SKILLS CHECKLIST

EMERGENCY MEDICAL SERVICES

FOR RECERTIFICATION

NAME

ID #

DATE

PRINT STUDENT’S NAME

Objective: Given a partner, the EMT will demonstrate his/her competency in dealing with proper assessment and the treatment of the environmentally ill patient. As outlined in BLS-2014 Environmental Emergencies and EMT Patient Care Guidelines.

SCENE SIZE-UP (must verbalize)  Safety Precautions (BSI)

 Scene Safety

 Determines MOI/NOI

 Number of Patients

 Additional Resources

INITIAL ASSESSMENT (must verbalize)  ABC’s  Bleeding

 Obvious Injury  Body Position

 SICK  NOT SICK

SUBJECTIVE (FOCUSED HISTORY)    

 Chief Complaint  Medications  Medical Hx

Establishes rapport with patient Permission To Treat SAMPLE/OPQRST MOI/NOI

OBJECTIVE INFORMATION (PHYSICAL EXAM)  CMS/Swelling  Lung Sounds  2nd Set of Vitals

 Skin Signs  HEENT  DCAP/BTLS

 Baseline Vital Signs (With Temp)  Medical Exam  Trauma Exam

ASSESSMENT (IMPRESSION)  Must Verbalize Impression

 ALS If Indicated: Why

PLAN (TREATMENT) Immediate Life Threats Proper Oxygen Therapy Pulse Ox/Glucometry Positioning Patient Consider IOS

 Prevent Heat Loss And/Or To Warm Patient  Cooling Patient  Stabilize Appropriately  CMS After Movement

    

Consider EpiPen Ongoing Assessment Determine Decon Needs CPR For Hypothermic Reports “At patient’s side”

CRITICAL FAIL  Take/verbalize BSI/Safety Precautions/Scene Safety  Appropriately provide/manage airway, breathing, bleeding control, treatment for shock

 Administer O2 Appropriate Rate And Delivery  Need For ALS

COMMUNICATION AND DOCUMENTATION

MEETS STANDARDS (RECERT)

 Delivers timely and effective short report (if indicated)  Completes SOAP narrative portion of incident response form

 YES  NO 2nd ATTEMPT  YES  NO

EVALUATOR SIGN YOUR NAME

IF NO EXPLAIN

ID #

Date:___________Written Score ________ (online / other)

    

Student Name _______________ _________ Meets Standards Yes / No

 Mental Status  C-Spine

BLS 2014 – Environmental Emergencies

BLS-2014 – Environmental Emergencies

TIME  Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds (Pulse Oximetry) (Glucometry)

Medications taken by patient at home

Allergies

Chief Complaint

Narrative

©2014 Seattle/King County EMS

SKILLS CHECKLIST

EMERGENCY MEDICAL SERVICES

FOR RECERTIFICATION

NAME

ID #

DATE

PRINT STUDENT’S NAME

Objective: Given a partner the EMT will demonstrate his/her competency in dealing with proper assessment and the treatment of the geriatric patient. as outlined in BLS-2014-Geriatric Medicine and EMT Patient Care Guidelines.

SCENE SIZE-UP (must verbalize)  (BSI)

 Scene Safety

 MOI/NOI

 Additional Resources

INITIAL ASSESSMENT (must verbalize)  Mental Status  C-Spine  Bleeding

 ABC’s  Skin Signs  Chief complaint

 Obvious Trauma  Body Position

 SICK  NOT SICK

 Chief Complaint  SAMPLE/OPQRST

 Medications  Medical Hx

 HEENT  Lung Sounds  Neck Veins

 Palpated  CMS/Swelling  2nd Set Of Vitals

SUBJECTIVE (FOCUSED HISTORY)  Establishes rapport with patient (reassures and cams) and obtains consent to treat (implied/actual)

OBJECTIVE (PHYSICAL EXAM)    

Baseline Vital Signs (With Temp) Medical Exam Trauma Exam DCAP/BTLS

ASSESSMENT (IMPRESSION)  Must Verbalize Impression

 ALS If Indicated: Why

PLAN (TREATMENT)    

Immediate Life Threats Proper Oxygen Therapy Pulse Ox/Glucometry Positioning Patient

Consider IOS Steps To Prevent Heat Loss Ongoing Assessment Reports “At Patient’s Side”

CRITICAL FAIL  Safety Precautions/Scene Safety  ABC’s

 Administer O2 Appropriate Rate And Delivery  Need For ALS

COMMUNICATION AND DOCUMENTATION

MEETS STANDARDS (RECERT)

 Delivers timely and effective short report (if

 YES  NO 2nd ATTEMPT  YES  NO

indicated)

 Completes SOAP narrative portion of incident response form EVALUATOR SIGN YOUR NAME

ID

IF NO EXPLAIN

Date:___________Written Score ________ (online / other)

   

Student Name ________________________________ Meets Standards Yes / No

 Number of Patients

BLS 2014 – Geriatric Medicine

BLS 2014 – Geriatric Medicine

TIME  Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds (Pulse Oximetry) (Glucometry)

Medications taken by patient at home

Allergies

Chief Complaint

Narrative

©2014 Seattle/King County EMS

SKILLS CHECKLIST

EMERGENCY MEDICAL SERVICES

FOR RECERTIFICATION

NAME

ID #

DATE

PRINT STUDENT’S NAME

Objective: Given a partner the EMT will demonstrate his/her competency in dealing with proper assessment and the treatment of the obstetrical patient. As outlined in BLS-2014-OB/GYN Emergencies and EMT Patient Care Guidelines.

SCENE SIZE-UP (must verbalize)  Safety Precautions (BSI)

 Scene Safety

 MOI/NOI

 Number of Patients

 Additional Resources

 Mental Status  C-Spine

 ABC’s  Bleeding

 Obvious Injury  Body Position

 SICK  NOT SICK

SUBJECTIVE (FOCUSED HISTORY)  Establishes rapport with patient  Permission To Treat  SAMPLE/OPQRST

 Chief Complaint  Medications  Medical Hx

OBJECTIVE (PHYSICAL EXAM)     

   

Baseline Vital Signs (With Temp) Medical Exam Trauma Exam Skin Signs HEENT

Lung Sounds Para/Grava Neck Veins DCAP/BTLS

   

CMS/Swelling Crowning Assessment Of Mother Assessment Of Baby

ASSESSMENT (IMPRESSION)  Must Verbalize Impression

 ALS If Indicated: Why

PLAN (TREATMENT)      

Immediate Life Threats Proper Oxygen Therapy Pulse Ox/Glucometry Positioning Patient Consider IOS Transportation Decision

Proper Bleeding Control Prepare For Birth Hemorrhage Prevent Heat Loss (Mom And Baby) Ongoing Assessment Reports “At patient’s side”

CRITICAL FAIL  Safety Precautions (BSI)/Scene Safety  Appropriately provide/manage airway, breathing, bleeding control, treatment of shock

 Administer O2 Appropriate Rate And Delivery  Need For ALS

COMMUNICATION AND DOCUMENTATION

MEETS STANDARDS (RECERT)

 Written Delivers timely and effective short report (if indicated)  Completes SOAP narrative portion of incident response form

 YES  NO 2nd ATTEMPT  YES  NO

EVALUATOR SIGN YOUR NAME

ID #

IF NO EXPLAIN

Date:___________Written Score ________ (online / other)

     

Student Name _______________________________ Meets Standards Yes / No

INITIAL ASSESSMENT (must verbalize)

BLS 2014 – OB/GYN Emergencies

BLS-2014 – OB/GYN Emergencies

TIME  Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds (Pulse Oximetry) (Glucometry)

Medications taken by patient at home

Allergies

Chief Complaint

Narrative

©2014 Seattle/King County EMS

SKILLS CHECKLIST

EMERGENCY MEDICAL SERVICES

FOR RECERTIFICATION

NAME

ID #

DATE

PRINT STUDENT’S NAME

Objective: Given a partner the EMT will demonstrate his/her competency in dealing with proper

assessment and the treatment of the orthopedic patient. as outlined in BLS-2014-Orthopedic Injuries and EMT Patient Care Guidelines. SCENE SIZE-UP (must verbalize)  Safety Precautions (BSI)

 Scene Safety

 MOI/NOI

 Number of Patients

 Additional Resources

BLS 2014 – Orthopedic Injuries

BLS-2014 – Orthopedic Injuries

INITIAL ASSESSMENT (must verbalize)  ABC’s  Skin Signs

 Obvious Trauma  Body Position

 SICK  NOT SICK

SUBJECTIVE (FOCUSED HISTORY)  Establishes rapport with patient  Permission To Treat  SAMPLE/OPQRST

 Chief Complaint  MOI/NOI  Medications

OBJECTIVE (PHYSICAL EXAM)  HEENT  CMS Before & After  DCAP/BTLS

 Baseline Vital Signs (With Temp)  Medical Exam  Trauma Exam

 Lung Sounds  Medical Hx  2nd Exam

ASSESSMENT (IMPRESSION)  ALS If Indicated: Why

 Must Verbalize Impression

PLAN (TREATMENT)     

Immediate Life Threats Proper Oxygen Therapy Pulse Ox/Glucometry Positioning Patient Consider IOS for MOI

Bandaging And Splinting Stabilize Fracture Appropriately Steps To Prevent Heat Loss Pulses Distally Ongoing Assessment

CRITICAL FAIL  Safety Precautions (BSI)/Scene Safety  Appropriately provide/manage airway,

 Administer O2 Appropriate Rate And Delivery  Need For ALS

breathing, bleeding control, treatment of shock COMMUNICATION

MEETS STANDARDS (RECERT)

 Delivers timely and effective short report (if indicated)  Completes SOAP narrative portion of incident response form

 YES  NO 2nd ATTEMPT  YES  NO

EVALUATOR SIGN YOUR NAME

IF NO EXPLAIN

ID #

Date:___________Written Score ________ (online / other)

    

Student Name ________________________________ Meets Standards Yes / No

 Mental Status  C-Spine

TIME  Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds (Pulse Oximetry) (Glucometry)

Medications taken by patient at home

Allergies

Chief Complaint

Narrative

©2014 Seattle/King County EMS

SKILLS CHECKLIST

EMERGENCY MEDICAL SERVICES

FOR RECERTIFICATION

NAME

ID #

DATE

PRINT STUDENT’S NAME

Objective: Given a partner the EMT will demonstrate his/her competency in dealing with proper

assessment and the treatment of the patient that is short of breath. As outlined in BLS-2014Respiratory Emergencies and EMT Patient Care Guidelines. SCENE SIZE-UP (must verbalize)  Safety Precautions (BSI)

 Scene Safety

 MOI/NOI

 Number of Patients

 Additional Resources

INITIAL ASSESSMENT (must verbalize)  ABC’s  Skin Signs

 Obvious Trauma  Body Position

 SICK  NOT SICK

SUBJECTIVE (FOCUSED HISTORY)  Establishes rapport with patient  Permission To Treat  SAMPLE/OPQRST

 Chief Complaint  Medications  Medical Hx

OBJECTIVE (PHYSICAL EXAM)  HEENT  Lung Sounds  Duration of SOB

 Baseline Vital Signs (With Temp)  Medical Exam/Trauma Exam  DCAP/BTLS

 Productive Cough  Body Position  2nd Exam

ASSESSMENT (IMPRESSION)  ALS If Indicated: Why

 Must Verbalize Impression

PLAN (TREATMENT)     

Immediate Life Threats Proper Oxygen Therapy Pulse Ox/Glucometry Positioning Patient Consider IOS

Suction Airway (if indicated) Manual Ventilation Assist Patient With Inhaler Consider EpiPen Ongoing Assessment

CRITICAL FAIL  Safety Precautions (BSI)/Scene Safety  Appropriately provide/manage airway, breathing, bleeding control, treatment of shock

 Administer O2 Appropriate Rate And Delivery  Need For ALS

COMMUNICATION

MEETS STANDARDS (RECERT)

 Delivers timely and effective short report (if indicated)  Completes SOAP narrative portion of incident response form

 YES  NO nd 2 ATTEMPT  YES  NO

EVALUATOR SIGN YOUR NAME

IF NO EXPLAIN

ID #

Date:___________Written Score ________ (online / other)

    

Student Name ________________________________ Meets Standards Yes / No

 Mental Status  C-Spine

BLS 2014 – Respiratory Emergencies

BLS-2014 – Respiratory Emergencies

TIME  Blood Pressure Pulse Rate Respiratory Rate Consciousness ECG Rhythm Oxygen Meds (Pulse Oximetry) (Glucometry)

Medications taken by patient at home

Allergies

Chief Complaint

Narrative

©2014 Seattle/King County EMS

INFECTIOUS DISEASE PROGRAM REVIEW

BLS 2014 – Infectious Disease EMERGENCY MEDICAL SERVICES

REQUIRED ANNUALLY FOR RECERTIFICATION

NAME

ID #

DATE

PRINT STUDENT’S NAME

Objective: To fulfill the requirements of WAC 296-305-0251 which states “All firefighter/EMTs shall be required to annually review the infectious disease information, updates, protocols, and equipment used in their department’s infectious disease plan. Additional specific training requirements are outlined in WAC 296-82312005.”

 The CBT621-EMT11-Infectious Disease course was completed and the “written” exam was completed with a score greater than 70%.  The person who conducted the required review of the department’s infectious disease policy is knowledgeable about the program and its contents. The review contained:  A general explanation of the epidemiology, symptoms and transmission of various infectious diseases. (covered in CBT621-EMT11-Infectious Disease )  An explanation of the department’s exposure control plan  Information and application of/about available personal protective equipment (PPE) using the MEGG approach to ‘donning’ and ‘doffing’.  Information pertaining to the reporting of an exposure  Information about post exposure evaluation and follow-up procedures following an exposure incident

This review fulfills the requirements set forth in WAC 296-305-0251 and WAC 296-823-12005 (It is advised that the above WACs are reviewed to assure compliance with Washington State law.) MEETS STANDARDS (RECERT)  YES  NO nd 2 ATTEMPT  YES EVALUATOR SIGN YOUR NAME

IF NO EXPLAIN

ID #

SKILLS CHECKLIST

EMERGENCY MEDICAL SERVICES

FOR RECERTIFICATION

NAME

ID #

DATE

PRINT STUDENT’S NAME

Objective: Given a partner the EMT will demonstrate his/her competency in dealing with proper assessment and the treatment of the patient in cardiac arrest.

SCENE SIZE-UP (must verbalize)  SP

 Scene Safety

 Additional Resources

 Airway

 Breathing

Unconscious

 P

 NR

1 Rescuer  P  NR 2 Rescuer Remediation  P  NR Initiates compression immediately Full release off chest with decompression Depth adequate for patient – approximately 2 inches Compression rate of at least 100 *Decrease time between shock and No Shock and compressions Chest rise with ventilations The Perfect Strip 1 minute of perfect CPR

 P

 NR

      

      

INITIAL ASSESSMENT (must verbalize)  LOC

 Circulation

FBAO Conscious

 P

 NR

CPR

P P P P P P P

NOTES

MEETS STANDARDS (RECERT)

    

 Yes 

BSI/Scene Safety O2 Over Ventilating Compression Rate 120 Failure to minimize interruptions

EVALUATOR SIGN YOUR NAME

No

2nd ATTEMPT  Yes  No ID #

IF NO EXPLAIN

EMS Online in cooperation with King County EMS and Seattle Fire Department

Date:___________Written Score ________ (online / other)

CRITICAL FAIL

NR NR NR NR NR NR NR

Student Name ________________________________ Meets Standards Yes / No

 MOI/NOI

2014 CBT/OTEP-Adult CPR

2014 CBT/OTEP-Adult CPR

SKILLS CHECKLIST

EMERGENCY MEDICAL SERVICES

FOR RECERTIFICATION

NAME

ID #

DATE

PRINT STUDENT’S NAME

Objective: Given a partner the EMT will demonstrate his/her competency in dealing with proper assessment and the treatment of the patient in cardiac arrest.

SCENE SIZE-UP (must verbalize)  SP

 Scene Safety



 Airway

 Breathing

Additional Resources

PRIMARY ASSESSMENT (must verbalize)  LOC

 Circulation

FBAO Conscious

 P

 NR

Unconscious

 P

 NR

 P  P

 NR  NR

FBAO - Responsive FBAO – Unresponsive

 P  P

 NR  NR

 P  P

 NR  NR

FBAO - Responsive FBAO – Unresponsive

 P  P

 NR  NR

CHILD 1 Rescuer 2 Rescuer

INFANT 1 Rescuer 2 Rescuer

NOTES

MEETS STANDARDS (RECERT)

    

 Yes 

BSI/Scene Safety O2 Over Ventilating Compression Rate 120 Failure to minimize interruptions

EVALUATOR SIGN YOUR NAME

No

2nd ATTEMPT  Yes  ID #

No

IF NO EXPLAIN

EMS Online in cooperation with King County EMS and Seattle Fire Department

Date:___________Written Score ________ (online / other)

CRITICAL FAIL

Student Name ________________________________ Meets Standards Yes / No

 MOI/NOI

2014 CBT/OTEP-Child/Infant CPR

2014 CBT/OTEP-Child/Infant CPR