NAME 2012 CBT 434-EMT12 Cardiovascular Emergencies EMERGENCY MEDICAL SERVICES (11/22/2011) MH PRINT STUDENT S NAME SKILLS CHECKLIST FOR RECERTIFICATION ID # DATE Objective: Given a partner, appropriate equipment and a patient with a cardiac complaint, demonstrate appropriate assessment and treatment as outlined in CBT 434-EMT12 and EMT Patient Care Guidelines. SCENE SIZE-UP (must verbalize) BSI Scene Safety Determines MOI/NOI Number of Patients Additional Resources INITIAL ASSESSMENT (must verbalize) Mental Status Chief complaint Airway C-spine SUBJECTIVE (FOCUSED HISTORY) Breathing Circulation Bleeding Obvious Trauma Body Position SICK NOT SICK Establishes rapport with patient (reassures and calms) and obtains consent to treat (implied/actual) Determines patient s chief complaint and follows SAMPLE and OPQRST investigation Determines time of onset of complaint, signs or symptoms (appreciates the need for rapid transport) Obtains names/dosages of current medications and were any taken (e.g., Viagra, Cialis, Levitra, NTG) OBJECTIVE (PHYSICAL EXAM) Records and documents baseline vital signs - listens to lung sounds and compares sides Performs appropriate medical / trauma exam exposes/checks for bleeding and/or injuries Connects monitoring leads and monitors patient (if trained to do so and if appropriate) Obtains second set of vital signs and compares to baseline ASSESSMENT (IMPRESSION) Verbalizes impression (i.e. Acute Coronary Syndrome [ACS]) Determines if ALS is needed states rationale PLAN (TREATMENT) GENERAL CARE (Check all that apply) Indicates need for ALS and/or Reports APS to Dispatch Administers appropriate rate and delivery of oxygen (as indicated) Properly positions patient Properly assists with patient s nitroglycerine (if indicated) COMMUNICATION AND DOCUMENTATION Places monitor on pt. (if trained) Considers Index of Suspicion Glucometry (if indicated) Oximetry Administers Aspirin (325mg) Initiates Code ACS" On-scene time <15 min (when possible) Performs pt. reassessment Delivers timely and effective short report (if indicated) Completes SOAP narrative portion of incident response form CRITICAL (FAIL) CRITERIA DID NOT Take/verbalize BSI Appropriately provide/manage airway, breathing, bleeding control, treatment of shock Properly administers oxygen Indicate need for ALS and/or MEETS STANDARDS (RECERT) 2 nd ATTEMPT PRINT EVALUATOR S NAME EVALUATOR S SIGNATURE EVALUATOR ID # IF NO EXPLAIN CBT 434-EMT 12 Cardiovascular Emergencies Student Name Recert Yes No Date Written Score (online / other)
TIME (APS) Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds (Aspirin) Pulse Oximetry Glucometry Medications taken by patient at home Allergies Chief Complaint Narrative
NAME 2012 CBT 442-EMT 12 Neurological Emergencies EMERGENCY MEDICAL SERVICES (11/21/2011) MH PRINT STUDENT S NAME SKILLS CHECKLIST FOR RECERTIFICATION ID # DATE Objective: Given a partner, proper equipment and a patient with s/s of a neurological emergency, demonstrate appropriate assessment and treatment as outlined in CBT 442-EMT12 and EMT Patient Care Guidelines. SCENE SIZE-UP (must verbalize) BSI Scene Safety Determines MOI/NOI Number of Patients Additional Resources INITIAL ASSESSMENT (must verbalize) Mental Status Chief complaint Airway C-spine SUBJECTIVE (FOCUSED HISTORY) Breathing Circulation Bleeding Obvious Trauma Body Position SICK NOT SICK Establishes rapport with patient (reassures and calms) and obtains consent to treat (implied/actual) Determines patient s chief complaint and follows SAMPLE and OPQRST investigation Determines time of onset of complaint, signs or symptoms (appreciates the need for rapid transport) Obtains names/dosages of current medications OBJECTIVE (PHYSICAL EXAM) Records and documents baseline vital signs Performs appropriate medical / trauma exam exposes/checks for bleeding and/or injuries Performs the FAST Exam (Facial droop, Arm drift, Slurred Speech and Time of Onset) Obtains second set of vital signs and compares to baseline ASSESSMENT (IMPRESSION) Verbalizes impression (i.e. Acute CVA) Determines if ALS is needed states rationale PLAN (TREATMENT) GENERAL CARE (Check all that apply) Indicates need for ALS and/or Reports APS to Dispatch Administers appropriate rate and delivery of oxygen (as indicated) Considers 95% SpO2 for decision Properly positions patient Performs FAST Exam (interprets) COMMUNICATION AND DOCUMENTATION Considers Index of Suspicion Glucometry (required for suspected CVA) Oximetry Initiates Code CVA" On-scene time <15 min (when possible) Performs pt. reassessment Early notification to ED Delivers timely and effective short report (if indicated) Completes SOAP narrative portion of incident response form CRITICAL (FAIL) CRITERIA DID NOT Take/verbalize BSI Appropriately provide/manage airway, breathing, bleeding control, treatment of shock Properly administers oxygen Indicate need for ALS and/or MEETS STANDARDS (RECERT) 2 nd ATTEMPT PRINT EVALUATOR S NAME EVALUATOR S SIGNATURE EVALUATOR ID # IF NO EXPLAIN CBT 442-EMT 12 Neurological Emergencies Student Name Recert Yes No Date Written Score (online / other)
TIME (APS) Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds Pulse Oximetry Glucometry Medications taken by patient at home Allergies Chief Complaint Narrative
NAME 2012 CBT 445-EMT12 Upper Body Trauma EMERGENCY MEDICAL SERVICES (11/21/2011) MH PRINT STUDENT S NAME SKILLS CHECKLIST FOR RECERTIFICATION ID # DATE Objective: Given a partner(s), proper equipment and a patient with upper body trauma, demonstrate appropriate assessment and treatment as outlined in CBT 445-EMT12 and EMT Patient Care Guidelines. SCENE SIZE-UP (must verbalize) BSI Scene Safety Determines MOI/NOI Number of Patients Additional Resources INITIAL ASSESSMENT (must verbalize) Mental Status Chief complaint Airway C-spine SUBJECTIVE (FOCUSED HISTORY) Breathing Circulation Bleeding Obvious Trauma Body Position SICK NOT SICK Establishes rapport with patient (reassures and calms) and obtains consent to treat (implied/actual) Determines patient s chief complaint and appreciates MOI Follows SAMPLE and OPQRST investigation (if possible) Obtains names/dosages of current medications (if possible to include anti-coagulants) OBJECTIVE (PHYSICAL EXAM) Records and documents baseline vital signs Performs appropriate medical / trauma exam - exposes/checks for bleeding and/or injuries Notes/records any neurologic deficits Obtains second set of vital signs and compares to baseline ASSESSMENT (IMPRESSION) Verbalizes impression (appreciates MOI) Determines if ALS is needed states rationale PLAN (TREATMENT) GENERAL CARE (Check all that apply) Indicates need for ALS and/or Reports APS to Dispatch Immediately stabilizes the head in a neutral in-line position Administers appropriate rate and delivery of oxygen (as indicated) Applies dressing/bandage to wound (as indicated) COMMUNICATION AND DOCUMENTATION Properly positions patient Performs proper spinal immobilization Prevents pt. heat loss Monitors patient vital signs Considers MOI, IOS Glucometry (if indicated) Oximetry Performs pt. reassessment Delivers timely and effective short report (if indicated) Completes SOAP narrative portion of incident response form CRITICAL (FAIL) CRITERIA DID NOT Take/verbalize BSI Appropriately provide/manage airway, breathing, bleeding control, treatment of shock Properly administers oxygen Indicate need for ALS and/or MEETS STANDARDS (RECERT) 2 nd ATTEMPT PRINT EVALUATOR S NAME EVALUATOR S SIGNATURE EVALUATOR ID # IF NO EXPLAIN CBT 445-EMT12 Upper Body Trauma Student Name Recert Yes No Date Written Score (online / other)
TIME (APS) Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds Pulse Oximetry Glucometry Medications taken by patient at home (use of anti-coagulants) Allergies Chief Complaint Narrative
NAME 2012 CBT 450-EMT 12 Endocrine Emergencies EMERGENCY MEDICAL SERVICES (11/21/2011) MH PRINT STUDENT S NAME SKILLS CHECKLIST FOR RECERTIFICATION ID # DATE Objective: Given a partner, appropriate equipment and a patient with an endocrine emergency, demonstrate appropriate assessment and treatment as outlined in CBT 450-EMT 12 and EMT Patient Care Guidelines. SCENE SIZE-UP (must verbalize) BSI Scene Safety Determines MOI/NOI Number of Patients Additional Resources INITIAL ASSESSMENT (must verbalize) Mental Status Chief complaint Airway C-spine SUBJECTIVE (FOCUSED HISTORY) Breathing Circulation Bleeding Obvious Trauma Body Position SICK NOT SICK Establishes rapport with patient (reassures and calms) and obtains consent to treat (implied/actual) Determines patient s chief complaint and follows SAMPLE and OPQRST investigation Determines time of onset of complaint, signs or symptoms Obtains names/dosages of current medications and were any taken OBJECTIVE (PHYSICAL EXAM) Records and documents baseline vital signs - confirms patient s ability to swallow (as indicated) Performs appropriate medical / trauma exam exposes/checks for bleeding and/or injuries Performs blood glucometry and records findings (if trained to do so) Obtains second set of vital signs and compares to baseline ASSESSMENT (IMPRESSION) Verbalizes impression (i.e.: hypoglycemia) Determines if ALS is needed states rationale PLAN (TREATMENT) GENERAL CARE (Check all that apply) Indicates need for ALS and/or Reports APS to Dispatch Administers appropriate rate and delivery of oxygen (as indicated) Properly positions patient Performs blood glucometry records: (findings/time [Pre/Post]) COMMUNICATION AND DOCUMENTATION Provides oral glucose (if indicated) Monitors patient vital signs Considers Index of Suspicion Oximetry Follows proper after-care procedures (if indicated) Performs pt. reassessment Delivers timely and effective short report (if indicated) Completes SOAP narrative portion of incident response form CRITICAL (FAIL) CRITERIA DID NOT Take/verbalize BSI Appropriately provide/manage airway, breathing, bleeding control, treatment of shock Properly administers oxygen Indicate need for ALS and/or MEETS STANDARDS (RECERT) 2 nd ATTEMPT PRINT EVALUATOR S NAME EVALUATOR S SIGNATURE EVALUATOR ID # IF NO EXPLAIN CBT 450-EMT 12 Endocrine Emergencies Student Name Recert Yes No Date Written Score (online / other)
TIME (APS) Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds Pulse Oximetry Glucometry Medications taken by patient at home Allergies Chief Complaint Narrative
NAME 2012 CBT 931-EMT 12 Death and Dying EMERGENCY MEDICAL SERVICES (11/21/2011) MH PRINT STUDENT S NAME CHECKLIST FOR RECERTIFICATION ID # DATE Objective: In a roundtable discussion group and given POLST, DNR orders or advanced directives, EMS providers will discuss and demonstrate appropriate assessment, treatment and interaction given at least three death and dying scenarios (to include compelling reasons, if applicable), applying the guidelines outlined in CBT 931-EMT 12 and EMT Patient Care Guidelines. Roundtable Exercise This exercise for CBT 931-EMT 12 Death and Dying course with a roundtable discussion panel was completed. The above individual met standards regarding specific knowledge of: - advanced directives - POLST - DNR orders - compelling reasons The exercise contained: A general explanation of the physiology of death (as covered in CBT 931-EMT 12 ) - cessation of pulse and breathing - cool/cold body temperature - dependent lividity - rigor mortis An explanation/discussion regarding (as covered in CBT 931-EMT 12 ) - withholding resuscitation - compelling reasons - the dying patient - palliative measures (comfort care) Legal/ethical concerns (as covered in CBT 931-EMT 12) - why families call 911 (when in doubt, resuscitate) - withholding CPR - advanced directives - POLST This exercise/review evaluation fulfills the practical requirements for this course. COMMUNICATION AND DOCUMENTATION Reports APS to Dispatch Delivers timely and effective short report (if indicated) MEETS STANDARDS (RECERT) 2 nd ATTEMPT PRINT EVALUATOR S NAME EVALUATOR S SIGNATURE EVALUATOR ID # IF NO EXPLAIN CBT 931-EMT 12 Death and Dying Student Name Recert Yes No Date Written Score (online / other)
TIME (APS) Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Dependent Lividity Rigor Mortis Body Temperature POLST Directive Medications taken by patient at home Allergies Chief Complaint Narrative
NAME 2012 CBT 940-EMT12 Sepsis EMERGENCY MEDICAL SERVICES (11/21/2011) MH PRINT STUDENT S NAME SKILLS CHECKLIST FOR RECERTIFICATION ID # DATE Objective: Given a partner, appropriate equip. and a patient with an infection-type complaint, demonstrate appropriate assessment and treatment as outlined in CBT 940-EMT12 and EMT Patient Care Guidelines. SCENE SIZE-UP (must verbalize) BSI Scene Safety Determines MOI/NOI Number of Patients Additional Resources INITIAL ASSESSMENT (must verbalize) Mental Status Chief complaint Airway C-spine SUBJECTIVE (FOCUSED HISTORY) Breathing Circulation Bleeding Obvious Trauma Body Position SICK NOT SICK Establishes rapport with patient (reassures and calms) and obtains consent to treat (implied/actual) Determines patient s chief complaint and follows SAMPLE and OPQRST investigation Determines time of onset of complaint, signs or symptoms Obtains names/dosages of current medications and were any taken OBJECTIVE (PHYSICAL EXAM) Records and documents baseline vital signs - listens to lung sounds and compares sides Performs appropriate medical / trauma exam exposes/checks for bleeding and/or injuries Determines patient s body temperature (oral, tympanic, etc.) Obtains second set of vital signs and compares to baseline ASSESSMENT (IMPRESSION) Verbalizes impression (i.e. Possible Sepsis [SIRS]) Determines if ALS is needed states rationale PLAN (TREATMENT) GENERAL CARE (Check all that apply) Indicates need for ALS and/or Reports APS to Dispatch Administers appropriate rate and delivery of oxygen (as indicated) Properly positions patient Performs Posturals (as indicated) COMMUNICATION AND DOCUMENTATION Considers the Sepsis Triad (Fever, HR>SBP, RR>20) Considers Index of Suspicion Glucometry/Oximetry On-scene time <15 min (when possible) Performs pt. reassessment Early notification to ED ( patient has possible sepsis ) Delivers timely and effective short report (if indicated) Completes SOAP narrative portion of incident response form CRITICAL (FAIL) CRITERIA DID NOT Take/verbalize BSI Appropriately provide/manage airway, breathing, bleeding control, treatment of shock Properly administers oxygen Indicate need for ALS and/or MEETS STANDARDS (RECERT) 2 nd ATTEMPT PRINT EVALUATOR S NAME EVALUATOR S SIGNATURE EVALUATOR ID # IF NO EXPLAIN CBT 940-EMT 12 Sepsis Student Name Recert Yes No Date Written Score (online / other)
TIME (APS) Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds Pulse Oximetry Glucometry Temperature Medications taken by patient at home Allergies Chief Complaint Narrative