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National Registry of Emergency Medical Technicians®

Emergency Medical Technician Psychomotor Examination

PATIENT ASSESSMENT/MANAGEMENT – TRAUMA

Candidate: Examiner:

Date: Signature:

Scenario # Actual Time Started: __________ Note: Areas denoted by “**” may be integrated within sequence of Primary Survey/Resuscitation Possible

Points Points

Awarded

- (1 point)

© 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OHAll materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e201/10-16

Takes or verbalizes appropriate PPE precautions 1SCENE SIZE-UPDetermines the scene/situation is safe 1Determines the mechanism of injury/nature of illness 1Determines the number of patients 1Requests additional EMS assistance if necessary 1Considers stabilization of the spine 1PRIMARY SURVEY/RESUSCITATIONVerbalizes general impression of the patient 1Determines responsiveness/level of consciousness 1Determines chief complaint/apparent life-threats 1Airway 2 -Opens and assesses airway (1 point) -Inserts adjunct as indicated (1 point)Breathing -Assess breathing (1 point) -Assures adequate ventilation (1 point) 4 -Initiates appropriate oxygen therapy (1 point) -Manages any injury which may compromise breathing/ventilation (1 point)Circulation -Checks pulse (1point) -Assess skin [either skin color, temperature or condition] (1 point) -Assesses for and controls major bleeding if present (1 point)

4

-Initiates shock management [positions patient properly, conserves body heat] (1 point)Identifies patient priority and makes treatment/transport decision (based upon calculated GCS) 1HISTORY TAKINGObtains baseline vital signs [must include BP, P and R] (1 point) 1Attempts to obtain SAMPLE history 1SECONDARY ASSESSMENTHead -Inspects and palpates scalp and ears (1 point) ** -Assesses eyes (1 point) 3 -Inspects mouth**, nose** and assesses facial area (1 point)Neck** -Checks position of trachea (1 point) -Checks jugular veins (1 point) -Palpates cervical spine (1 point) 3

Chest** -Inspects chest (1 point) -Palpates chest (1 point) -Auscultates chest (1 point) 3

Abdomen/pelvis** -Inspects and palpates abdomen (1 point) -Assesses pelvis (1 point) 3 -Verbalizes assessment of genitalia/perineum as needed (1 point)Lower extremities** -Inspects, palpates and assesses motor, sensory and distal circulatory functions (1 point/leg) 2Upper extremities -Inspects, palpates and assesses motor, sensory and distal circulatory functions (1 point/arm) 2Posterior thorax, lumbar and buttocks** -Inspects and palpates posterior thorax (1 point) -Inspects and palpates lumbar and buttocks areas (1 point) 2

Manages secondary injuries and wounds appropriately 1REASSESSMENTDemonstrates how and when to reassess the patient 1

Actual Time Ended: ___________ TOTAL 42

CRITICAL CRITERIA____ Failure to initiate or call for transport of the patient within 10 minute time limit____ Failure to take or verbalize appropriate PPE precautions____ Failure to determine scene safety____ Failure to assess for and provide spinal protection when indicated____ Failure to voice and ultimately provide high concentration oxygen____ Failure to assess/provide adequate ventilation____ Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock____ Failure to differentiate patient’s need for immediate transportation versus continued assessment/treatment at the scene____ Performs other assessment before assessing/treating threats to airway, breathing and circulation____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate interventionYou must factually document your rationale for checking any of the above critical items on the reverse side of this form.

National Registry of Emergency Medical Technicians® Emergency Medical Technician Psychomotor Examination

PATIENT ASSESSMENT/MANAGEMENT – MEDICAL


Date: Signature:

Scenario #

Actual Time Started: __________ Possible Points

Points Awarded

ene


Takes or verbalizes appropriate PPE precautions 1SCENE SIZE-UPDetermines the scene/situation is safe 1Determines the mechanism of injury/nature of illness 1Determines the number of patients 1Requests additional EMS assistance if necessary 1Considers stabilization of the spine 1PRIMARY SURVEY/RESUSCITATIONVerbalizes the general impression of the patient 1Determines responsiveness/level of consciousness (AVPU) 1Determines chief complaint/apparent life-threats 1Assesses airway and breathing-Assessment (1 point) -Assures adequate ventilation (1 point) -Initiates appropriate oxygen therapy (1 point) 3

Assesses circulation-Assesses/controls major bleeding (1 point) -Checks pulse (1 point) 3-Assesses skin [either skin color, temperature or condition] (1 point)Identifies patient priority and makes treatment/transport decision 1HISTORY TAKINGHistory of the present illness-Onset (1 point) -Quality (1 point) -Severity (1 point)-Provocation (1 point) -Radiation (1 point) -Time (1 point) 8-Clarifying questions of associated signs and symptoms related to OPQRST (2 points)Past medical history-Allergies (1 point) -Past pertinent history (1 point) -Events leading to present illness (1 point) 5-Medications (1 point) -Last oral intake (1 point)SECONDARY ASSESSMENTAssesses affected body part/system-Cardiovascular -Neurological -Integumentary -Reproductive 5-Pulmonary -Musculoskeletal -GI/GU -Psychological/SocialVITAL SIGNS-Blood pressure (1 point) -Pulse (1 point) -Respiratory rate and quality (1 point each) 4States field impression of patient 1Interventions [verbalizes proper interventions/treatment] 1REASSESSMENTDemonstrates how and when to reassess the patient to determine changes in condition 1Provides accurate verbal report to arriving EMS unit 1Actual Time Ended: ___________ TOTAL 42CRITICALCRITERIA____ Failure to initiate or call for transport of the patient within 15 minute time limit____ Failure to take or verbalize appropriate PPE precautions____ Failure to determine scene safety before approaching patient____ Failure to voice and ultimately provide appropriate oxygen therapy____ Failure to assess/provide adequate ventilation____ Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock____ Failure to differentiate patient’s need for immediate transportation versus continued assessment or treatment at the scene____ Performs secondary examination before assessing and treating threats to airway, breathing and circulation____ Orders a dangerous or inappropriate intervention____ Failure to provide accurate report to arriving EMS unit____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention

You must factually document your rationale for checking any of the above critical items on the reverse side of this form.

Candidate: ________________________________________ Examiner: __________________________________________

Date: _____________________________________________ Signature: __________________________________________

Actual Time Started: __________

CRITICAL CRITERIA____ Failure to take or verbalize appropriate PPE precautions____ Failure to assemble the oxygen tank and regulator without leaks____ Failure to prefill the reservoir bag____ Failure to adjust the oxygen flow rate to the non-rebreather mask of at lease 10 L/minute____ Failure to ensure a tight mask seal to patient’s face____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention




OXYGEN ADMINISTRATION BY NON-REBREATHER MASK

Takes or verbalizes appropriate PPE precautions 1Gathers appropriate equipment 1Cracks valve on the oxygen tank 1Assembles the regulator to the oxygen tank 1Opens the oxygen tank valve 1Checks oxygen tank pressure 1Checks for leaks 1Attaches non-rebreather mask to correct port of regulator 1Turns on oxygen flow to prefill reservoir bag 1Adjusts regulator to assure oxygen flow rate of at least 10 L/minute 1Attaches mask to patient’s face and adjusts to fit snugly 1


PossiblePoints

PointsAwarded


Candidate: ________________________________________ Examiner: __________________________________________

Date: _____________________________________________ Signature: __________________________________________




BVM VENTILATION OF AN APNEIC ADULT PATIENT

Takes or verbalizes appropriate PPE precautions 1Checks responsiveness 1Requests additional EMS assistance 1Checks breathing and pulse simultaneously 1NOTE: After checking responsiveness, then checking breathing and pulse for no more than 10 seconds, examiner informs candidate, “The patient is unresponsive, apneic and has a weak pulse of 60.”Opens airway properly 1NOTE: The examiner must now inform the candidate, “The mouth is full of secretions and vomitus.”Prepares rigid suction catheter 1Turns on power to suction device or retrieves manual suction device 1Inserts rigid suction catheter without applying suction 1Suctions the mouth and oropharynx 1NOTE: The examiner must now inform the candidate, “The mouth and oropharynx are clear.”Opens the airway manually 1Inserts oropharyngeal airway 1NOTE: The examiner must now inform the candidate, "No gag reflex is present and the patient accepts the airway adjunct."**Ventilates the patient immediately using a BVM device unattached to oxygen[**Award this point if candidate elects to ventilate initially with BVM attached to reservoir and oxygen so long as 1first ventilation is delivered within 30 seconds.]NOTE: The examiner must now inform the candidate that ventilation is being properly performed without difficulty.Re-checks pulse for no more than 10 seconds 1Attaches the BVM assembly [mask, bag, reservoir] to oxygen [15 L/minute] 1Ventilates the patient adequately-Proper volume to cause visible chest rise (1 point) 2-Proper rate [10 – 12/minute (1 ventilation every 5 – 6 seconds)] (1 point)Note: The examiner must now ask the candidate, “How would you know if you are delivering appropriate volumes with each ventilation?”


CRITICAL CRITERIA____ After suctioning the patient, failure to initiate ventilations within 30 seconds or interrupts ventilations for greater than 30 seconds at any time____ Failure to take or verbalize appropriate PPE precautions____ Failure to suction airway before ventilating the patient____ Suctions the patient for an excessive and prolonged time____ Failure to check responsiveness, then check breathing and pulse simultaneously for no more than 10 seconds____ Failure to voice and ultimately provide high oxygen concentration [at least 85%]____ Failure to ventilate the patient at a rate of 10 – 12/minute (1 ventilation every 5 – 6 seconds)____ Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible]____ Insertion or use of any adjunct in a manner dangerous to the patient____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention


PossiblePoints

PointsAwarded


National Registry of Emergency Medical Technicians

Advanced Level Psychomotor Examination

SUPRAGLOTTIC AIRWAY DEVICE

Candidate: Examiner: Date: Signature: Device:

NOTE: If candidate elects to initially ventilate with BVM attached to reservoir and oxygen, full credit must be awarded for steps denoted by

“**” so long as first ventilation is delivered within 30 seconds.

Actual Time Started: Possible Points

Points Awarded

Actual Time Ended: TOTAL 18

Critical Criteria Failure to initiate ventilations within 30 seconds after using appropriate PPE or interrupts ventilations for greater than 30 seconds at any time Failure to take or verbalize appropriate PPE precautions

Failure to voice and ultimately provide high oxygen concentration [at least 85%] Failure to ventilate the patient at a rate of 10 – 12/minute (1 ventilation every 5 – 6 seconds) Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible] Failure to pre-oxygenate patient prior to insertion of the supraglottic airway device Failure to insert the supraglottic airway device at a proper depth or location within 3 attempts Failure to properly secure device per manufacturer’s instructions Failure to confirm that patient is being ventilated properly by auscultation bilaterally over lungs and over the epigastrium Insertion or use of any adjunct in a manner dangerous to the patient

Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention


© 2019 National Registry of Emergency Medical Technicians, Inc., Columbus, OH

All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. p304/04-19

Takes or verbalizes appropriate PPE precautions 1 Opens the airway manually 1 Elevates tongue, inserts simple adjunct [oropharyngeal or nasopharyngeal airway] 1 NOTE: Examiner now informs candidate no gag reflex is present and patient accepts adjunct

**Ventilates patient immediately with bag-valve-mask device unattached to oxygen 1 **Ventilates patient with room air 1 NOTE: Examiner now informs candidate that ventilation is being performed without difficulty and that pulse oximetry indicates

the patient’s blood oxygen saturation is 85%

Attaches oxygen reservoir to bag-valve-mask device and connects to high-flow oxygen regulator

[12 – 15 L/minute] 1

Ventilates patient at a rate of 10 – 12/minute (1 ventilation every 5 – 6 seconds) with appropriate volumes 1 NOTE: After 30 seconds, examiner auscultates and reports breath sounds are present and equal bilaterally and medical direction

has ordered insertion of a supraglottic airway. The examiner must now take over ventilation.

Checks/prepares supraglottic airway device 1 Lubricates distal tip of the device [may be verbalized] 1 NOTE: Examiner to remove OPA and move out of the way when candidate is prepared to insert device.

Positions head properly 1 Performs a tongue-jaw lift 1 Inserts device to proper depth 1 Properly secures device per manufacturer’s instructions 1 Ventilates patient and confirms proper ventilation by auscultation bilaterally over lungs and over the

epigastrium 1

Adjusts ventilation as necessary 1 Verifies proper tube placement by secondary confirmation such as capnography, capnometry, EDD or

colorimetric device 1

NOTE: The examiner must now ask the candidate, “How would you know if you are delivering appropriate volumes with

each ventilation?”

Secures device or confirms that the device remains properly secured 1 Ventilates patient at proper rate and volume while observing capnography/capnometry and pulse oximeter 1



CARDIAC ARREST MANAGEMENT / AED

Candidate: Examiner: Date: Signature:

Actual Time Started: __________ PossiblePoints

PointsAwarded


Takes or verbalizes appropriate PPE precautions 1Determines the scene/situation is safe 1

1Checks patient responsiveness 1

Requests additional EMS assistance 1Checks breathing and pulse simultaneously 1NOTE: After checking responsiveness, then checking breathing and pulse for no more than 10 seconds,examiner informs candidate, “The patient is unresponsive, apneic and pulseless.”

Immediately begins chest compressions [adequate depth and rate; allows the chest to recoil completely] 1

Performs 2 minutes of high-quality, 1-rescuer adult CPR-Adequate depth and rate (1 point)-Correct compression-to-ventilation ratio (1 point)-Allows the chest to recoil completely (1 point) 5

-Adequate volumes for each breath (1 point)-Minimal interruptions of no more than 10 seconds throughout (1 point)

NOTE: After 2 minutes (5 cycles), candidate assesses patient and second rescuer resumes compressions while candidate operates AED.Turns on power to AED 1Follows prompts and correctly attaches AED to patient 1Stops CPR and ensures all individuals are clear of the patient during rhythm analysis 1Ensures that all individuals are clear of the patient and delivers shock from AED 1Immediately directs rescuer to resume chest compressions 1


Critical Criteria____ Failure to take or verbalize appropriate PPE precautions____ Failure to check responsiveness, then check breathing and pulse simultaneously for no more than 10 seconds____ Failure to immediately begin chest compressions as soon as pulselessness is confirmed____ Failure to demonstrate acceptable high-quality, 1-rescuer adult CPR____ Interrupts CPR for more than 10 seconds at any point____ Failure to correctly attach the AED to the patient____ Failure to operate the AED properly____ Failure to deliver shock in a timely manner____ Failure to ensure that all individuals are clear of patient during rhythm analysis and before delivering shock

[verbalizes “All clear” and observes]____ Failure to immediately resume compressions after shock delivered____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention


Direct assistant to retrieve AED



SPINAL IMMOBILIZATION (SUPINE PATIENT)


Date: Signature:

Actual Time Started: __________ Possible Points

Points Awarded


Takes or verbalizes appropriate PPE precautions 1Directs assistant to place/maintain head in the neutral, in-line position 1Directs assistant to maintain manual stabilization of the head 1Reassesses motor, sensory and circulatory function in each extremity 1Applies appropriately sized extrication collar 1Positions the immobilization device appropriately 1Directs movement of the patient onto the device without compromising the integrity of the spine 1Applies padding to void between the torso and the device as necessary 1Immobilizes the patient’s torso to the device 1Evaluates and pads behind the patient’s head as necessary 1Immobilizes the patient’s head to the device 1Secures the patient’s legs to the device 1Secures the patient’s arms to the device 1Reassesses motor, sensory and circulatory function in each extremity 1


CRITICAL CRITERIA____ Failure to immediately direct or take manual stabilization of the head____ Failure to properly apply appropriately sized cervical collar before ordering release of manual stabilization____ Released or ordered release of manual stabilization before it was maintained mechanically____ Manipulated or moved the patient excessively causing potential spinal compromise____ Head immobilized to the device before device sufficiently secured to the torso____ Patient moves excessively up, down, left or right on the device____ Head immobilization allows for excessive movement____ Upon completion of immobilization, head is not in a neutral, in-line position____ Failure to reassess motor, sensory and circulatory functions in each extremity after immobilizing patient to the device____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention




SPINAL IMMOBILIZATION (SEATED PATIENT)


Date: Signature:

Actual Time Started: __________ Possible

Points Points

Awarded


Takes or verbalizes appropriate PPE precautions 1Directs assistant to place/maintain head in the neutral, in-line position 1Directs assistant to maintain manual stabilization of the head 1Reassesses motor, sensory and circulatory functions in each extremity 1Applies appropriately sized extrication collar 1Positions the immobilization device behind the patient 1Secures the device to the patient’s torso 1Evaluates torso fixation and adjusts as necessary 1Evaluates and pads behind the patient’s head as necessary 1Secures the patient’s head to the device 1Verbalizes moving the patient to a long backboard 1Reassesses motor, sensory and circulatory function in each extremity 1


CRITICAL CRITERIA____ Failure to immediately direct or take manual stabilization of the head____ Failure to properly apply appropriately sized cervical collar before ordering release of manual stabilization____ Released or ordered release of manual stabilization before it was maintained mechanically____ Manipulated or moved patient excessively causing potential spinal compromise____ Head immobilized to the device before device sufficiently secured to the torso____ Device moves excessively up, down, left or right on the patient’s torso____ Head immobilization allows for excessive movement____ Torso fixation inhibits chest rise, resulting in respiratory compromise____ Upon completion of immobilization, head is not in a neutral, in-line position____ Failure to reassess motor, sensory and circulatory functions in each extremity after voicing immobilization to the long backboard____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention




BLEEDING CONTROL/SHOCK MANAGEMENT

Candidate: Examiner: Date: Signature:


Possible PointsPoints Awarded


Takes or verbalizes appropriate PPE precautions 1

Applies direct pressure to the wound 1

NOTE: The examiner must now inform candidate that the wound continues to bleed.

Applies tourniquet 1

NOTE: The examiner must now inform candidate that the patient is exhibiting signs and symptoms of hypoperfusion.

Properly positions the patient 1

Administers high concentration oxygen 1

Initiates steps to prevent heat loss from the patient 1

Indicates the need for immediate transportation 1


CRITICAL CRITERIA____ Failure to take or verbalize appropriate PPE precautions____ Failure to administer high concentration oxygen____ Failure to control hemorrhage using correct procedures in a timely manner____ Failure to indicate the need for immediate transportation____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention




LONG BONE IMMOBILIZATION

Candidate:

Date:

Examiner: Signature:

Actual Time Started: Possible Points

Points Awarded


Takes or verbalizes appropriate PPE precautions 1Directs application of manual stabilization of the injury 1Assesses distal motor, sensory and circulatory functions in the injured extremity 1

NOTE: The examiner acknowledges, “Motor, sensory and circulatory functions are present and normal.”

Measures the splint 1Applies the splint 1Immobilizes the joint above the injury site 1Immobilizes the joint below the injury site 1Secures the entire injured extremity 1Immobilizes the hand/foot in the position of function 1Reassesses distal motor, sensory and circulatory functions in the injured extremity 1NOTE: The examiner acknowledges, “Motor, sensory and circulatory functions are present and normal.”


Critical Criteria____ Failure to immediately stabilize the extremity manually____ Grossly moves the injured extremity____ Failure to immobilize the joint above and the joint below the injury site____ Failure to immobilize the hand or foot in a position of function____ Failure to reassess distal motor, sensory and circulatory functions in the injured extremity before and after splinting____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention




JOINT IMMOBILIZATION

Candidate:

Date:

Examiner: Signature:

Actual Time Started: __________ PossiblePoints

PointsAwarded


Takes or verbalizes appropriate PPE precautions 1Directs application of manual stabilization of the injury 1Assesses distal motor, sensory and circulatory functions in the injured extremity 1NOTE: The examiner acknowledges, “Motor, sensory and circulatory functions are present and normal.”Selects the proper splinting material 1Immobilizes the site of the injury 1Immobilizes the bone above the injury site 1Immobilizes the bone below the injury site 1Secures the entire injured extremity 1Reassesses distal motor, sensory and circulatory functions in the injured extremity 1NOTE: The examiner acknowledges, “Motor, sensory and circulatory functions are present and normal.”

Actual Time Ended: __________ TOTAL 9

Critical Criteria____ Failure to immediately stabilize the extremity manually____ Grossly moves the injured extremity____ Failure to immobilize the bone above and below the injury site____ Failure to reassess distal motor, sensory and circulatory functions in the injured extremity before and after splinting____ Failure to manage the patient as a competent EMT____ Exhibits unacceptable affect with patient or other personnel____ Uses or orders a dangerous or inappropriate intervention


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