2001 EMT-Intermediate: NSC
Instructor Course Guide
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Table of Contents
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HISTORY AND DEVELOPMENT PHILOSOPHY
As part of the revision project for the EMT-Intermediate and EMT-Paramedic: National Standard Curricula (NSC), the contractor was directed to develop the EMT-Paramedic and EMT-Intermediate Continuing Education, National Guidelines. The guidelines document, developed as a substitute for traditional refresher courses, gives the reader an overview of competency assurance mechanisms to promote the delivery of medically appropriate patient care. The guidelines document defined refresher programs as follows:
Refresher programs are a review of the original program in a condensed number of hours. While ideal for the purpose of remediation, they are not intended to expand the cognitive or psychomotor ability above the entry level. Therefore, refresher courses should not be considered a means of continued expansion of cognitive information and introduction of new psychomotor skills. They are not intended to deliver relevant contemporary information to practitioners who are currently active in the field.
Although the guidelines document is widely used by the EMS community, the definition for refresher programs caused the EMS community to ask that refresher courses be developed. A contract to develop the refresher courses went to the National Association of EMS Educators (NAEMSE) and they convened a task force of EMS stakeholders inclusive of regulators, physicians, association representatives, providers, and educators.
Some challenges undertaken by the task force were:
The task force used EMS provider practice data, an EMS literature review, expert opinion, and a final EMS community review to develop the refresher programs. Previous versions of EMS refresher programs have been based on a perceived need and not on scientific evidence. With this in mind, the Refresher Development Task Force relied heavily on the findings of the 1999 NREMT Practice Analysis and the following documents:
Each of the above documents was created as individual projects, but they are designed to work as a systems approach to EMS and integrate with one another. Contact the NHTSA EMS Division to obtain copies of these documents.
In 1994, the National Registry of Emergency Medical Technicians (NREMT) performed the first nationally conducted practice analysis of EMS. The information obtained in the first analysis was used in the development of the 1998 EMT-Paramedic and 1999 EMT-Intermediate: NSC. In 1999, the NREMT conducted its second practice analysis.
The 1999 NREMT Practice Analysis is a scientific, randomized national sampling of practicing EMT-Paramedic and EMT-Intermediates. The EMTs participating in the practice analysis provided data on 123 various patient assessments focusing on patient care and operational tasks that make up the day-to-day functions of the providers. Each provider indicated the frequency they performed each task and the potential for harm they experienced accomplishing each task. A Practice Analysis Committee reviewed the data, validated the responses, and published the data in a peer reviewed medical journal. The NREMT Practice Analysis Committee used this data to develop a plan that grouped the identified tasks into the following six content areas:
The specific tasks from the practice analysis are listed in appendix A. The NREMT supplied the data from their practice analysis to the EMT-Intermediate refresher development task force. This information was used to help determine specific content for the refresher course.
The refresher task force used the NREMT data to identify tasks that are infrequent and may cause potential harm to the patient if delayed, performed improperly, or omitted when providing care. The panel decided to "refresh" these tasks since patient outcome is jeopardized if the task is not correctly performed. An example of this would be "Provide care to an infant or child with cardiac arrest." The practice analysis categorizes this task as number 113 of 123 for frequency, but lists it as the number one task for potential for harm. The panel agreed and decided to include this task as a mandatory part of the refresher program.
Likewise, a task such as "Provide care to a patient with a painful, swollen, deformed extremity" is listed as task number 98 in frequency and number 100 as potential for harm. This task is not included as a mandatory part of the refresher program. Other tasks that are performed frequently and lack potential for harm are not included as a mandatory part of this refresher program. Again, the refresher course only targets infrequently performed tasks with a high potential for harm.
Upon further review of the practice analysis, the task force identified a few frequently performed tasks that have a very high potential for harm. The task force decided to also include all tasks with a high potential for harm, regardless of their frequency of performance.
Another tool used in the development of this refresher program was an EMS literature review. The literature review found issues not identified by the data from the NREMT Practice Analysis. The task force also sought expert opinion and feedback from the EMS community to identify additional course content.
Traditional refresher programs refresh material already known by the students. The intent of these programs is to maintain a students competence in knowledge and skill performance. This refresher program embraces the same concept, but it also encourages the inclusion of new and expanded information. New and expanded information may be added to the course but not at the expense of content that is core material for the program. This course is not designed to be continuing education for the participants. If a system wishes to incorporate additional information or a new intervention that requires a substantial amount of time to teach, the information must be offered in addition to the content of the refresher program. Moreover, this course is not a transition or bridge course for EMT-Intermediates to become certified at the revised 1999 EMT-Intermediate level.
The participant make-up in a refresher program may challenge the instructional staff. Participants who attend a refresher program may do so for a variety of reasons. Some students may not have practiced for a period of time and are attending to gain back their level of competence prior to practicing again. Others may attend to remediate or gain refresher or continuing education hours. Knowledge of the participant make-up will help the instructors meet the participants needs. A thorough knowledge of the re-credentialing requirements and approval process is a must for any organization sponsoring a refresher program.
NREMT PRACTICE ANALYSIS TASK ITEMS
The NREMT Practice Analysis task items are listed at the beginning of each module. These tasks are included based upon their performance frequency and potential for harm.
OBJECTIVES and DECLARATIVE MATERIAL
The objectives and declarative material are extracted from the 1999 EMT-Intermediate: NSC and they support the identified practice analysis tasks. The objectives and declarative material are renumbered for formatting purposes; however, the original objective number from the NSC is found at the end of each objective. The declarative material provides guidance for programs to use to establish their own individual lesson plans.
The objectives in modules 1-5 are mandatory objectives and must be included in every refresher program. The objectives for the operational section should be considered recommended content for the refresher course. Any other objectives and declarative information has not been included and should be developed by the sponsoring agency.
The length of this refresher program will vary according to a number of factors. Some of these factors are as follows:
The recommended time to instruct the mandatory objectives for the refresher program is 40 to 80 hours. Training institutes will need to adjust these times based on their individual needs. The agencies responsible for program oversight are cautioned against using these hours as a measure of program quality. Competence of the participants, not adherence to arbitrary time frames, is the true measurement of program quality.
COURSE PLANNING CONSIDERATIONS
The first step for the needs assessment is the performance of a comprehensive analysis of the factors that influence the local pre-hospital emergency care delivery system. Some factors included in this analysis are:
The second step of the needs assessment is an analysis of the education needs of the course participants. This assessment may include the following:
The information collected during the assessment process may be used as a guide to select specific material for the classroom. The assessment results can determine the course format, course schedule, and course methods. The selected material may be subjected to national, State, and local standards.
The following steps will assist with the design and implementation of the course design.
Determine regulatory requirements for course conduct:
The refresher course will be approved or accredited by the appropriate local
or state agency. A part of this approval process will be the length of the
course, the course content, and the faculty requirements or restrictions.
Develop schedule:
The course is designed to allow programs to present the material in a
variety of formats. The program may be delivered in class sessions that might
include 8 hour consecutive days or may be taught in a shorter sessions extended
over a period of months.
Determine class size:
The course emphasizes the evaluation of participant skills. Class size
should be manageable and allow students an opportunity to ask questions and
receive answers or assistance from the instructor.
Since the instructor must observe and evaluate student performance, it is essential that the groups size not be too large when evaluating practical skills. Consider segmenting the class into smaller groups, such as 6:1 (students to instructor) when doing the practical skills session.
Instructing a refresher program for practicing EMT-Intermediates is a challenge. We often hear that refresher programs lack challenge, cover material already well known, and are not deemed as useful for the participants. Faculty members must possess expertise in both the content area they instruct and in multiple delivery styles. Instructors must be proficient in performing the skills that they are instructing. Knowing your students abilities and the local EMS systems expectations is essential for a successful program.
Instructional staff must be appropriately credentialed according to local or state requirements. The course medical director must be available throughout the program and be aware of the course design and evaluation instruments being used. The course medical director may be utilized for medical expertise.
Given the repetitive nature of refresher education, it is easy for participants to become bored and lack enthusiasm about the program. The overuse of lecturing is ineffective as the sole method of learning. To improve the quality of the educational experience for instructors and participants, creative and innovative instructional activities are strongly recommended. Consider using some of the following:
Case Presentation
Case presentation and discussion helps participants apply and understand the
content by relating to their field experiences. The instructional staff can
generate cases by using actual calls. Instructors should develop case studies to
highlight key points of their presentations and the area of content being
delivered. The most successful case presentations are those placing the
participant(s) in a decision-making role allowing them to see the consequences
of their decisions. Case presentations can be used in any format, such as, large
classes, small groups, and individual instruction. Several examples and
templates for case construction are in Appendix B.
Simulations
Simulations are case presentations incorporating role-playing situations.
The role players may be other participants, programmed (standardized) patients,
or manikins. Simulations work best when they are realistic and present
situations the participant(s) may encounter, highlighting key points of the
content area. Instructors and participants may critique simulations if the
classroom environment is adequate.
Technology
We live in a time when technology is expanding in development and practical
use. Though it is hard to say what will be the state of the art delivery system
for education resources in the future, participation by the student will likely
enhance the learning process.
Distributed learning includes several alternative methods and media usage. Self-study programs, videotapes, audiotapes, and computer-based instruction are just a few examples of distributed learning. These alternative methods of instruction provide an opportunity to review and learn new cognitive knowledge, but they may not replace the need to practice or demonstrate a psychomotor skill. The use of a distributed learning process may best be applied in the remediation of cognitive knowledge identified in a needs assessment. Course directors and the credentialing agency should evaluate distributed learning products to assure that they meet the course goals and objectives.
In order for the refresher program sponsor to issue a certificate of program completion, an evaluation process must be employed. The evaluation process should measure both cognitive knowledge and psychomotor skills. Individuals who are unsuccessful may be counseled and a course of action for remediation developed.
Authoring a valid written evaluation is both a science and an art. While some instructors possess skills in writing test questions, some others may not. A variety of commercially available test question banks may be useful to the instructional staff during the refresher program. Regardless of the tool used, the purpose of the cognitive measurement tool must be known before a test can be validated. The instructional staff must use basic test construction principles to develop written evaluation instruments.
Written evaluation questions should be balanced to the program content. Items should be based upon what is taught and emphasized throughout the program and should have a difficulty measurement. A test written so each participant can obtain a score of 90% without taking the course lacks measurement ability and validation. Test items must be reviewed by faculty members, including the course medical director, to ensure content validation. Correct answers need to be the best choice or the only correct answer. Incorrect answers and distracters should be plausible to the item and have some attraction to the less than competent participant. Finally, a pass/fail score should be established based upon item analysis and judgment by faculty members responsible for issuing course completion certificates.
The following have been identified as essential items in the 2001 EMT-Intermediate Refresher Program:
Trauma assessment |
Medical assessment |
Ventilation
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Cardiac arrest management
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Medication administration
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Oral scenarios |
Basic skills
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Lifting, moving, and carrying patients |
Validation of psychomotor performance must be accomplished prior to issuing a certificate of course completion. Three opportunities are available to the instructional staff to validate a participants performance.
Pretest
The use of a psychomotor pretest is the best measurement of an individuals
performance. The pretest identifies skills that need to be emphasized during the
course. Likewise, if all candidates possess competency in a skill prior to
taking the program, it may not be necessary to cover that skill.
Skill Labs
When the sponsoring agency does not administer a pretest, the staff can use
the skill labs to measure the competency of each participant. The skill labs
ensure validation is sprinkled throughout the refresher program.
End of Program
At the end of the refresher program an evaluation process can be utilized if
a pretest and skill labs were not used. If an end of program evaluation process
is used, some skills may need to be re-evaluated if participants are
unsuccessful.
Participants must have documentation of demonstrating competence for each skill identified during the program regardless of what process is used.
The refresher curriculum is the minimum acceptable content to be covered by education programs. With certifying agency approval, the student may meet some program objectives by satisfactorily completing a nationally recognized trauma life support program, cardiac care program, or pediatric care program. Although some certifying agencies allow providers to attend continuing education programs, it is recommended that providers participate in regularly scheduled group education sessions as well.
Participants who do not complete the programs objectives or pass the evaluation process should have their performance reviewed by one of the instructional staff members. The participants strengths and weaknesses should be identified and a plan developed that helps the participant successfully complete the requirements. This plan may include additional classroom time, clinical time, field time, or repeating the entire program.
Refresher programs are often provided by the same instructional staff in a variety of settings to different groups of participants. The program staff should evaluate each program for its effectiveness when completed. The evaluation can include the participants point of view by administering post program evaluation surveys. Some questions to ask when evaluating program effectiveness include:
At the end of each program, the faculty and course medical director must meet to determine if the course met its desired needs. The faculty needs to review content design, measurements, course completion criteria, and participant comments. Adjustments to future programs may be indicated once the evaluation process is complete.
The development of this document would not have been possible without the involvement and help of the following task force members and organizations. Gratitude and thanks are also extended to all the individuals who made comments during the development of this document.
Refresher Curriculum Development Task Force Members
Linda M. Abrahamson |
Joann Freel Executive Director National Association of EMS Educators Carnegie, Pennsylvania NAEMSE Task Force Administrator |
Mike Armacost Director Colorado Department of Health Prehospital Care Program Denver, Colorado NASEMSD |
Art Hsieh Section Chief EMS Inservice Training San Francisco Fire Department San Francisco, California NAEMSE |
David Bryson EMS Specialist NHTSA Washington, DC NHTSA |
Jon Krohmer, MD Kent County EMS Grand Rapids, Michigan NAEMSP |
William E. Brown Jr. Executive Director National Registry of EMTs Columbus, Ohio NREMT |
David LaCombe Deputy Chief Sanibel Fire Rescue District Sanibel, Florida Expert Writer |
Debra Cason EMS Program Director UT Southwestern Medical Center Dallas, Texas NAEMSE Project Director |
Dennis Mitchell EMS Instructor University of Arkansas for Medical Sciences Little Rock, Arkansas NAEMT |
Russell Crowley EMS Education Director Alabama Department of Health EMS Division Montgomery, Alabama NCSEMSTC |
Steve Mercer Education Coordinator Iowa Department of Public Health Bureau of EMS Des Moines, Iowa NAEMSE Project Coordinator |
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Robert K. Waddell II Director EMS Systems MCHB/EMSC National Resource Center Washington, DC MCHB/EMSC |
MODULE I: AIRWAY / VENTILATION
NREMT PRACTICE ANALYSIS TASK ITEM
COGNITIVE OBJECTIVES
At the completion of this unit, the EMT-Intermediate will be able to:
1.1 | Describe the indications, contraindications, advantages,
disadvantages, complications, and technique for ventilating a patient by:
(C-1) / 2-1.31
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1.2 | Explain the advantage of the two-person method when ventilating with the bag-valve-mask. (C-1) / 2-1.32 |
1.3 | Compare the ventilation techniques used for an adult patient to those used for pediatric patients. (C-3) / 2-1.36 |
1.4 | Describe indications, contraindications, advantages, disadvantages, complications, and technique for ventilating a patient with an automatic transport ventilator (ATV). (C-1) / 2-1.33 |
1.5 | Define how to ventilate with a patient with a stoma, including mouth-to-stoma and bag-valve-mask-to-stoma ventilation. (C-1) / 2-1.37 |
1.6 | Describe the special considerations in airway management and ventilation for patients with facial injuries. (C-1) / 2-1.63 |
1.7 | Describe the special considerations in airway management and ventilation for the pediatric patient. (C-1) / 2-1.64 |
PSYCHOMOTOR OBJECTIVES
At the completion of this unit, the EMT-Intermediate will be able to:
1.8 |
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1.9 | Ventilate a pediatric patient using the one and two person techniques. (P-2) / 2-1.77 |
1.10 | Perform bag-valve-mask ventilation with an in-line small-volume nebulizer. (P-2) / 2-1.74 |
DECLARATIVE
NREMT TASK ANALYSIS ITEMS
COGNITIVE OBJECTIVES
At the completion of this unit, the EMT-Intermediate will be able to:
2.1 | Identify the specific mechanical, pharmacological and electrical therapeutic interventions for patients with arrhythmias causing compromise. (C-1) / 5-2.13 |
2.2 | Describe the pharmacological agents available to the EMT-Intermediate for use in the management of arrhythmias and cardiovascular emergencies. (C-2) / 5-2.22 |
2.3 | Develop, execute and evaluate a treatment plan based on the field impression for the patient with chest pain that may be indicative of angina or myocardial infarction. (C-3) / 5-2.23 |
2.4 | List and describe the pharmacological agents available to the EMT-Intermediate for use in the management of a patient with cardiac compromise. (C-1) / 5-2.28 |
2.5 | List the interventions prescribed for the patient with a hypertensive emergency. (C-1) / 5-2.31 |
2.6 | Identify local protocol dictating circumstances and situations where resuscitation efforts would not be initiated. (C-1) / 5-2.36 |
2.7 | Identify local protocol dictating circumstances and situations where resuscitation efforts would be discontinued. (C-1) / 5-2.37 |
2.8 | Identify the critical actions necessary in caring for the patient in cardiac arrest. (C-2) / 5-2.38 |
PSYCHOMOTOR OBJECTIVES
At the completion of this unit, the EMT-Intermediate will be able to:
2.9 | Set up and apply a transcutaneous pacing system. (P-3) / 5-2.45 |
2.10 | Given the model of a patient with signs and symptoms of pulmonary edema, position the patient to afford comfort and relief. (P-3) / 5-2.46 |
DECLARATIVE
NREMT TASK ANALYSIS ITEMS
COGNITIVE OBJECTIVES
At the completion of this unit, the EMT-Intermediate will be able to:
3.1 | Describe physical manifestations in anaphylaxis. (C-1) / 5-4.6 |
3.2 | Recognize the signs and symptoms related to anaphylaxis. (C-1) / 5-4.7 |
3.3 | Differentiate among the various treatment and pharmacological interventions used in the management of anaphylaxis. (C-3) / 5-4.8 |
3.4 | Correlate abnormal findings in assessment with the clinical significance in the patient with anaphylaxis. (C-3) / 5-4.10 |
3.5 | Develop a treatment plan based on field impression in the patient with allergic reaction and anaphylaxis. (C-3) / 5-5.11 |
3.6 | List signs and symptoms of near-drowning. (C-1) / 5-8.32 |
3.7 | Discuss the complications and protective role of hypothermia in the context of near-drowning. (C-1) / 5-8.33 |
3.8 | Correlate the abnormal findings in assessment with the clinical significance in the patient with near-drowning. (C-3) / 5-8.34 |
3.9 | Differentiate among the various treatments and interventions in the management of near-drowning. (C-3) / 5-8.35 |
3.10 | Integrate pathophysiological principles and the assessment findings to formulate a field impression and implement a treatment plan for the near-drowning patient. (C-3) / 5-8.36 |
3.11 | Review the signs and symptoms related to the most common poisonings by overdose. (C-1) / 5-5.11 |
3.12 | Correlate the abnormal findings in assessment with the clinical significance in patients with the most common poisonings by overdose. (C-3) / 5-5.12 |
DECLARATIVE
NREMT PRACTICE ANALYSIS TASK ITEM
Cognitive Objectives
At the completion of this unit, the EMT-Intermediate will be able
to:
4.1 | State the reasons for performing a rapid trauma assessment. (C-1) / 3-3.29 |
4.2 | Apply the techniques of physical examination to the trauma patient. (C-1) / 3-3.31 |
4.3 | Describe the areas included in the rapid trauma assessment and discuss what should be evaluated. (C-1) / 3-3.32 |
4.4 | Differentiate cases when the rapid assessment may be altered in order to provide patient care. (C-3) / 3-3.33 |
4.5 | Discuss the treatment plan and management of hemorrhage and shock. (C-1) / 4-2.6 |
4.6 | Develop, execute and evaluate a treatment plan based on the field impression for the hemorrhage or shock patient. (C-3) / 4-2.38 |
4.7 | Discuss the management of thoracic injuries. (C-1) / 4-4.7 |
4.8 | Identify the need for rapid intervention and transport of the patient with chest wall injuries. (C-1) / 4-4.8 |
4.9 | Discuss the management of chest wall injuries. (C-1) / 4-4.12 |
4.10 | Discuss the management of lung injuries. (C-1) / 4-4.15 |
4.11 | Identify the need for rapid intervention and transport of the patient with lung injuries. (C-1) / 4-4.16 |
4.12 | Discuss the management of myocardial injuries. (C-1) / 4-4.19 |
4.13 | Identify the need for rapid intervention and transport of the patient with myocardial injuries. (C-1) / 4-4.20 |
4.14 | Discuss the management of vascular injuries. (C-1) / 4-4.23 |
4.15 | Discuss the management of esophageal injuries. (C-1) / 4-4.29 |
4.16 | Discuss the management of tracheo-bronchial injuries. (C-1) / 4-4.32 |
4.17 | Discuss the management of traumatic asphyxia. (C-1) / 4-4.35 |
Psychomotor Objectives
At the completion of this unit, the EMT-Intermediate will be able to:
4.18 | Using the techniques of physical examination, demonstrate the assessment of a trauma patient. (P-2) / 3-3.68 |
4.19 | Demonstrate the rapid trauma assessment used to assess a patient based on mechanism of injury. (P-2) / 3-3.69 |
4.20 | Demonstrate the management of a patient with signs and symptoms of compensated hypovolemic shock. (P-2) / 4-2.42 |
4.21 | Demonstrate the management of a patient with signs and symptoms of decompensated hypovolemic shock. (P-2) / 4-2.44 |
4.22 | Demonstrate a clinical assessment to determine the proper management modality for a patient with a suspected traumatic spinal injury. (P-1) / 4-5.16 |
4.23 | Demonstrate a clinical assessment to determine the proper management modality for a patient with a suspected non-traumatic spinal injury. (P-1) / 4-5.17 |
4.24 | Demonstrate immobilization of the urgent and
non-urgent patient with assessment findings of spinal injury from the
following presentations: (P-1) / 4-5.18
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4.25 | Demonstrate preferred methods for stabilization of a helmet from a potentially spine injured patient. 4-5.19 |
4.26 | Demonstrate the following techniques of
management for thoracic injuries: (P-1) / 4-4.44
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Declarative
NREMT PRACTICE ANALYSIS TASK ITEM
Cognitive Objectives
At the completion of this unit, the EMT-Intermediate will be able to:
5.1 | Describe techniques for successful assessment of infants and children. (C-1) / 6-3.4 |
5.2 | Discuss the appropriate equipment utilized to obtain pediatric vital signs. (C-1) / 6-3.9 |
5.3 | Determine appropriate airway adjuncts for infants and children. (C-1) 6-3.10 |
5.4 | Discuss complications of improper utilization of airway adjuncts with infants and children. (C-1) 6 3.11 |
5.5 | Discuss appropriate ventilation devices for infants and children. (C-1) 6-3.12 |
5.6 | Discuss complications of improper utilization of ventilation devices with infants & children. (C-1) 6-3.13 |
5.7 | Discuss appropriate endotracheal intubation equipment for infants and children. (C-1) / 6-3.14 |
5.8 | Identify complications of improper endotracheal intubation procedure in infants and children. (C-1) / 6-3.15 |
5.9 | List the indications and methods for gastric decompression for infants and children. (C-1) / 6-3.23 |
5.10 | Differentiate between upper airway and lower airway obstruction. (C-3) / 6-3.24 |
5.11 | Identify the major classifications of pediatric cardiac rhythms. (C-1) 6-3.55 |
5.12 | Discuss the primary etiologies of cardiopulmonary arrest in infants and children. (C-1) / 6-3.68 |
5.13 | Discuss age appropriate vascular access sites for infants and children. (C-1) 6-3.84 |
5.14 | Discuss the appropriate equipment for vascular access in infants and children. (C-1) 6-3.85 |
5.15 | Identify complications of vascular access for infants and children. (C-1) 6-3.86 |
5.16 | Identify common lethal mechanisms of injury in infants and children. (C-1) / 6-3.87 |
5.17 | Discuss anatomical features of children that predispose or protect them from certain injuries. (C-1) / 6-3.88 |
5.18 | Describe aspects of infant and children airway management that are affected by potential cervical spine injury. (C-1) / 6-3.89 |
5.19 | Identify infant and child trauma patients who require spinal immobilization. (C-1) / 6-3.40 |
5.20 | Discuss fluid management and shock treatment for infant and child trauma patient. (C-1) / 6-3.91 |
5.21 | Discuss the parent/ caregiver responses to the death of an infant or child. (C-1) / 6-3.102 |
5.22 | Discuss basic cardiac life support (CPR) guidelines for infants and children. (C-1) / 6-3.69 |
5.23 | Identify appropriate parameters for performing infant and child CPR. (C-1) / 6-3.70 |
5.24 | Integrate advanced life support skills with basic cardiac life support for infants and children. (C-3) / 6-3.71 |
5.25 | Describe the epidemiology, including the incidence, morbidity/ mortality, risk factors and prevention strategies for respiratory distress/ failure in infants and children. (C-1) / 6-3.19 |
5.26 | Discuss the pathophysiology of respiratory distress/ failure in infants and children. (C-1) / 6-3.20 |
5.27 | Discuss the assessment findings associated with respiratory distress/ failure in infants and children. (C-1) / 6-3.21 |
5.28 | Discuss the management/ treatment plan for respiratory distress/ failure in infants and children. (C-1) / 6-3.22 |
5.29 | Discuss the assessment findings associated with cardiac dysrhythmias in infants and children. (C-1) / 6-3.58 |
5.30 | Discuss the management/ treatment plan for cardiac dysrhythmias in infants and children. (C-1) / 6-3.59 |
5.31 | Discuss the pathophysiology of trauma in infants and children. (C-1) / 6-3.92 |
5.32 | Discuss the assessment findings associated with trauma in infants and children. (C-1) / 6-3.93 |
5.33 | Discuss the management/ treatment plan for trauma in infants and children. (C-1) / 6-3.94 |
PSYCHOMOTOR OBJECTIVES
At the completion of this unit, the EMT-Intermediate will be able to:
5.34 | Demonstrate the appropriate approach for treating infants and children. (P-2) / 6-3.112 |
5.35 | Demonstrate appropriate intervention techniques with families of acutely ill or injured infants and children. (P-2) / 6-3.113 |
5.36 | Demonstrate an appropriate assessment for different developmental age groups. (P-2) / 6-3.114 |
5.37 | Demonstrate an appropriate technique for measuring pediatric vital signs. (P-2) / 6-3.115 |
5.38 | Demonstrate the use of a length-based resuscitation device for determining equipment sizes, drug doses and other pertinent information for a pediatric patient. (P-2) / 6-3.116 |
5.39 | Demonstrate the techniques/procedures for treating infants and children with respiratory distress. (P-2) / 6-3.117 |
5.40 | Demonstrate proper technique for administering blow-by oxygen to infants and children. (P-2) / 6-3.118 |
5.41 | Demonstrate the proper utilization of a pediatric non-rebreather oxygen mask. (P-2) / 6-3.119 |
5.42 | Demonstrate appropriate use of airway adjuncts with infants and children. (P-2) / 6-3.120 |
5.43 | Demonstrate appropriate use of ventilation devices for infants and children. (P-2) 6-3.121 |
5.44 | Demonstrate endotracheal intubation procedures in infants and children. (P-2) / 6-3.122 |
5.45 | Demonstrate appropriate treatment/ management of intubation complications for infants and children. (P-2) / 6-3.123 |
5.46 | Demonstrate proper placement of a gastric tube in infants and children. (P-2) / 6-3.124 |
5.47 | Demonstrate an appropriate technique for insertion of peripheral intravenous catheters for infants and children. (P-2) / 6-3.125 |
5.48 | Demonstrate an appropriate technique for administration of intramuscular, inhalation, subcutaneous, rectal, endotracheal and oral medication for infants and children. (P-2) / 6-3.126 |
5.49 | Demonstrate an appropriate technique for insertion of an intraosseous line for infants and children. (P-2) / 6-3.127 |
5.50 | Demonstrate appropriate interventions for infants and children with a partially obstructed airway. (P-2) / 6-3.128 |
5.51 | Demonstrate appropriate airway and breathing control maneuvers for infant and child trauma patients. (P-2) / 6-3.129 |
5.52 | Demonstrate appropriate treatment of infants and children requiring advanced airway and breathing control. (P-2) / 6-3.130 |
5.53 | Demonstrate appropriate immobilization techniques for infant and child trauma patients. (P-2) / 6-3.131 |
5.54 | Demonstrate treatment of infants and children with head injuries. (P-2) / 6-3.132 |
5.55 | Demonstrate appropriate treatment of infants and children with chest injuries. (P-2) / 6-3.133 |
5.56 | Demonstrate appropriate treatment of infants and children with abdominal injuries. (P-2) / 6-3.134 |
5.57 | Demonstrate appropriate treatment of infants and children with extremity injuries. (P-2) / 6-3.135 |
5.58 | Demonstrate appropriate treatment of infants and children with burns. (P-2) / 6-3.136 |
5.59 | Demonstrate appropriate parent/ caregiver interviewing techniques for infant and child death situations.(P-2) / 6-3.137 |
5.60 | Demonstrate proper infant CPR. (P-2) / 6-3.138 |
5.61 | Demonstrate proper child CPR. (P-2) / 6-3.139 |
5.62 | Demonstrate proper techniques for performing infant and child defibrillation and synchronized cardioversion.(P-2) / 6-3.140 |
Declarative
MODULE VI: OTHER RECOMMENDED CONTENT AREAS
Operations
NREMT PRACTICE ANALYSIS TASK ITEM
Other Suggested Topic Areas
Appendix A
NREMT Practice Analysis (1999)
NREMT Practice Analysis (1999)
Below is a list of the tasks extracted from the 1999 NREMT Practice
Analysis. Each participant involved in the random survey was asked to indicate
the frequency in which they utilized an identified task. In addition to
frequency, the participants were asked to provide input on the potential of harm
and difficulty they experienced in accomplishing each task. The chart below
identifies those task, based on either frequency and/or potential for harm, that
was used in the creation of this document. The task force utilized those task
that were identified as having low frequency of performance and a high potential
for harm along with the tasks that had a high frequency of performance and a
high potential for harm. 24 of the 123 tasks were identified as meeting the
above criteria and were utilized as the basis for the mandatory portion of this
refresher curriculum.
Task |
Frequency |
Potential for Harm |
---|---|---|
Assess a patient experiencing an allergic reaction |
s |
s |
Assess a patient with possible overdose |
s |
s |
Assess a near-drowning patient |
s |
s |
Assess an infant or child with cardiac arrest |
s |
s |
Assess an infant or child with respiratory distress |
s |
s |
Assess an infant or child with shock (hypoperfusion) |
s |
s |
Assess an infant or child with trauma |
s |
s |
Assess a patient with a head injury |
s |
s |
Assess a patient with a suspected spinal injury |
s |
s |
Perform a rapid trauma assessment |
s |
s |
Provide ventilatory support for a patient |
s |
s |
Attempt to resuscitate a patient in cardiac arrest |
s |
s |
Provide care to a patient experiencing cardiovascular compromise |
s |
s |
Provide post-resuscitation care to a cardiac arrest patient |
s |
s |
Provide care to the patient experiencing an allergic reaction |
s |
s |
Provide care to a near-drowning patient |
s |
s |
Provide care to an infant or child with cardiac arrest |
s |
s |
Provide care to an infant or child with respiratory distress |
s |
s |
Provide care to an infant or child with shock (hypoperfusion) |
s |
s |
Provide care to an infant or child with trauma |
s |
s |
Provide care to a patient with a chest injury |
s |
s |
Provide care to a patient with an open abdominal injury |
s |
s |
Provide care to a patient with shock (hypoperfusion) |
s |
s |
Provide care to a patient with suspected spinal injury |
s |
s |
Appendix B
Practice Scenario and Scenario Template
Scenario Template
Lectures have traditionally been the backbone for most educational
endeavors. While this type of education process has been used in the past,
todays students are seeking greater challenges in the classroom. One
alternative method for education is the use of scenario based education.
Scenario based education allows the instructor and student to achieve a more
realistic approach to patient care situations. This refresher curriculum can be
delivered to the experienced provider through the use of scenarios.
This scenario template has been included for use during the refresher course. The template was designed by the NREMT for use with their oral scenario station. The recommendation would be for the instructor to develop scenarios that met the objectives of this curriculum for use in the classroom portion as well as the skill labs.
BACKGROUND INFORMATION | |
EMS System description (including urban/rural setting) | |
Vehicle type/response capabilities | |
Proximity to and level/type of facilities | |
DISPATCH INFORMATION | |
Nature of the call | |
Location | |
Dispatch time | |
Weather | |
Personnel on scene | |
SCENE SURVEY INFORMATION | |
Scene considerations | |
Patient location | |
Visual appearance | |
Age, gender, weight | |
Immediate surroundings (bystanders, family members present, etc.) | |
PATIENT ASSESSMENT | |
Chief complaint | |
History of present illness/injury | |
Patient responses, symptoms, and pertinent negatives | |
PAST MEDICAL HISTORY | |
Past medical history | |
Medications and allergies | |
Social/family concerns | |
EXAMINATION FINDINGS | |
Initial vital signs | B/P P R SpO2 |
Respiratory | |
Cardiovascular | |
Gastrointestinal | |
Genitourinary | |
Musculoskeletal | |
Neurologic | |
Integumentary | |
Hematologic | |
Immunologic | |
Endocrine | |
Psychiatric | |
PATIENT MANAGEMENT | |
Initial stabilization | |
Treatments | |
Monitoring | |
Additional resources | |
Patient response to interventions | |
TRANSPORT DECISION | |
Lifting and moving the patient | |
Mode | |
Facilities | |
CONCLUSION | |
Field impression | |
Rationale for field impression | |
Related pathophysiology | |
Verbal report | |
MANDATORY ACTIONS | |
POTENTIALLY HARMFUL/DANGEROUS ACTIONS ORDERED/PERFORMED | |
Practice Scenario
BACKGROUND INFORMATION | |
EMS System description (including urban/rural setting) | Suburban EMS that responds to both emergency and non-emergency calls |
Vehicle type/response capabilities | 2 person Intermediate/99 level transporting service |
Proximity to and level/type of facilities | 30 minutes to the attending physicians
office 15 minutes to the community hospital |
DISPATCH INFORMATION | |
Nature of the call | Woman cant walk, requests transport to her physicians office, non-emergent |
Location | Well kept walk-up single family dwelling |
Dispatch time | 1512 hours |
Weather | 68 F, clear spring day |
Personnel on scene | Daughter who is serving as primary care giver |
SCENE SURVEY INFORMATION | |
Scene considerations | 10 cement steps up to the front door No access for stretcher from any other doorway |
Patient location | 1st floor, back bedroom, narrow hallways & doorways |
Visual appearance | Patient sitting in bed with multiple pillows holding her in an upright position, pale in color, does not respond to your presents in the room |
Age, gender, weight | 58 year old female, 200 pounds |
Immediate surroundings (bystanders, family members present, etc.) | Clean, neat, well-kept surroundings Daughter is only family member present |
PATIENT ASSESSMENT | |
Chief complaint | Altered level of consciousness |
History of present illness/injury | Daughter states "My Mother just passed out a couple of minutes ago from the pain." Patient woke this morning with a painful left leg that has increased in pain, unable to walk without sever pain. Daughter states that her mother, "Has a small score on her left inner thigh that has gotten bigger over the past few hours and her doctor wants to see her in his office." |
Patient responses, symptoms, and pertinent negatives | Patient opens her eyes to loud verbal stimulus but does not verbally respond |
PAST MEDICAL HISTORY | |
Past medical history | Adult onset of diabetes controlled with diet and oral medication, hypertension, hernia repair several years ago |
Medications and allergies | Glucophage bid, Lasix 20 mg qid, dilitazem
qid, and Colace qid NKA |
Social/family concerns | Patient lives alone after death of husband two years ago, daughter comes to her home each day to help mother with daily chores |
EXAMINATION FINDINGS | |
Initial vital signs | B/P 100/pa;pation P 130, rapid and weak R 8 |
Respiratory | Lung sounds are diminished bilaterally |
Cardiovascular | Tachycardia, hypotensive |
Gastrointestinal | ----- |
Genitourinary | ----- |
Musculoskeletal | ----- |
Neurologic | Opens her eyes to loud verbal stimulus and
withdraws to pain Utters incomprehensible sounds Pupils equal and responds sluggishly to light |
Integumentary | Large ecchymotic area over the patients
entire left inner thigh extending into the groin, pelvis, and left lower
abdomen Area is hot to touch with crepitation under the skin Skin is pale, hot, and moist to the touch |
Hematologic | ---- |
Immunologic | ---- |
Endocrine | Blood glucose 370 mg/dL |
Psychiatric | ---- |
PATIENT MANAGEMENT | |
Initial stabilization | Assisted ventilations with high flow oxygen |
Treatments | Assisted ventilations with high flow oxygen, IV enroute |
Monitoring | ECG sinus tachycardia, SpO2 85% |
Additional resources | Consider transportation to facility with immediate surgical capabilities and hyperbarics |
Patient response to interventions | No change |
TRANSPORT DECISION | |
Lifting and moving the patient | Place in Reeves stretcher to ambulance stretcher |
Mode | Rapid |
Facilities | Emergency department |
CONCLUSION | |
Field impression | Septic shock |
Rationale for field impression | Rapidly extending extremity infection, febrile, hypotension, and tachycardia with altered LOC |
Related pathophysiology | "What is the basis for septic shock in this
case?" Sever bacterial infection |
Verbal report | "Please provide me with a verbal report on
this patient." Must include chief complaint, interventions, current patient condition, and ETA |
MANDATORY ACTIONS | |
Rapid identification of life-threat and
immediate transportation to the emergency department High flow oxygen |
|
POTENTIALLY HARMFUL/DANGEROUS ACTIONS ORDERED/PERFORMED | |
Delayed transportation for on scene
interventions Taking the patient to the doctors office |
BACKGROUND & DISPATCH INFORMATION
You are an Intermediate on a transporting Intermediate unit. You are working with an Intermediate partner in a suburban EMS system. You are thirty (30) minutes away from the attending physicians office and fifteen (15) minutes from the community hospital. At 1512 hours, you are dispatched to a residence for a non-emergent transport of a woman to her doctors office. It is a clear spring day with temperature of 68o F. A woman who identifies herself as the patients daughter meets you at the door. |
Appendix C
Practical Evaluation Skill Sheets
(Modeled after the NREMT Practical Skill Sheets)
The practical skill sheets included in this appendix were modeled after the National Registry of Emergency Medical Technicians (NREMT) Advanced Level Practical Examination for the 1999 EMT-Intermediate National Standard Curriculum. These skill sheets should not be used as a substitute during a NREMT Advanced Level Practical Examination. The sheets were designed to be used as a standardized evaluation instrument for determining an individuals competency for an identified psychomotor skill.
Modeled after the National Registry of Emergency Medical Technicians Advanced Level Practical Examination
Candidate: ___________________________________________________Examiner: ______________________________________________________________
Date: _________________________________________________________Signature: _____________________________________________________________
Scenario # _________________________________________________________________________________________________________________________
Time Start: __________________ |
Possible |
Points |
|
---|---|---|---|
Takes or verbalizes body substance isolation precautions |
1 |
||
SCENE SIZE_UP | |||
Determines the scene/situation is safe |
1 |
||
Determines the mechanism of injury/nature of illness |
1 |
||
Determines the number of patients |
1 |
||
Requests addition help if necessary |
1 |
||
Considers stabilization of spine |
1 |
||
INITIAL ASSESSMENT/RESUSCITATION | |||
Verbalizes general impression of the patient |
1 |
||
Determines responsiveness/level of consciousness |
1 |
||
Determines chief complaint/apparent life-threats |
1 |
||
Airway Opens and assesses airway (1 point) -Inserts adjunct as indicated (1 point) |
2 |
||
Breathing -Assesses breathing (1 point) -Assures adequate ventilation (1 point) -Initiates appropriate oxygen therapy (1 point) -Manages any injury which may compromise breathing/ventilation (1 point) |
4 |
||
Circulation -Checks pulse (1 point) -Assess skin [either skin color, temperature, or condition] (1 point) -Assesses for and controls major bleeding if present (1 point) -Initiates shock management (1 point) |
4 |
||
FOCUSED HISTORY AND PHYSICAL EXAMINATION/RAPID TRAUMA ASSESSMENT | |||
Selects appropriate assessment |
1 |
||
Obtains or directs assistant to obtain baseline vital signs |
1 |
||
Obtains SAMPLE history |
1 |
||
DETAILED PHYSICAL EXAMINATION | |||
Head -Inspects mouth**, nose**, and assesses facial area (1 point) -Inspects and palpates scalp and ears (1 point) -Assesses eyes for PERRL** (1 point) |
3 |
||
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) -Verbalizes assessment of genitalia/perineum as needed (1 point) |
3 |
||
Lower extremities** -Inspects, palpates, and assesses motor, sensory, and distal circulation functions (1 point/leg) |
2 |
||
Upper extremities -Inspects, palpates, and assesses motor, sensory, and distal circulation functions (1 point/arm) |
2 |
||
Posterior thorax,
lumbar, and buttocks** -Inspects and palpates posterior thorax (1 point) -Inspects and palpates lumbar and buttocks area (1 point) |
2 |
||
Manages secondary injuries and wounds appropriately |
1 |
||
Performs ongoing assessment |
1 |
||
Time End: TOTAL |
43 |
||
CRITICAL CRITERIA | |||
Failure to initiate or call for transport of the patient within 10 minute time limit | |||
Failure to take or verbalize body substance isolation precautions | |||
Failure to determine scene safety | |||
Failure to assess for and provide spinal protection when indicated | |||
Failure to voice and ultimately provide high concentration of oxygen | |||
Failure to assess/provide adequate ventilation | |||
Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock [hypoperfusion] | |||
Failure to differentiate patients need for immediate transportation versus continued assessment/treatment at the scene | |||
Does other detailed/focused history or physical exam before assessing/treating threats to airway, breathing, and circulation | |||
Orders a dangerous or inappropriate intervention |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Patient Assessment - Medical
Candidate: __________________________________________________________________Examiner:____________________________________________
Date: _______________________________________________________________________Signature: ___________________________________________
Scenario # ____________________________________
Time Start: ________________ |
Possible |
Points |
|
---|---|---|---|
Takes or verbalizes body substance isolation precautions |
1 |
||
SCENE SIZE_UP | |||
Determines the scene/situation is safe |
1 |
||
Determines the mechanism of injury/nature of illness |
1 |
||
Determines the number of patients |
1 |
||
Requests addition help if necessary |
1 |
||
Considers stabilization of spine |
1 |
||
INITIAL ASSESSMENT/RESUSCITATION | |||
Verbalizes general impression of the patient |
1 |
||
Determines responsiveness/level of consciousness |
1 |
||
Determines chief complaint/apparent life-threats |
1 |
||
Assesses airway and
breathing -Assesses breathing (1 point) -Assures adequate ventilation (1 point) -Initiates appropriate oxygen therapy (1 point) |
3 |
||
Circulation -Assesses/controls major bleeding (1 point) -Assess skin [either skin color, temperature, or condition] (1 point) -Assesses pulse (1 point) |
3 |
||
Identifies priority patients/makes transport decision |
1 |
||
FOCUSED HISTORY AND PHYSICAL EXAMINATION/RAPID TRAUMA ASSESSMENT | |||
History of present
illness -Onset (1 point) -Severity (1 point) -Provocation (1 point) -Time (1 point) -Quality (1 point) -Clarifying questions of associated signs and symptoms to OPQRTS (2 points) -Radiation (1 point) |
8 |
||
Past medical history -Allergies (1 point) -Past pertinent history (1 point) -Events leading to present illness (1 point) -Medications (1 point) -Last oral intake (1 point) |
5 |
||
Performs focused
physical examination [assess affected body part/system or, if indicated,
completes rapid assessment] -Cardiovascular -Neurological -Integumentary -Reproductive -Pulmonary -Musculoskeletal -GI/GU -Psychological/Social |
5 |
||
Vital signs -Pulse (1 point) -Respiratory rate and quality (1 point each) -Blood pressure (1 point) -AVPU (1 point) |
5 |
||
Diagnostics [must include application of ECG monitor for dyspnea and chest pain] |
2 |
||
States field impression of patient |
1 |
||
Verbalizes treatment plan for patient and calls for appropriate intervention(s) |
1 |
||
Transport decision re-evaluated |
1 |
||
ON-GOING ASSESSMENT | |||
Repeats initial assessment |
1 |
||
Repeats vital signs |
1 |
||
Evaluates response to treatments |
1 |
||
Repeats focused assessment regarding patient complaint or injuries |
1 |
||
Time End: TOTAL |
48 |
||
CRITICAL CRITERIA | |||
Failure to initiate or call for transport of the patient within 15 minute time limit | |||
Failure to take or verbalize body substance isolation precautions | |||
Failure to determine scene safety before approaching patient | |||
Failure to voice and ultimately provide high concentration of oxygen | |||
Failure to assess/provide adequate ventilation | |||
Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock [hypoperfusion] | |||
Failure to differentiate patients need for immediate transportation versus continued assessment/treatment at the scene | |||
Does other detailed or focused history or physical exam before assessing/treating threats to airway, breathing, and circulation | |||
Failure to determine the patients primary problem | |||
Orders a dangerous or inappropriate intervention | |||
Failure to assess for and provide spinal protection when indicated | |||
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Ventilatory Management - Adult
Candidate: _____________________________________________________________Examiner: _________________________________________________
Date: __________________________________________________________________Signature: ________________________________________________
NOTE: If candidate elects to ventilate initially 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
Possible |
Points |
||
---|---|---|---|
Takes or verbalizes body substance isolation 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 devise unattached to oxygen |
1 |
||
"*" Hyperventilates patient with room air |
1 |
||
Note: Examiner now informs candidate that ventilation is being performed without difficulty and that pulse oximetry indicates the patients blood oxygen saturation is 85% | |||
Attaches oxygen reservoir to bag-mask device and connects to high flow oxygen regulator [12-15 L/min] |
1 |
||
Ventilates patient at a rate of 10-20/minute with appropriate volumes |
1 |
||
Note: After 30 seconds, examiner auscultates and reports breath sounds are present, equal bilaterally and medical direction has ordered intubation. The examiner must now take over ventilation | |||
Directs assistant to pre-oxygenate patient |
1 |
||
Identifies/selects proper equipment for intubation |
1 |
||
Checks equipment for: -Cuff leaks (1 point) -Laryngoscope operational with bulb tight (1 point) |
2 |
||
Note: Examiner to remove OPA and move out of the way when candidate is prepared to intubate | |||
Positions head properly |
1 |
||
Inserts blade while displacing tongue |
1 |
||
Elevates mandible with laryngoscope |
1 |
||
Introduces ET tube and advances to proper depth |
1 |
||
Inflates cuff to proper pressure and disconnects syringe |
1 |
||
Confirms proper placement by auscultation bilaterally over each lung and over epigastrium |
1 |
||
Note: Examiner to ask "If you had proper placement, what should you expect to hear?" | |||
Secures ET tube (may be verbalized) |
1 |
||
Note: Examiner now asks candidate, "Please demonstrate one additional method of verifying proper tube placement in this patient." | |||
Identifies/selects proper equipment |
1 |
||
Verbalizes findings and interpretations [compares indicator color to the colorimetric scale and states reading to examiner] |
1 |
||
Note: Examiner now states, "You see secretions in the tube and hear gurgling sounds with the patients exhalations." | |||
Identifies/selects a flexible suction catheter |
1 |
||
Pre-oxygenates patient |
1 |
||
Marks maximum insertion length with thumb and forefinger |
1 |
||
Inserts catheter into ET tube leaving catheter port open |
1 |
||
At proper insertion depth, covers catheter port and applies suction while withdrawing catheter |
1 |
||
Ventilates/directs ventilation of patient as catheter is flushed with sterile water |
1 |
||
Total |
27 |
||
CRITICAL CRITERIA | |||
Failure to initiate ventilations within 30 seconds after applying gloves or interrupts ventilations for grater than 30 seconds at any time | |||
Failure to take or verbalize body substance isolation precautions | |||
Failure to voice and ultimately provide high oxygen concentration [at least 85%] | |||
Failure to ventilate patient at a rate of at least 10/minute | |||
Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible] | |||
Failure to pre-oxygenate patient prior to intubation and suctioning | |||
Failure to successfully intubate within 3 attempts | |||
Failure to disconnect syringe immediately after inflating cuff of ET tube | |||
Uses teeth as a fulcrum | |||
Failure to assure proper tube placement by auscultation bilaterally and over the epigastrium | |||
If used, stylet extends beyond end of ET tube | |||
Inserts any adjunct in a manner dangerous to the patient | |||
Suctions the patient for more than 15 seconds | |||
Does not suction the patient |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Dual Lumen Airway
Device (Combitube or PTL
)
Candidate: ______________________________________________________________Examiner: __________________________________________________________
Date: ___________________________________________________________________Signature: __________________________________________________________
NOTE: If candidate elects to ventilate initially 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
Possible |
Points |
|||
---|---|---|---|---|
Takes or verbalizes body substance isolation 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 devise unattached to oxygen |
1 |
|||
"*" Hyperventilates patient with room air |
1 |
|||
Note: Examiner now informs candidate that ventilation is being performed without difficulty | ||||
Attaches oxygen reservoir to bag-mask device and connects to high flow oxygen regulator [12-15 L/min] |
1 |
|||
Ventilates patient at a rate of 10-20/minute with appropriate volumes |
1 |
|||
Note: After 30 seconds, examiner auscultates and reports breath sounds are present, equal bilaterally and medical direction has ordered insertion of a dual lumen airway. The examiner must now take over ventilation | ||||
Directs assistant to pre-oxygenate patient |
1 |
|||
Checks/prepares 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 | ||||
Uses Combitube |
Uses PTL |
|||
Inserts device in mid-line and to depth so printed ring is at level of teeth | Inserts device in mid-line until bite block flange is at level of teeth |
1 |
||
Inflates pharyngeal cuff with proper volume and removes syringe | Secures strap |
1 |
||
Inflates distal cuff with proper volume and removes syringe | Blows into tube #1 to adequately inflate both cuffs |
1 |
||
Attaches/directs attachment of BVM to the first [esophageal placement] lumen and ventilates |
1 |
|||
Confirms placement and ventilation through correct lumen by observing chest rise, auscultation over the epigastrium, and bilaterally over each lung |
1 |
|||
Note: The examiner states, "You do not see rise and fall of the chest and you only hear sounds over the epigastrium." | ||||
Attaches/directs attachment of BVM to the second [endotracheal placement] lumen and ventilates |
1 |
|||
Confirms placement and ventilation through correct lumen by observing chest rise, auscultation over the epigastrium, and bilaterally over each lung |
1 |
|||
Note: The examiner confirms adequate chest rise, absent sounds over the epigastrium, and equal bilateral breath sounds. | ||||
Secures device or confirms that the device remains properly secured |
1 |
|||
Total |
20 |
|||
CRITICAL CRITERIA | ||||
Failure to initiate ventilations within 30 seconds after applying gloves or interrupts ventilations for grater than 30 seconds at any time | ||||
Failure to take or verbalize body substance isolation precautions | ||||
Failure to voice and ultimately provide high oxygen concentration [at least 85%] | ||||
Failure to ventilate patient at a rate of at least 10/minute | ||||
Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible] | ||||
Failure to pre-oxygenate patient prior to insertion of the dual lumen airway device | ||||
Failure to insert the dual lumen airway device at a proper depth or at either proper place within 3 attempts | ||||
Failure to inflate both cuffs properly | ||||
Combitube failure to remove the syringe immediately after inflation of each cuff | ||||
PTL - failure to secure the strap prior to cuff inflation | ||||
Failure to confirm that the proper lumen of the device is being ventilated by observing chest rise, auscultation over the epigastrium, and bilaterally over each lung | ||||
Inserts any adjunct in a manner dangerous to the patient |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Dynamic Cardiology
Candidate: __________________________________________________________________Examiner: ____________________________________________
Date:_______________________________________________________________________ Signature: ____________________________________________
Level of testing: NREMT-Intermediate/99 NREMT-Paramedic
Time start: ___________________ |
Possible |
Points |
|
---|---|---|---|
Takes or verbalizes infection control precautions |
1 |
||
Checks level of responsiveness |
1 |
||
Checks ABCs |
1 |
||
Initiates CPR if appropriate [verbally] |
1 |
||
Attaches ECG monitor in a timely fashion or applies paddles for "Quick Look" |
1 |
||
Correctly interprets initial rhythm |
1 |
||
Appropriately manages initial rhythm |
2 |
||
Notes change in rhythm |
1 |
||
Checks patient condition to include pulse and, if appropriate, BP |
1 |
||
Correctly interprets second rhythm |
1 |
||
Appropriately manages second rhythm |
2 |
||
Notes change in rhythm |
1 |
||
Checks patient condition to include pulse and, if appropriate, BP |
1 |
||
Correctly interprets third rhythm |
1 |
||
Appropriately manages third rhythm |
2 |
||
Notes change in rhythm |
1 |
||
Checks patient condition to include pulse and, if appropriate, BP |
1 |
||
Correctly interprets fourth rhythm |
1 |
||
Appropriately manages fourth rhythm |
2 |
||
Orders high percent of supplemental oxygen at proper times |
1 |
||
Time end: Total |
24 |
||
|
|||
CRITICAL CRITERIA | |||
Failure to deliver first shock in a timely manner due to operator delay in machine use or providing treatments other than CPR with simple adjuncts | |||
Failure to deliver second or third shocks without delay other than the time required to reassess rhythm and recharge paddles | |||
Failure to verify rhythm before delivering each shock | |||
Failure to ensure the safety of self and others [verbalizes "All Clear" and observes] | |||
Inability to deliver DC shock [does not use machine properly] | |||
Failure to demonstrate acceptable shock sequence | |||
Failure to order initiation or resumption of CPR when appropriate | |||
Failure to order correct management of airway [ET when appropriate] | |||
Failure to order administration of appropriate oxygen at proper time | |||
Failure to diagnose or treat 2 or more rhythms correctly | |||
Orders administration of an inappropriate drug or lethal dosage | |||
Failure to correctly diagnose or adequately treat v-fib, v-tach, or asystole |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Static Cardiology
Candidate: _________________________________________________________________Examiner: ___________________________________________________________
Date: _____________________________________________________________________Signature: ___________________________________________________________
Set # _______________________
Level of testing: NREMT-Intermediate/99 NREMT-Paramedic
Note: No points for treatment may be awarded if the diagnosis is incorrect.
Only document incorrect responses in space provided
Time start: ___________________ |
Possible |
Points |
---|---|---|
STRIP #1 Diagnosis: |
1 |
|
Treatment: |
2 |
|
STRIP #2 Diagnosis: |
1 |
|
Treatment: |
2 |
|
STRIP #3 Diagnosis: |
1 |
|
Treatment: |
2 |
|
STRIP #4 Diagnosis: |
1 |
|
Treatment: |
2 |
|
Time end: ______________________________________________Total |
12 |
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Intravenous Therapy
Candidate: ___________________________________________________________________Examiner: _______________________________________
Date: ________________________________________________________________________Signature: ______________________________________
Level of testing: NREMT-Intermediate/99 NREMT-Paramedic
Time start: ___________________ |
Possible |
Points Awarded |
|
---|---|---|---|
Checks selected IV
fluid for: -Proper fluid (1 point) -Clarity (1 point) |
2 |
||
Selects appropriate catheter |
1 |
||
Selects proper administration set |
1 |
||
Connects IV tubing to the bag |
1 |
||
Prepares administration set [fills drip chamber and flushes tubing] |
1 |
||
Cuts or tears tape [at any time before venipuncture] |
1 |
||
Takes/verbalizes body substance isolation precautions {prior to venipuncture] |
1 |
||
Applies tourniquet |
1 |
||
Palpates suitable vein |
1 |
||
Cleanses site appropriately |
1 |
||
Performs
venipuncture -Inserts stylet (1 point) -Notes or verbalizes flashback (1 point) -Occludes vein proximal to catheter (1 point) -Removes stylet (1 point) -Connects IV tubing to catheter (1 point) |
5 |
||
Disposes/verbalizes disposal of needle in proper container |
1 |
||
Releases tourniquet |
1 |
||
Runs IV for a brief period to assure patent line |
1 |
||
Secures catheter [tapes securely or verbalizes] |
1 |
||
Adjusts flow rate as appropriate |
1 |
||
Time end: Total |
21 |
||
|
|||
CRITICAL CRITERIA | |||
Failure to establish a patent and properly adjusted IV within 6 minute time limit | |||
Failure to take or verbalize body substance isolation precautions prior to performing venipuncture | |||
Contaminates equipment or site without appropriately correcting situation | |||
Performs any improper technique resulting in the potential for uncontrolled hemorrhage, catheter shear, or air embolism | |||
Failure to successfully establish IV within 3 attempts during 6 minute time limit | |||
Failure to dispose/verbalize disposal of needle in proper container |
Note: Check here ( ) if candidate did not establish a patent IV and do not evaluate IV Bolus Medications
Intravenous Bolus Medications
Time start:___________________________________ |
Possible |
Points |
|
---|---|---|---|
Asks patient for known allergies |
1 |
||
Selects correct medication |
1 |
||
Assures correct concentration of drug |
1 |
||
Assembles prefilled syringe correctly and dispels air |
1 |
||
Continues body substance isolation precautions |
1 |
||
Cleanses injection sit [Y-port or hub] |
1 |
||
Reaffirms medication |
1 |
||
Stops IV flow [pinches tubing or shuts off] |
1 |
||
Administers correct dose at proper push rate |
1 |
||
Disposes/verbalizes proper disposal of syringe and needle in proper container |
1 |
||
Flushes tubing [runs wide open for a brief period] |
1 |
||
Adjusts drip rate to TKO/KVO |
1 |
||
Verbalizes need to observe patient for desired effect/adverse side effects |
1 |
||
Time end: _____________________________________Total |
13 |
||
CRITICAL CRITERIA | |||
Failure to begin administration of medication within 3 minute time limit | |||
Contaminates equipment or site without appropriately correcting situation | |||
Failure to adequately dispel air resulting in potential for air embolism | |||
Injects improper drug or dosage [wrong drug, incorrect amount, or pushes at inappropriate rate] | |||
Failure to flush IV tubing after injecting medication | |||
Recaps needle or failure to dispose/verbalize disposal of syringe and needle in proper container |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Pediatric (<2 yrs.)
Ventilatory Management
Candidate: ___________________________________________________________Examiner: ______________________________________________________________
Date:________________________________________________________________Signature: ______________________________________________________________
NOTE: If candidate elects to ventilate initially 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
Possible Points |
Points Awarded |
||
---|---|---|---|
Takes or verbalizes body substance isolation 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 devise unattached to oxygen |
1 |
||
"*" Hyperventilates patient with room air |
1 |
||
Note: Examiner now informs candidate that ventilation is being performed without difficulty and that pulse oximetry indicates the patients blood oxygen saturation is 85% | |||
Attaches oxygen reservoir to bag-mask device and connects to high flow oxygen regulator [12-15 L/min] |
1 |
||
Ventilates patient at a rate of 20-30/minute and assures adequate chest expansion |
1 |
||
Note: After 30 seconds, examiner auscultates and reports breath sounds are present, equal bilaterally and medical direction has ordered intubation. The examiner must now take over ventilation | |||
Directs assistant to pre-oxygenate patient |
1 |
||
Identifies/selects proper equipment for intubation |
1 |
||
Checks laryngoscope to assure operational with bulb tight |
1 |
||
Note: Examiner to remove OPA and move out of the way when candidate is prepared to intubate | |||
Places patient in neutral or sniffing position |
1 |
||
Inserts blade while displacing tongue |
1 |
||
Elevates mandible with laryngoscope |
1 |
||
Introduces ET tube and advances to proper depth |
1 |
||
Directs ventilation of patient |
1 |
||
Confirms proper placement by auscultation bilaterally over each lung and over epigastrium |
1 |
||
Note: Examiner to ask "If you had proper placement, what should you expect to hear?" | |||
Secures ET tube (may be verbalized) |
1 |
||
Total |
17 |
||
CRITICAL CRITERIA | |||
Failure to initiate ventilations within 30 seconds after applying gloves or interrupts ventilations for grater than 30 seconds at any time | |||
Failure to take or verbalize body substance isolation precautions | |||
Failure to pad under the torso to allow neutral head position or sniffing position | |||
Failure to voice and ultimately provide high oxygen concentration [at least 85%] | |||
Failure to ventilate patient at a rate of at least 20/minute | |||
Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible] | |||
Failure to pre-oxygenate patient prior to intubation | |||
Failure to successfully intubate within 3 attempts | |||
Uses teeth as a fulcrum | |||
Failure to assure proper tube placement by auscultation bilaterally and over the epigastrium | |||
Inserts any adjunct in a manner dangerous to the patient | |||
Attempts to use any equipment not appropriate for the pediatric patient |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Pediatric Intraosseous Infusion
Candidate: _____________________________________________________________Examiner: __________________________________________________________
Date: __________________________________________________________________Signature:__________________________________________________________
Time start:___________________________ |
Possible |
Points |
|
---|---|---|---|
Checks selected IV
fluid for: -Proper fluid (1 point) -Clarity (1 point) |
2 |
||
Selects
appropriate equipment to include: -IO needle (1 point) -Syringe (1 point) -Saline (1 point) -Extension set (1 point) |
4 |
||
Selects proper administration set |
1 |
||
Connects administration set to bag |
1 |
||
Prepares administration set [fills drip chamber and flushes tubing] |
1 |
||
Prepares syringe and extension tubing |
1 |
||
Cuts or tears tape [at any time before IO puncture] |
1 |
||
Takes or verbalizes body substance isolation precautions [prior to IO puncture] |
1 |
||
Identifies proper anatomical site for IO puncture |
1 |
||
Cleanses site appropriately |
1 |
||
Performs IO
puncture: -Stabilizes tibia (1 point) -Inserts needle at proper angle (1 point) -Advances needle with twisting motion until "pop" is felt (1 point) -Unscrews cap and removes stylet from needle (1 point) |
4 |
||
Disposes of needle in proper container |
1 |
||
Attaches syringe and extension set to IO needle and aspirates |
1 |
||
Slowly injects saline to assure proper placement of needle |
1 |
||
Connects administration set and adjusts flow rate as appropriate |
1 |
||
Secures needle with tape and supports with bulky dressing |
1 |
||
Time end: ________________________________________Total |
23 |
||
CRITICAL CRITERIA | |||
Failure to establish a patent and properly adjusted IO within 6 minute time limit | |||
Failure to take or verbalize body substance isolation precautions prior to performing IO puncture | |||
Contaminates equipment or site without appropriately correcting situation | |||
Performs any improper technique resulting in the potential for air embolism | |||
Failure to assure correct needle placement before attaching administration set | |||
Failure to successfully establish IO infusion within 2 attempts during 6 minute time limit | |||
Performing IO puncture in an unacceptable manner [improper site, incorrect needle angle, etc.] | |||
Failure to dispose of needle in proper container | |||
Orders or performs any dangerous or potentially harmful procedure |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Spinal Immobilization (Seated
Patient)
Candidate: _____________________________________________________________Examiner:__________________________________________________________
Date: __________________________________________________________________Signature: _________________________________________________________
Time start: __________________________ |
Possible |
Points |
|
---|---|---|---|
Takes or verbalizes body substance isolation precautions |
1 |
||
Directs assistant to place/maintain head in the neutral, in-line position |
1 |
||
Directs assistant to maintain manual immobilization of the head |
1 |
||
Reassesses motor, sensory, and circulation function in each extremity |
1 |
||
Applies appropriately sized extrication collar |
1 |
||
Positions the immobilization device behind the patient |
1 |
||
Secures the device to the patients torso |
1 |
||
Evaluates torso fixation and adjusts as necessary |
1 |
||
Evaluates and pads behind the patients head as necessary |
1 |
||
Secures the patients head to the device |
1 |
||
Verbalizes moving the patient to a long backboard |
1 |
||
Reassesses motor, sensory, and circulation function in each extremity |
1 |
||
Time end: _____________________________Total |
12 |
||
CRITAL CRITERIA | |||
Did not immediately direct or take manual immobilization of the head | |||
Did not properly apply appropriately sized cervical collar before ordering release of manual immobilization | |||
Released or ordered release of manual immobilization before it was maintained mechanically | |||
Manipulated or moved patient excessively causing potential spinal compromise | |||
Head immobilized to the device before device sufficiently secured to torso | |||
Device moves excessively up, down, left, or right on the patients 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 | |||
Did not reassess motor, sensory, and circulation functions in each extremity after voicing immobilization to the long backboard |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Spinal Immobilization (Supine
Patient)
Candidate: ___________________________________________________________Examiner:__________________________________________________________
Date:________________________________________________________________Signature:__________________________________________________________
Time start: ____________________ |
Possible |
Points |
|
---|---|---|---|
Takes or verbalizes body substance isolation precautions |
1 |
||
Directs assistant to place/maintain head in the neutral, in-line position |
1 |
||
Directs assistant to maintain manual immobilization of the head |
1 |
||
Reassesses motor, sensory, and circulation function in each extremity |
1 |
||
Applies appropriately sized extrication collar |
1 |
||
Positions the immobilization device appropriately |
1 |
||
Directs movement of the patient onto the device without compromising the integrity of the spine |
1 |
||
Applies padding to the voids between the torso and the device as necessary |
1 |
||
Immobilizes the patients torso to the device |
1 |
||
Evaluates and pads behind the patients head as necessary |
1 |
||
Secures the patients head to the device |
1 |
||
Secures the patients legs to the device |
1 |
||
Secures the patients arms to the device |
1 |
||
Reassesses motor, sensory, and circulation function in each extremity |
1 |
||
Time end: _______________________Total |
14 |
||
CRITICAL CRITERIA | |||
Did not immediately direct or take manual immobilization of the head | |||
Did not properly apply appropriately sized cervical collar before ordering release of manual immobilization | |||
Released or ordered release of manual immobilization before it was maintained mechanically | |||
Manipulated or moved patient excessively causing potential spinal compromise | |||
Head immobilized to the device before device sufficiently secured to torso | |||
Device moves excessively up, down, left, or right on the patients torso | |||
Head immobilization allows for excessive movement | |||
Upon completion of immobilization, head is not in a neutral, in-line position | |||
Did not reassess motor, sensory, and circulation functions in each extremity after voicing immobilization to the device |
You must factually document your rational for checking any of the above critical items on the reverse side of this form.
Modeled after the National Registry of Emergency Medical
Technicians Advanced Level Practical Examination
Bleeding Control / Shock
Management
Candidate: __________________________________________________________Examiner:_________________________________________________________
Date:_______________________________________________________________Signature:_________________________________________________________
Time Started: ___________________________ |
Possible |
Points |
|
---|---|---|---|
Takes or verbalizes body substance isolation precautions |
1 |
||
Applies direct pressure to the wound |
1 |
||
Elevates the extremity |
1 |
||
NOTE: The examiner must now inform the candidate that the wound continues to bleed. |
|||
Applies an additional dressing to the wound |
1 |
||
NOTE: The examiner must now inform the candidate that the wound still continues to bleed. The second dressing does not control the bleeding. |
|||
Locates and applies pressure to appropriate pressure point |
1 |
||
NOTE: The examiner must now inform the candidate that the bleeding is controlled |
|||
Bandages the wound |
1 |
||
NOTE: The examiner must now inform the 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 transport |
1 |
||
Time End: __________________________________________TOTAL |
10 |
||
CRITICAL CRITERIA |
|||
Did not take or verbalize body substance isolation precautions | |||
Did not apply high concentration of oxygen | |||
Applied a tourniquet before attempting other methods of bleeding control | |||
Did not control hemorrhage in a timely manner | |||
Did not indicate a need for immediate transportation | |||
You must factually document your rational for checking any of the above critical items on the reverse side of this form.