheral Nervous Sys WEEK 15 A Exam 12 Wed July 16 (Ch 10-12) Pettengill 16 July Ch 13 Disorders of Glucose Metabolism Ch 14 Disorders of Homeostasis Ch 15 Addiction Disorder - Alcoholism Ch 16 Toxicological Emergencies WEEK 16 A Exam 13 Wed July 23 (Ch 13-16) Pettengill 16 July Review for Mid-Term Exam WEEK 17 A MID-TERM EXAM Wed July 30 Pettengill 16 July 30 - Aug 5 Volume II Ch 17 Psychiatric Disorders Ch 18 Behavioral Disorders Ch 19 Disorders: Abdominal Hemorrgage Ch 20 Disorder: Abdominal Pain Ch 21 Loss of Renal Function WEEK 18 A Exam 14 Wed Aug 6 Ch 17-21) Pettengill 16 Aug 6-12 Volume II Ch 22 Vascular Disorders Ch 23 Bleeding Disorders Ch 24 Back Pain Ch 25 Disorder of Central Circulation Ch 26 Disorders of the Head, Eyes, Ears, Etc WEEK 19 A Exam 15 Wed Aug 13 (Ch 22-16) Pettengill 16 Aug Volume II Ch 27 Infectious Diseases, Fever Ch 28 Infectious Diseases, Rash Ch 29 Disorders of the Immune System Ch 30 Anaphylaxis WEEK 20 A Exam 16 Wed Aug 20 (Ch 27-30) Pettengill 16 Aug Volume II Ch 31 Bariatric Medicine Ch 32 Disorders: Unexplained Weight Loss Ch 33 Medical Resuscitation Scenarios WEEK 21 A Exam 17 Wed Aug 27 (Ch 31-33) Pettengill 20 Aug 27 - Sept 2 Volume II Ch 34 Gynecological Disorders Ch 35 Normal Pregnancy Ch 36 Complications of Pregnancy Ch 37 Normal Childbirth Ch 38 Care of the Normal Newborn Ch 39 Special Considerations in Neonates WEEK 22 A Exam 18 Wed Sept 3 (Ch 34-39) Pettengill 16

107 Sept 2-9 Volume II Ch 40 Assessment of the Stable Child Ch 41 The Critically Ill Child Ch 42 Pediatric Medical Emergencies Ch 43 Child Abuse and Neglect WEEK 23 A PALS Wed Sept 10 Pettengill 16 Sept Thursday B PALS Thurs Sept 11 WEEK 24 A Exam 19 Wed Sept 17 (Ch 40-43) Pettengill 16 Sept Volume II Ch 44 Geriatrics Ch 45 Patients With Special Needs Ch 46 Care of the Chronically Ill Patient Ch 47 Violence in the Community WEEK 25 A Exam 20 Wed Sept 24 (Ch 44-47) Pettengill 16 Sept Vol III Ch 1 Trauma Overview Ch 2 Traumatic Brain Injury Ch 3 Neck and Facial Trauma Ch 4 Spinal Trauma Ch 5 Thoracic Trauma WEEK 26 A Exam 21 Wed Oct 1 (Ch 1-5) Pettengill 16 Oct 1-7 Vol III Ch 6 Abdominal and Genitourinary Trauma Ch 7 Orthopaedic Trauma Ch 8 Soft-Tissue Injury Ch 9 Burn Trauma Ch 10 Pediatric Trauma Considerations WEEK 27 A Exam 22 Wed Oct 8 (Ch 6-10) Pettengill 16 Oct 8-14 Vol III Ch 12 Heat Emergencies Ch 13 Cold Emergencies Ch 14 Mountain Medicine Ch 15 Water Emergencies Ch 16 Envenomation WEEK 28 A Exam 21 Wed Oct 15 (Ch 12-16) Pettengill 16 Oct ITLS Wed Oct 15 Vol III Ch 17 EMS Vehicle and Transport Safety Ch 18 Air Medical Transport Ch 19 Specialty Care Transport Ch 20 National Incident Management Ch 21 Emergency Response to Terrorism Thursday B ITLS Thursday Oct 16 WEEK 29 A Exam 22 Wed Oct 29 (Ch 17-21) Pettengill 16 Oct Review Anatomy & Physiology WEEK 30 A Exam 23 Wed Oct 29 Anatomy & Physiology Pettengill 16 Oct 29 - Nov 4 Review Pharmacology WEEK 31 A Exam 24 Wed Nov 5 Pharmacology Exam Pettengill 16 Nov 5-11 Review Medical

108 Skills Practice WEEK 32 A Exam 25 Wed Nov 12 Medical Exam Pettengill 16 Nov Review Cardiology Skills Practice WEEK 33 A Exam 26 Wed Nov 19 Cardiology Exam Pettengill 16 Nov Review Airway and Trauma Skills Practice WEEK 34 A Exam 27 Wed Nov 26 Airway and Trauma Exam Pettengill 16 Nov 26 - Dec 2 Review For Final Exam Skills Practice WEEK 35 Skills Practice Pettengill 16 Dec 3-11 B National Registry Skills Testing, Dec 6th Pettengill 8 A FINAL EXAM Didactic Hours 600 Clinical Hours 600 (300 EMS, 300 ED, Specialties) Total Hours 1200 Lead Instructor: Joyce Pettengill, NREMT-P, EMT-P, Level II Instructor, Clinical Coordinator pettengj@faytechcc.edu Cell phone: Office: Notes: It is the responsibility of the student to make up any homework/quizzes/exams that are missed. The instructor will not contact you for make-up work! Make-up times must be scheduled in advance with the Lead Instructor.

109 Failure to make-up missed assignments or exams in a resonable time will result in a zero. Copies of your CPR, TABE, EMT-B, Anatomy/Physiology certifications are required along with any other certifications pertinent to the class. No tobacco products are allowed in the classroom, smoking areas are designated outside. No hats, caps, sun glasses, or hoodies allowed in class. Eating in the classroom is prohibited, unless authorized by the instructor. You must secure a parking pass on the first day of class if you do not already have one and park in the designated white lines. Students are not allowed to sit on the desks, rock in the chairs, or prop their feet up in the chairs or on the desks. Safety comes first. Breaks will be given periodically, but do not abuse the priviledge or it will be lost. Foul language or cursing is not allowed and you are to conduct yourself as professional adults. Good Luck to each of you! Joyce "Ability" is what you are capable of doing. "Motivation" determines what you do. "Attitude" determines how well you do it.

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111 PARAMEDIC COMPUTER LITERACY COMPILATION Submitted by Joyce Pettengill Student 1 98% Student 25 88% Student 2 90% Student 26 87% Student 3 99% Student 27 90% Student 4 94% Student 28 93% Student 5 97% Student 29 91% Student 6 92% Student 30 89% Student 7 93% Student 31 95% Student 8 96% Student 32 91% Student 9 93% Student 33 88% Student 10 97% Student 34 86% Student 11 91% Student 35 90% Student 12 93% Student 36 88% Student 13 96% Student 37 89% Student 14 97% Student 38 90% Student 15 93% Student 39 98% Student 16 90% Student 40 94% Student 17 88% Student 41 96% Student 18 91% Student 42 92% Student 19 90% Student 43 97% Student 20 87% Student 44 91% Student 21 94% Student 45 87% Student 22 92% Student 46 97% Student 23 89% Student 47 98% Student 24 94% AVERAGE 92%

112 END-OF-YEAR REPORT Mission Statement Serve our community as a learning-centered institution to build a globally competitive workforce supporting economic development P.O. Box Hull Road Fayetteville, North Carolina