- Trauma
PatientAssessment/Management
Start Time:
Date:
Stop Time:
Candidate's Name:
Points
Possible
Evaluator's Name:
T a k e s , o r v e r b a l i z e s ,b o d y s u b s t a n c e i s o l a t i o n p r e c a u t i o n s
Points
Awardod
1
SCENESIZE.UP
Determinesthe mechanism of injury
,|
,|
Determinesthe number of oatients
1
Requestsadditional help if necessary
1
C o n s i d e r ss t a b i l i z a t i o no f s p i n e
1
Determinesthe scene is safe
INITIALASSESSMENT
i , / e r b a l i z e sg e n e r a l i m p r e s s i o n o f t h e p a t i e n t
1
1
1
D e t e r m i n e s r e s p o n s i v e n e s s / l e v e lo f c o n s c i o u s n e s s
Determineschief complaint/apparent life threats
Assesses airway and breathing
{ssesses circulation
Assessment
Initiates appropriate oxygen therapy
Assures adequate ventilation
Injury management
1
1
1
1
Assesses/controls major bleeding
Assesses oulse
Assesses skin (color, temperature and condition)
I
1
1
1
dentifies priority patients/makes transport decision
:OCUSEDHISTORYAND PHYSICATEXAM]NATION/RAPID
TBAUMA ASSESSMENT
ielects appropriate assessmenl
lfocused or rapid assessment)
1
Jbtains, or directs assistance to obtain, baseline vital signs
1
) b t a i n s S . A . M . P . L . E .h i s t o r v
1
)ETAILEDPHYSICALEXAMINATION
A s s e s s e st h e h e a d
nspects and palpates the scalp and ears
\ssesses the eyes
\ssesses the facial areas includinq oral and nasal areas
1
1
1
\ssesses the neck
nspects and palpates the neck
A s s e s s e sf o r J V D
{ s s e s s e s f o r t r a c h a e ld e v i a t i o n
1
1
1
Assessesthe chest
nspecrs
)alpates
\ u s c ul t a t e s
1
1
1
\ssesses the abdomen
\ssesses the oelvis
/erbalizes assessment of genitalia/perineumas needed
'l
point for each extremity
includes inspection, palpation, and assessment of motor,
sensory and crrculatory function
1
1
1
Assesses the abdomen/oelvis
Assesses the extremities
Assessesthe Dosterior
Assesses thorax
Assesses lumbar
4
1
1
Manages secondary injuries and wounds appropriately
1 point for appropriate management of the secondary injury/wound
1
V e r b a l i z e sr e - a s s e s s m e n t o f t h e v i t a l s i g n s
1
CriticalCriteria
recautrons
Did
u
ro n
not
o t ttake.
a K e , or
o r verbalize.
v e r D a t t z e ,bodv
b o d y substance
sur
isolationp
orecautions
_
Total:
40
_
Did not determine scene safety
D i d n o t a s s e s sf o r s p i n a l p r o t e c t i o n
_
_
_
_
_
Did not providefor spinalprotectionwhen indicated
Did not providehigh concentrationof oxygen
D i d n o t f i n d ,o r m a n a g e p
, r o b l e m sa s s o c i a t ew
d i t h a i r w a y ,b r e a t h i n gh, e m o r r h a goer s h o c k( h y p o p e r f u s i o n )
Did not differentiatepatient'sneed for transportation
versuscontinuedassessmentat the scene
Did other detailedphysicalexaminationbeforeassessing
the airway,breathingand circulation
D i d n o t t r a n s p o rpt a t i e n tw i t h i n ( 1 0 ) m i n u t et i m e l i m i t
26
- Medical
PatientAssessment/Management
Start Time:
Date:
Stop Time:
Candidate's Name:
Points
Po3!ible
Evaluator'sName:
Takes,or verbalizes,
body substanceisolationprecautions
rotntS
Awa.d€d
1
SCENESIZE-UP
Determines
the sceneis safe
1
Determinesthe mechanism of injury/nature of illness
1
Determines
the numberof oatients
Requests additional help if necessary
1
1
Considers stabilizationof spine
1
NITIALASSESSMENT
1
1
V e r b a l i z e sg e n e r a l i m p r e s s i o n o f t h e p a t i e n t
D e t e r m i n e s r e s p o n s i v e n e s s / l e v e lo f c o n s c i o u s n e s s
Determines chief complaint/apparent life threats
1
Assesses airway and breathing
Assessment
Initiatesappropriateoxygentherapy
Assuresadeouateventilation
Assesses circulation
Assesses/controls major bleeding
Assesses pulse
Assesses skin (color, temperature and condition)
d e n r i fi e s p r i o r i t v p a t i e n t s / m a k e s t r a n s p o r t d e c i s i o n
1
1
1
1
I
1
1
:OCUSEDHISTORYAND PHYSICALEXAMINATION/RAPID
ASSESSMENT
Respiratory
'l
(,4ssess history of present illness)
Signs and symptoms
Cardiac
i Onset?
rOnset?
'Provokes?
r Provokes?
* Ouality?
r O u a l i t y?
'Radiates?
r Radiates?
* Severity?
'Severity ?
'Time?
iTime?
* InterventionsT
l Interventions?
Altelod Montal
Status
rDescription of
the episode.
rOnset?
r Duration?
'Associated
Symptoms?
rEvidence of
Trauma?
l lnterventions?
r Seizures?
r Fever
Allergic
Reaction
'History of
allergies?
*What were
you exposed
to?
rHow were
you
e x p o s e d?
r Effects ?
+P r o g r e s s i o n ?
r Interventions?
Poisoning/
Ovardosa
r S u b s t a n c e?
rWhen did you
ingest/become
exposed?
lHow much did
you ingest?
rOver what time
p e r i o d?
r Interventions?
r Estimated
weight?
Environmantal
Emergency
Obstotrics
r Source?
rAre you pregnant?
r Environmenl? ' H o w l o n g h a v e y o u
r Duration?
been pregnant?
* Lossof
iPain or
? contractions?
consciousness
rEffects rBleeding or
generalor
d i s c h a r g e?
rDo you feel the
local?
need to push?
rLast menstrual
Eehavioral
rHow do you feel?
I Determine
suicidal
tendencies.
lls the palient a
threat to self or
o t h e r s?
rls there a medical
problem?
r Interventions?
period?
{llergies
1
Vledicalaons
I
)ast pertinent historv
,|
l - a s to r a l i n t a k e
1
Event leading to present illness (rule out trauma)
1
)erforms focused physical examination (assesses affected body part/system or, if indicated, completes rapid assessment)
yitafs (obtans baseline vital signs)
1
nterventions
Transport
(obtains medical direction or verbalizes standing order for medication interventions
and verbalizes proper additional intervention/treatment)
1
1
( r e - e v a l u a t e s t h e t r a n s p o r td e c i s i o n )
1
V e r b a l i z e st h e c o n s i d e r a t i o n f o r c o m p l e t i n g a d e t a i l e d p h y s i c a l e x a m i n a t i o n
1
ONGOINGASSESSMENT(verbalized)
Repeatsinitialassessment
1
1
1
Repeatsvital signs
Repeatsfocusedassessmentregardingpatientcomplaintor injuries
Critical Criteria
_
_
_
_
_
_
_
_
_
Total:
Did not take, or verbalize,body substanceisolationprecautionswhen necessary
Did not determinescenesafety
Did not obtainmedicaldirectionor verbalizestandingordersfor medicalinterventions
Did not providehigh concentrationof oxygen
Did not find or manageproblemsassociatedwith airway,breathing,hemorrhageor shock (hypoperfusionl
Did not differentiatepatient'sneedfor transportationversuscontinuedassessmentat the scene
examinationbeforeassessingthe airway,breathingand circulation
Did detailedor focusedhistory/physical
Did not ask questionsabout the presentillness
intervention
Administereda dangerousor inappropriate
27
30
BAG.VALVE.MASK
APNEICPATIENT
StartTime:
StopTime:
Date:
Candidate'sName:
Points
Points
Possible Awarded
Name:
Evaluator's
precautions
isolation
fakes,or verbalizes,
bodysubstance
1
y'oicesopeningthe airway
y'oicesinsertingan airwayadjunct
1
,l
Selectsappropriatelysized mask
1
,l
Createsa propermask-to-face
seal
patientat no lessthan 800 ml volume
Ventilates
(The examiner must wifness for at leasf 30 seconds)
Connectsreservoirand oxygen
1
1
1
Adjustsliterflowto 15 liters/minute
or greater
The examiner indicates arrival of a second EMT. The second EMT is instructed to
ventilatethe patientwhile the candidatecontrols the maskand the airway
Voicesre-openingthe airway
Createsa propermask-to-faceseal
1
1
Instructs
assistant
to resumeventilation
at propervolumeperbreath
(The examiner must wifness for at leasf 30 seconds/
Total:
CriticalCriteria
precautions
Didnottake,or verbalize,
bodysubstance
isolation
Didnotimmediately
ventilate
the patient
Interrupted
ventilations
for morethan20 seconds
Didnotprovidehighconcentration
of oxygen
Didnot provide,or directassistant
to provide,propervolume/breath
per minuteare below800ml)
(morethantvvo(2) ventilations
exhalation
Didnotallowadequate
29
1
11
SPINALIMMOBILIZATION
SEATEDPATIENT
StartTime:
StopTime:
Date:
Candidate'sName:
Points
Points
Possible Awarded
Evaluator's
Name:
precautions
Takes,or verbalizes,
bodysubstance
isolation
Directs
assistant
to place/maintain
headin the neutralin-lineposition
Directs
to maintain
manualimmobilization
assistant
of the head
Reassesses
motor,sensoryand circulatory
functionin eachextremity
Appliesappropriately
sizedextrication
collar
Positions
the immobilization
devicebehindthe patient
1
1
1
1
1
1
Securesthe deviceto the patient'storso
1
Evaluatestorso fixationand adjustsas necessary
Evaluatesand pads behindthe patient'sheadas necessary
1
Securesthe patient'shead to the device
1
Verbalizes
movingthe patientto a longboard
Reassesses
motor,sensoryandcirculatory
functionin eachextremity
1
I
Total:
1
12
Critical Griteria
Did not immediately
direct,or take,manualimmobilization
of the head
Released,or orderedreleaseof, manualimmobilization
beforeit was maintainedmechanicall
Patientmanipulated,
or movedexcessively,
causingpotential
spinalcompromise
Devicemovedexcessively
up,down,leftor righton the patient'storso
Headimmobilization
allowsfor excessive
movement
Torsofixationinhibits
chestrise,resulting
in respiratory
compromise
Uponcompletion
of immobilization,
headis notin the neutralposition
Didnotassessmotor,sensoryand circulatory
functionin eachextremityaftervoicing
immobilization
to the longboard
lmmobilized
headto the boardbeforesecuringthe torso
30
SPINALIMMOBILIZATION
SUPINEPATIENT
StartTime:
StopTime:
Date:
Candidate'sName:
Points
Points
Possible Awarded
Name:
Evaluator's
fakes,or verbalizes,
bodysubstanceisolationprecautions
Directsassistant
headin the neutralin-lineposition
to place/maintain
1
Directsassistantto maintainmanualimmobilization
of the head
1
Reassesses
motor,sensoryandcirculatory
functionin eachextremity
Appliesappropriately
sizedextrication
collar
1
Positions
deviceappropriately
the immobilization
Directsmovementof the patientonto the devicewithoutcompromising
rheintegrityof the spine
1
Appliespaddingto voids betweenthe torso and the boardas necessary
mmobilizesthe patient'storso to the device
1
1
1
1
1
valuatesand pads behindthe patient'sheadas necessary
lmmobilizes
the patient'sheadto the device
1
Securesthe patient'slegs to the device
1
Secures
the patient'sarmsto the device
Reassesses
motor,sensoryandcirculatory
functionin eachextremity
1
1
Total:
1
14
Critical Griteria
Didnotimmediately
direct,or take,manualimmobilization
of the head
Released,
or orderedreleaseof, manualimmobilization
beforeit was maintained
mechanicall
Patientmanipulated,
or movedexcessively,
causingpotential
spinalcompromise
Patientmovesexcessively
up,down,leftor righton the patient'storso
Headimmobilization
allowsfor excessivemovement
Uponcompletion
of immobilization,
headis notin the neutralposition
Didnotassessmotor,sensoryandcirculatory
functionin eachextremityafterimmobilization
to the device
lmmobilized
headto the boardbeforesecuringthe torso
3l
IMMOBILIZATION
SKILLS
LONGBONEINJURY
StartTime:
StopTime:
Date:
Candidate'sName:
Points
Points
Possible Awarded
Evaluator'sName:
fakes, or verbalizes,body substanceisolationprecautions
,,
of the injury
Directsapplication
of manualstabilization
1
1
functionin the injuredextremity
Assesses
motor,sensoryand circulatory
fVote.'The examiner acknowledges "motor, sensory and circulatory function are
presentand normal"
Measuresthe splint
1
Appliesthe splint
mmobilizes
the joint abovethe injurysite
1
lmmobilizes
the joint belowthe injurysite
1
Securesthe entireinjuredextremity
1
lmmobilizes
the hand/footin the positionof function
1
1
functionin the injuredextremit' 1
Reassesses
motor,sensoryandcirculatory
Mote,'The examiner acknowledges"motor,sensory and circulatory function are
presentand normal"
Total:
10
CriticalCriteria
Grosslymovesthe injuredextremity
thejointaboveandthejointbelowthe injurysite
Didnotimmobilize
functionin the injuredextremity
Didnot reassessmotor,sensoryandcirculatory
beforeandaftersplinting
1)
IMMOBILIZATION
SKILLS
JOINTINJURY
StartTime:
StopTime:
Date:
Candidate'sName:
Points
Points
Possible Awarded
Evaluator'sName:
precautions
1
Iakes,or verbalizes,
isolation
bodysubstance
1
Directsapplication
of the shoulderinjury
of manualstabilization
1
functionin the injuredextremity
Assesses
motor,sensoryandcirculatory
Mofe.'The examiner acknowledges"motor, sensory and circulatory function are present
and normal."
Selectsthe propersplintingmaterial
1
lmmobilizes
the siteof the injury
joint
lmmobilizes
the boneabovethe injured
1
lmmobilizes
the bone belowthe injuredjoint
1
1
Reassesses
functionin the injuredextremit' 1
motor,sensoryand circulatory
t\lote.'The examiner acknowledges"motor, sensory and circulatory function are present
and normal."
Total:
8
CriticalCriteria
Didnotsupportthejointso thatthejointdid notbeardistalweight
the boneaboveandbelowthe injuredsite
Didnotimmobilize
functionin the injuredextremitybefore
Didnot reassessmotor,sensoryandcirculatory
andaftersplinting
33
IMMOBILIZATION
SKILLS
TRACTION
SPLINTING
StartTime:
StopTime:
Date:
Candidate'sName:
Points
Points
Possible Awarded
Evaluator's
Name:
precautions
bodysubstance
isolation
l-akes,
or verbalizes,
1
of manualstabilization
Directsapplication
of the injuredleg
1
Directsthe application
of manualtraction
1
,l
Assesses
motor,sensoryand circulatory
functionin the injuredextremity
Mofe.'The examiner acknowledges "motor, sensory and circulatory function are
presentand normal"
Prepares/adjusts
splintto the properlength
1
Positionsthe splintnext to the injuredleg
1
Appliesthe proximalsecuringdevice(e.9.. ischialstrap)
Appliesthe distalsecuringdevice(e.g..anklehitch)
1
Appliesmechanical
traction
1
Positions/secures
the supportstraps
1
Re-evaluates
the proximal/distal
securingdevices
1
1
Reassesses
motor,sensoryand circulatory
1
functionin the injuredextremity
Note:Theexaminer acknowledges"motor, sensoryand circulatory function are
presentand normal"
Mofe: The examiner must ask the candidate how helshe would prepare the
p atient fo r tra ns po rtati o n
Verbalizes
securingthe torsoto the longboardto immobilize
the hip
1
Verbalizes
securingthe splintto the longboardto preventmovementof the splint
I
Total:
14
CriticalCriteria
Lossof tractionat anypointafterit was applied
Didnot reassessmotor,sensoryandcirculatory
functionin the injuredextremitybefore
andaftersplinting
Thefootwas excessively
rotatedor extendedaftersplintwas applied
Didnotsecurethe ischialstrapbeforetakingtraction
of the injuredleg
Finallmmobilization
failedto supportthefemuror preventrotation
mechanical
traction
Secured
the legto the splintbeforeapplying
Note:lf the Sagar splint or the KendricksTraction Deviceis used without elevating the patient'sleg, applicationof
manualtraction is not necessary. Thecandidateshould be awardedone (1) point as if manual traction were
applied.
Note:lf the legis elevatedat all, manual traction must be applied beforeelevating the leg. Theankle hitch may be
appliedbeforeelevatingthe legand usedto providemanualtraction.
1q
BLEEDING
CONTROUSHOCK
MANAGEMENT
StartTime:
StopTime:
Date:
Candidate'sName:
Points
Points
Possible Awarded
Evaluator's
Name:
Takes,or verbalizes,
bodysubstanceisolationprecautions
I
Appliesdirectpressureto the wound
1
Elevates
the extremity
1
Note: The examiner must now inform the candidatethat the wound continues fo bleed.
Applies
an additional
dressing
to thewound
1
Note: The examiner must now inform the candidate that the wound still continues to
bleed. Ihe second dressingdoes not control the bleeding.
Locatesand appliespressureto appropriate
arterialpressurepoint
1
Note:Theexaminer must now inform the candidatethat the hleedingis controlled
Bandagesthe wound
1
lVofe.'The examiner must now inform the candidate the patient is now showing srgns
and symptoms indicative of hypopertusion
Properlypositions
the patient
Applies
highconcentration
oxygen
Initiates
stepsto preventheatlossfromthe patient
1
lndicatesthe need for immediatetransportation
1
1
1
Total:
10
Gritical Griteria
precautions
Didnottake,or verbalize,
isolation
bodysubstance
Didnotapplyhighconcentration
of oxygen
Applieda tourniquet
othermethodsof bleedingcontrol
beforeattempting
Didnotcontrolhemorrhage
in a timelymanner
Didnot indicatea needfor immediate
transportation
35
AIRWAY,OXYGENANDVENTILATION
SKILLS
ANDSUCTION
UPPERAIRWAYADJUNCTS
StartTime:
StopTime:
Date:
Gandidate'sName:
Evaluator'sName:
OROPHARYNGEAL
AIRWAY
Points
Points
Possible Awarded
Takes,or verbalizes,body substanceisolationprecautions
1
Selectsappropriately
sizedairway
1
Measures
airway
Insertsairwaywithoutpushingthetongueposteriorly
1
1
Note:The examiner must advisethe candidatethat the patientis gagging and
becomingconscious
the oropharyngeal
ainruay
Removes
1
SUCTION
Alofe;The examiner must advise the candidate to suction the patient's airway
Turnson/prepares
suctiondevice
1
Assurespresenceof mechanicalsuction
1
Inserts
the suctiontip withoutsuction
Applies
suctionto the oropharynx/nasopharynx
1
1
NASOPHARYNGEAL
AIRWAY
lVofe;The examiner must advisethe candidafeto rnserta nasopharyngealairway
Selectsappropriately
sizedairway
1
airway
Measures
Verbalizes
lubrication
of the nasalairway
1
,l
Fullyinsertsthe ainruay
with the bevelfacingtowardthe septum
1
Total:
CriticalCriteria
precautions
Didnottake,or verbalize,
isolation
bodysubstance
Didnotobtaina patentairwaywiththe oropharyngeal
airway
Didnotobtaina patentairuaywiththe nasopharyngeal
airuuay
Didnotdemonstrate
an acceptable
suctiontechnique
Inserted
anyadjunctin a mannerdangerous
to the patient
13
MOUTHTO MASKWITHSUPPLEMENTAL
OXYGEN
StartTime:
StopTime:
Date:
Gandidate'sName:
Evaluator'sName:
Points
Points
Possible Awarded
Takes,or verbalizes,bodysubstanceisolationprecautions
1
Connectsone-wavvalveto mask
Openspatient'sairwayor confirmspatient'sairwayis open
(manually
or withadjunct)
1
1
Establishes
and maintainsa propermaskto face seal
1
,l
Ventilates
the patientat the propervolumeand rate
(800-1200ml per breath/l0-20 breathsper minute)
Connects
the maskto highconcentration
of oxygen
1
Adjustsflow rate to at least 15 litersper minute
Continuesventilationof the patientat the propervolumeand rate
1
1
(800-1200ml per breath/l0-20 breathsper minute\
Nofe.'The examiner must ryitness ventilations for at least 30 seconds
Total:
Critical Criteria
precautions
isolation
Didnottake,or verbalize,
bodysubstance
Didnot adjustliterflowto at least15 litersper minute
Didnotprovidepropervolumeperbreath
(more than 2 ventilationsper minute were below 800ml)
Didnotventilatethe patientat a ratea 10-20breathsper minute
Didnotallowfor complete
exhalation
37
8
OXYGENADMINISTRATION
StartTime:
StopTime:
Date:
Candidate'sName:
Points
Possible
Evaluator'sName:
fakes, or verbalizes,body substanceisolationprecautions
1
Assembles
the regulator
to thetank
1
Cpensthe tank
1
Checksfor leaks
Checkstank pressure
1
Attachesnon-rebreathermask to oxygen
1
,l
Prefillsreservoir
1
literflowto 12litersperminuteor greater
Adjusts
1
Appliesand adjuststhe maskto the patient'sface
,l
Points
Awarded
Note: The examiner must advise the candidate that the patient is not tolerating the
non-rebreathermask. The medical director has ordered you to apply a nasal cannula
to the patient.
Attachesnasal cannulato oxygen
1
Adjusts
literflowto six (6)litersperminuteor less
1
Appliesnasalcannulato the patient
1
Note:The examinermust advisethe candidateto discontinueoxygentherapy
Removes
1
the nasalcannulafromthe patient
Shutsoff the regulator
Relievesthe pressurewithinthe regulator
1
I
Total:
15
CriticalCriteria
precautions
Didnottake,or verbalize,
bodysubstance
isolation
withoutleaks
Didnot assemblethe tankand regulator
Didnot prefillthe reservoir
bag
mask
Didnotadjustthe deviceto the correctliterflowfor the non-rebreather
(12litersper minuteor greater)
Didnot adjustthe deviceto the correctliterflowfor the nasalcannula
(6 litersper minuteor /ess/
38