CPR CheckOff - Cabrillo College · Explain to the patient why you are doing this. ... Objective: The examinee will demonstrate proficiency in immobilizing and bandaging a patient

Name______________________________

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CPR CheckOff

You must complete three Adult and Child One‐Rescuer CPR skill checks prior to the final exam. Have the proctor (TA or instructor) sign and date the entry.

1. Adult and Child One‐Rescuer CPR skill correctly demonstrated to:

Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________

Name______________________________

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Vital Signs CheckOff

You must complete 10 vital signs assessments. Enter your observed readings and have the proctor (TA or instructor) sign and date the entry.

1. BP (Auscultated)___________________ Pulse__________ Resp. __________

Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________


Proctor____________________________________ Date_________________

Cabrillo College EMT Training Program Application of Soft Restraints

Takes or verbalizes body substance isolation precautions

Student’s Name___________________________________Pass____Fail____ Examiner’s Name_________________________________Date____________

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Procedure Yes No Comments

• Plan your actions ahead of time. • At least four people are required to restrain a patient. Each person should be preassigned a

limb to restrain. Rescuers should act all at once to overwhelm the patient. • Grab clothing or large joints. Avoid placing pressure on the neck or chest. Avoid the mouth,

as some patients may try to bite rescuers. • Reassure the patient throughout the procedure. • Secure the patient on the ambulance gurney in a supine or lateral position. • If the patient is spitting at rescuers, a surgical mask or nonrebreather mask (connected to an

O2 source) can be placed over the patient’s face. • Continually monitor distal circulation in restrained extremities. • Once restrained, do not leave the patient at any time. Consider having extra personnel in the

ambulance’s patient compartment during transport. • Monitor ABCs during transport. • Do not remove restraints unless sufficient personnel are available to control the patient.

Objective: The examinee will demonstrate knowledge in the application of soft restraints.

Cabrillo College EMT Training Program Rapid Extrication



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• Position a rescuer in the rear seat and maintain cspine immobilization • Perform in initial assessment of the patient to assure that this is a high priority patient and this

is the most appropriate extrication technique to use. • Apply the ccollar and make sure the other three rescuers are properly positioned. One on

each side of the patient and one outside the vehicle ready with the long backboard. • Carefully start the quarter turn until the rescuer holding cspine is unable to turn any further

then stop the turn. • Carefully transfer the cspine immobilization to a rescuer outside the vehicle and on their

command complete the quarter turn so that the patient is now seated on the backboard perpendicular to the steering wheel.

• Lay the patient down onto the backboard making sure that cspine immobilization is always maintained and the chest and armpits are fully supported.

• Upon the command of the rescuer holding cspine, slide the patient into position on the backboard and apply the torso straps and then a “Head Bed” type device.

• Carefully remove the patient on the backboard from the vehicle. • Complete the assessment of PMS and any other additional assessment and management prior

to transport.

Objective: The examinee will demonstrate proficiency in performing a rapid extrication along with additional rescuers. Equipment: Auto, simulated patient, long backboard with straps, ccollar, assistants.

Cabrillo College EMT Training Program Sucking Chest Wound



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• An open chest wound is a true emergency that requires rapid initial care in immediate transport to a medical facility.

• Maintain an open airway and provide basic life support if necessary. • Seal the open chest would as quickly as possible. If need be, use your gloved hand. Do not

delay sealing the wound to find an occlusive dressing. • Apply an occlusive dressing to seal the wound. • Assess for signs of tension pneumothorax. Remove dressing if signs of tension pneumothorax

develop. • Administer high flow O2. • Auscultate lung sounds. • Care for shock. • Place patient in position of comfort:

• Upright – due to respiratory distress. • Shock position – if signs of shock appear. • On affected side, if possible. This allows the uninjured lung to expand without restriction.

• Transport as soon as possible.

Objective: The examinee will demonstrate proficiency in assessing and treating a patient with a sucking chest wound. Equipment: Simulated patient, occlusive dressing, tape, and stethoscope.

Cabrillo College EMT Training Program Impaled Object Stabilization



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• Do not remove the impaled object. • Expose the wound area, taking great care not to disturb the object. • Long impaled objects may have to be stabilized by hand during exposure, bleeding control and

dressing. • Control profuse bleeding by direct pressure if possible by placing your gloved hands on either

side of the object and exerting pressure downward. • Place several layers of a bulky dressing around the object and tape in place while maintaining

stabilization. • Care for shock. • Keep the patient at rest. • If possible, immobilize the affected area by splinting.

Objective: The examinee will demonstrate proficiency in stabilizing an impaled object. Equipment: Simulated patient, 4x4 pads, trauma dressing, scissors, tape, bandaging material.

Cabrillo College EMT Training Program Impaled Objects – Penetrating Eye Injury



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• Place patient in supine position. • Control profuse bleeding. • Stabilize the object. Place a roll of threeinch gauze bandage or folded 4x4s on either side of

the object, along the vertical axis of the head in a manner that will stabilize the object. • Apply rigid protection. Fit a disposable paper drinking cup or paper cone over the impaled

object and allow it to come to rest on the dressing rolls. Do not allow it to touch the object. Do not use a Styrofoam cup, which can flake.

• Dress and bandage the uninjured eye. This will help to reduce sympathetic eye movements. Explain to the patient why you are doing this.

• Provide O2 and care for shock.

Objective: The examinee will demonstrate proficiency in immobilizing and bandaging a patient with an impaled object in the eye. Equipment: Simulated patient, 4x4 pads, paper cup, scissors, tape, bandaging material.

Cabrillo College EMT Training Program Cooling Measures Infant



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• Unwrap and undress infant. • Transport in cool environment. • Sponge with tepid water (active cooling). • Stop cooling process as soon as infant begins to shiver.

Objective: The examinee will demonstrate proficiency in cooling an infant with a high fever. Equipment: Simulated infant (fully dressed), tepid water, towel, and blanket.

Cabrillo College EMT Training Program Avulsion (Complete) or Amputation



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• Control bleeding, if present. • Immobilize in position of comfort and dress wound. • In the case of avulsion assess neurovascular status of injured extremity.

• Assess distal pulse and perfusion, motor function and sensation (PMS). • Wrap avulsed tissue or amputated part in waterproof sterile dressing and place in container and

seal shut. • Apply ice or cold pack to container, assuring no direct contact with tissue. • Transport avulsed tissue or amputated part with patient.

Objective: The examinee will demonstrate knowledge of proper care for avulsion or amputation. Equipment: Simulated patient, avulsed part, ice pack, plastic bag, dressings, bandages, tape.

Cabrillo College EMT Training Program Insertion of Nasogastric Tube (NG Tube)



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Procedure Yes No Comments Preparation • Prepare all equipment. • Maintain adequate oxygenation of patient. • Measure tube length before insertion – nose to ear to xiphoid process. • Lubricate tube. Insertion • Gently insert tube through one nostril. Motion should be downward along the nasal floor. • Insert tube to predetermined measured location. Confirm Placement • To confirm placement of tube in stomach, listen over epigastrium as 1020cc of air is injected

through tube with syringe. A bubbling sound or rush of air should be heard by auscultation. • Apply suction to syringe. Gastric contents should be aspirated in the tube. Apply Suction • Secure NG tube with tape. • Attach NG tube to suction device to decrease gastric distention.

Reassess • Monitor tube’s efficacy and location to assure continued proper function.

Objective: The examinee will demonstrate proficiency in insertion of a nasogastric tube. Equipment: Nasogastric tube, manikin.

Cabrillo College EMT Training Program Insertion of Esophageal Combitube (ETC Airway)

Procedure continued from previous page.


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Procedure Yes No Comments Ventilate • Begin ventilation by attaching the BVM to the longer blue connecting tube marked No. 1. • Place a stethoscope over the patient’s stomach and auscultate for gurgling sounds. If no

sounds are heard, watch for chest rise and auscultate the chest for lung sounds bilaterally. If the chest rises and bilateral breath sounds are heard, the Combitube is in the esophagus. Continue ventilations.

• If the chest does not rise and breath sounds are not heard, the Combitube is in the trachea. In this case, remove the BVM from the No. 1 tube and attach it to the shorter clear connecting tube marked No. 2, then ventilate the patient through it. Again, auscultate for breath sounds in all lung fields, as well as the stomach. If there are no epigastric sounds and you see chest rise, continue ventilations.

• Continue ventilating the patient with a BVM supplied with 100% O2.

Reassess Monitor Combitube’s efficacy and location to assure continued proper function.

Objective: The examinee will demonstrate proficiency in inserting a Combitube. Equipment: Combitube kit, lube, stethoscope, BVM, airway manikin, assistant.

Cabrillo College EMT Training Program Insertion of Esophageal Combitube (ETC Airway)


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Procedure Yes No Comments Preparation • Position yourself at patient’s head. • Assess the patient for proper age and size. • Suction any materials or fluids that might be obstructing the airway.

Assembly • Have second rescuer preoxygenate with a BVM supplied with 100% O2. • Connect the bluetipped syringe (drawn up with at least 100ml of air) to the blue oneway

valve marked No. 1, then connect the whitetipped syringe (drawn up with at least 15ml of air) to the white oneway valve tube marked No. 2.

• Inflate both cuffs and check for leaks. Deflate cuffs. • Lubricate the distal end with a watersoluble lubricant.

Insertion • Keep the patient supine, with the head in a neutral, inline position. • Perform a jawlift maneuver. • Holding the Combitube so that it curves in the same direction as the natural curvature of the

pharynx, insert the tip and advance it carefully along the tongue. • Insert the Combitube until the airway’s black rings meet the level of the patient’s teeth. • Using the large syringe, inflate the pharyngeal cuff with 100ml of air, then remove syringe. • Using the small syringe, inflate the distal cuff with 10 to 15ml of air, then remove syringe.

Do not force the Combitube. If resistance is met, pull back and redirect the Combitube.

Procedure continues on next page.

Cabrillo College EMT Training Program Metered Dose Inhaler



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Procedure Yes No Comments Preparation • Consult medical control. • Check medication for its expiration date. • Reconfirm the five rights of drug administration:

right patient, right drug, right dose, right route and right time. • Explain the procedure to the patient.

Administration • Shake the canister vigorously for about 30 seconds. • If the patient has an oxygen mask on, remove the mask for the procedure. • Instruct the patient to put the inhaler in their hand and to hold it upright. • Instruct the patient to take a deep breath and to exhale fully. • Quickly have the patient place their lips around the mouthpiece, making a tight seal with their

lips. • Have the patient take a deep and slow breath over a fivesecond period. Simultaneously the

patient or you depress the canister. Make sure the patient has started the inhalation before the canister is depressed.

• Remove the inhaler and request that the patient hold their breath for up to 10 seconds if able. • Coach the patient to exhale slowly with pursed lips. • Administer oxygen to patient if needed. • Repeat second dose if so indication by medical control.

Timing is everything in the delivery of medication by the inhaler. You must make sure that the inhalation and the depression of the canister are timed effectively to ensure the medication will be absorbed.

Reassess • Reassess the patient’s vital signs and monitor their response to treatment.

Objective: The examinee will demonstrate the proper administration of a metered dose inhaler to a patient. Equipment: Metered dose inhaler, patient.

Cabrillo College EMT Training Program Administration of Activated Charcoal



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Activated charcoal has many contraindications for its use. Knowing these contraindications is important.

Administration • Determine the correct dose. • Shake the container thoroughly. • Place mixture into a covered container with a straw. • Let the patient know the medication does not taste good, and has a gritty texture. • Ask the patient to take medication.

• The patient needs to take the complete amount of the medication as prescribed.

The use of a covered container keeps the patient from seeing the medication and getting negative feelings.


Objective: The examinee will demonstrate the proper administration of activated charcoal to a patient. Equipment: Activated charcoal, covered container, patient.

Cabrillo College EMT Training Program Administration of Nebulized Medication



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right patient, right drug, right dose, right route and right time. • Assess the patient’s ability to use the nebulizer. • Explain the procedure to the patient.

The patient should be conscious and oriented enough to be able to assist with the administration of the medication.

Assemble the Nebulizer • Unscrew the lid of the nebulizer chamber, add medication as directed and reattach lid. • Fasten the Ttube to the nebulizer chamber. • Connect the mouth piece to one end of the Ttube and the flex tube to the other end. • Attach oxygen connecting tubing from nebulizer to O2 source. Adjust oxygen flow to six liters

per minute. You should be able to see a mist coming out of both the flex tube and the mouthpiece.

Administration • Ask the patient to sit as upright as possible. • Ask the patient to hold the nebulizer in their hand and to place the mouthpiece firmly in their

mouth. Lips should be sealed tightly around the mouthpiece. Ask them to breathe deeply and slowly, through their mouth.

• At times it may be necessary to shake the chamber slightly to remove medication attached to the wall of the chamber.

• Continue this treatment until the full amount of the medication is gone.

It is important to direct the patient to take deep and slow breaths. This allows the medication to be absorbed.


Objective: The examinee will demonstrate the proper administration of nebulized medication to a patient. Equipment: Nebulizer, O2 source, patient.

Cabrillo College EMT Training Program Trauma Patient Assessment



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Procedure Yes No Comments Scene Safety and Sizeup (5 questions)

Is the scene safe? What is the Mechanism of Injury (MOI)? What is the number of patients? What additional resources do I need? Do I need to take Cspine precautions?

Initial Assessment • Verbalize general impression of patient. (big sick or little sick) • Determine level of consciousness. (AVPU & A&OX4) • Determine chief complaint. ABCs • Manage problems associated with the airway, breathing and circulation. • Administer high concentration of oxygen, if necessary. Decide Patient priority for immediate transport. Significant Mechanism of Injury

• If the mechanism of injury was significant, perform a Rapid Trauma Assessment, addressing life threats as they are discovered.

NoSignificant Mechanism of Injury • If there is no significant mechanism of injury, perform a Focused History and Physical

Exam of the affected body system or area.

This includes inspection and palpation of the isolated area of complaint.

Obtain baseline vital signs. (Pulse, respirations and blood pressure)

Gather a SAMPLE history.

Manage secondary injuries and wounds appropriately.

Transport.

Perform a Detailed Physical Exam.

Perform Ongoing Assessment.

Objective: The examinee will demonstrate knowledge of the appropriate steps for a trauma patient assessment.

Cabrillo College EMT Training Program Bleeding Control and Shock Management



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Apply direct pressure to the wound with 4 X 4s. Expose injury site.

Elevate extremity • Elevate the injury to above the level of the heart.

Pressure Dressing • Apply pressure dressing to the wound.

Pressure Point • Apply firm direct pressure and elevation while locating and applying pressure to arterial

pressure point.

Assess distal circulation to ensure bandage was not applied too tight.

The patient is showing signs of shock. What should you do? • Position patient supine with feet elevated. • Apply high flow oxygen. • Cover patient with blanket to prevent heat loss. • Prepare for immediate transport. Reassess • Check for presence of radial pulse. • Note skin signs of patient. • Check capillary refill time.

Objective: The examinee will demonstrate proficiency in controlling bleeding. Equipment: 4 X 4s, cling wrap.

Cabrillo College EMT Training Program Sling and Swathe Immobilization



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Procedure Yes No Comments Prepare the Patient • Explain the splinting procedure to your patient, gaining their consent to apply a sling and

swathe. • Direct a second rescuer (if available) to apply manual stabilization of the bones above and

below the injury site. • Assess bilateral distal pulses and perfusion, motor function and sensation (PMS). Apply Sling • Position triangular bandage under the injured arm with the acute angle of the bandage over the

uninjured shoulder and the right angle of the bandage at the elbow of the injured arm. • Bring the lower portion of the bandage up over the injured arm and over the shoulder on the

same side. • If you do not suspect a spinal injury, draw up the ends of the bandage until the hand is several

inches above the elbow. • Tie the two ends of the sling together. • Reassess bilateral distal pulses and perfusion, motor function and sensation (PMS). Apply Swathe • Immobilize the shoulder girdle and upper extremity by tying a swathe around the chest and

injured arm with another bandage.

A pillow or pad can be placed under the arm for comfort.

Reassess • Reassess bilateral distal pulses and perfusion, motor function and sensation (PMS).

Be sure the device does not constrict distal circulation.

Objective: The examinee will demonstrate proficiency in applying a sling and swathe. Equipment: Simulated patient, triangular bandages.

Cabrillo College EMT Training Program Sager Traction Splint



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Procedure Yes No Comments Prepare the Patient • Determine that the patient is a candidate for a traction splint. • Direct assistant to stabilize leg while you expose the thigh and remove shoes and socks. • Explain the procedure to the patient, letting them know that this will alleviate some of the pain

and help prevent further leg injury. • Assess bilateral distal pulses and perfusion, motor function and sensation (PMS). • Apply the ankle hitch. • Temporarily take over stabilization of leg and direct assistant to apply and maintain manual

traction.

Indications are a closed midshaft femur fracture with no injuries to the proximal hip or distal leg (including knee).

Splint Leg • Position splint medially between the legs with the pulley on the same side and toward the

injured leg. • Secure the hip strap. • Attach ankle strap to splint. • Release the lock and apply mechanical traction. Observe the amount indicated on the traction

scale. It is suggested to use 10% of the patient’s body weight up to 15 pounds. • Release manual traction. • Position and secure Velcro support straps (top of thigh, knee, and ankle).

Do not secure a support strap over the fracture site.

Reassess • Recheck distal circulation, sensation and motor function of injured leg.

Objective: The examinee will demonstrate proficiency in applying a traction splint. Equipment: Simulated patient, Sager traction splint, assistant.

Cabrillo College EMT Training Program Hare Traction Splint



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Procedure Yes No Comments Prepare the Patient • Determine that the patient is a candidate for a traction splint. • Direct assistant to stabilize leg while you expose the thigh and remove shoes and socks. • Assess bilateral distal pulses and perfusion, motor function and sensation (PMS). • Apply the ankle hitch. • Temporarily take over stabilization of leg and direct assistant to apply and maintain manual

traction.

Indications are a closed midshaft femur fracture with no injuries to the proximal hip or distal leg (including knee).

Prepare Splint • Place splint parallel to uninjured extremity, adjust length 68 inches beyond foot and lock. • Adjust support straps (two above and two below the knee). • Support fracture site while lifting leg and maintaining manual traction.

Place splint under leg, position top portion against ischium. Splint Leg • Lower leg onto splint. • Place pad under groin strap. Secure groin strap. • Attach ankle strap to splint by rings and turn knob until manual traction is equaled. • Release manual traction. • Position and secure Velcro support straps (two above and two below the knee).

Do not secure a support strap over the fracture site.

Reassess • Recheck distal circulation, sensation and motor function of injured leg.

Objective: The examinee will demonstrate proficiency in applying a traction splint. Equipment: Simulated patient, hare traction splint, small pad for groin strap, assistant.

Cabrillo College EMT Training Program Emergency Childbirth

Procedure continued from previous page


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Procedure Yes No Comments Once head is delivered, suction baby’s mouth and nose Deliver the rest of the baby • Apply gentle downward pressure to head to release upper shoulder. • Apply gentle upward pressure on head to release lower shoulder. • Support the head, trunk and pelvis as rest of baby delivers. • Suction baby’s mouth and nose with bulb syringe again to clear secretions out of the airway. Stimulate baby’s breathing • Flick bottom of baby’s foot. Stroke baby’s back briskly. • Dry and warm the baby and monitor airway and breathing. • Assesses baby’s respiration, color and heart rate. • Wrap baby in blankets and keep at the same level as the vagina until the umbilical cord stops

pulsating. Double clamp cord • Place first clamp 10” from baby, second clamp 3” from first (4 fingers width) towards baby. • Cut the cord between the 2 clamps. • Note the exact time of birth. Assess baby’s APGAR at 1 minute. Verbalize what APGAR stands for.

Place baby on mother’s abdomen or to mother’s breast.

Deliver placenta and place in plastic bag.

Massage fundus.

Assess baby’s APGAR at 5 minutes.

Objective: The examinee will demonstrate proficiency in assisting with an emergency childbirth. Equipment: Childbirth manikin, infant manikin with umbilical cord and placenta, OB kit.

Cabrillo College EMT Training Program Emergency Childbirth


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Procedure Yes No Comments Assess • Approach patient, introduce self and ask permission to treat. • Ask patient, “Do you feel the need to bare down or move your bowels?” If answer is yes:

• Advise patient the need to examine for crowning. • Observe for crowning to determine if delivery is imminent.

• Asks 4 key questions if time permits: 1. “When did your contractions begin?” 2. “How far apart are the contractions?” 3. “Are you expecting any complications with the delivery?” 4. “When is your baby due?”

Preparation • Open OB kit. • Remove patient’s clothing that obstructs vaginal opening. • Drape patient for privacy using sheets leaving vaginal opening exposed. Cleanse perineum (vaginal area) • Wipe top to bottom, medial to lateral. • Place chux or towels under patient’s hips. Deliver baby’s head • With one hand, support and apply gentle counter pressure to baby’s head to prevent rapid

birth. • As head emerges makes sure the amniotic sac membrane has ruptured. If not, gently puncture

the sac with fingers removing it from the baby’s face. • Report to examiner the presence or absence of cord around neck when baby’s head is out. If

present loosen cord from around baby’s neck and slip cord over the head and shoulders. If cannot free the cord from around the neck, clamp the cord in 2 places and cut between the clamps.


Cabrillo College EMT Training Program Artificial Ventilation of a Stoma Breather



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Procedure Yes No Comments Preparation • Remove any items of clothing from the area of the stoma. • Clear the stoma of any obvious mucous plugs or secretions. • Leave the patient’s head and neck in a neutral position.

Ventilation • Select a mask, most often a pediatric mask that fits securely over the stoma and can be sealed

against the neck. • Hold the mask seal with your hand and ventilate the patient at the appropriate rate for their

age. • Assess the effectiveness of ventilations. Watch the chest for chest rise and fall.

Consider auscultation as soon as possible to ensure ventilations.

Problems • If no chest rise, suspect a partial laryngectomy. Seal the nose and mouth with one gloved hand

by placing the palm over the lips and pinching the nose between the third and fourth fingers. Continue ventilations.

• If unable to artificially ventilate through the stoma, consider sealing the stoma and ventilation through the mouth/nose.

Objective: The examinee will demonstrate proper artificial ventilation of a stoma breather. Equipment: Manikin with stoma, BVM with pediatric mask.

Cabrillo College EMT Training Program Suctioning Through an Endotracheal Tube



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Procedure Yes No Comments Preparation • Explain the procedure to the conscious patient. • Check and assemble the suction device. • Preoxygenate the patient by providing ventilations with 100% O2 for two minutes. • Approximate the length of the catheter to be inserted. • Clean the end of the endotracheal tube where the soft catheter will be inserted with an alcohol

wipe. • Place suction unit near head of patient and turn the unit on. • Attach the sterile soft catheter using a sterile gloved hand.

The suction catheter must be kept sterile during this entire procedure.

Suctioning • Using the sterile gloved dominant hand, place the soft catheter into the ET tube without

applying suction. • Advance the catheter slowly down the ET tube until it reaches the desired location. • Place your nondominant thumb over the hard plastic hole at the proximal end of the catheter

and apply suction. • Slowly withdraw the catheter using a twisting motion. • Clean the catheter in sterile water to remove debris and/or fluids.

If the patient gags during this procedure stop the advancement.

Never suction, or interrupt ventilation for more than 15 seconds.

Hyperventilate the patient and repeat the procedure if necessary.

Objective: The examinee will demonstrate the proper procedure to suction through an endotracheal tube. Equipment: Adult airway manikin, ET tube, suction device, soft catheter, sterile gloves, BVM with O2 attached.

Cabrillo College EMT Training Program Endotracheal Tube BVM Ventilation



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Attach BVM to end of endotracheal tube

Ventilation • Ventilate patient 810 breaths per minute or track unconscious breathing patient’s ventilations.

Reassess Airway/Ventilations • Assess tube placement by watching for chest rise. • Listen for bilateral breath sounds over chest and epigastrium

Objective: The examinee will demonstrate how to ventilate an intubated patient. Equipment: Adult airway manikin, #7 ET tube, stylette, laryngoscope and blade, 10cc syringe, adult ET holder, BVM

Cabrillo College EMT Training Program Infant Foreign Body Airway Obstruction



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Procedure Yes No Comments Performance Steps • Student states, “some of the signs of severe airway obstruction are: poor or no air exchange,

weak, ineffective cough, highpitched sounds while inhaling, turning blue, unable to cry or make sounds, unable to move air”.

Airway Maneuver • Kneel or sit with the infant in your lap. If easy to do, bare infant’s chest. • Hold infant face down with head slightly lower than the chest, resting on you forearm.

Support head and jaw with your hand. • Deliver up to five back slaps forcefully between the infant’s shoulder blades, using the heel of

your hand. • Place your free hand on the infant’s back, supporting the back of the infant’s head with the

palm. Turn the infant as a unit while carefully supporting the head and neck. Hold the infant on his back with your forearm resting on your thigh. Keep the infant’s head lower than the trunk.

• Provide up to five quick downward chest thrusts in the same location as chest compressions – just below the nipple line.

Assess • Repeat until the object is dislodged or the victim becomes unresponsive. Do not perform

blind finger sweeps because the foreign body may be pushed back into the airway causing further obstruction or injury.

• If the infant becomes unresponsive, stop back slaps and begin CPR.

CPR will have one extra step: each time you open the airway, look for the obstructing object in the back of the throat. If you see an object, remove it.

Objective: The examinee will demonstrate how to relieve a foreign body airway obstruction in both the conscious and unconscious infant.

Equipment: Infant manikin.

Cabrillo College EMT Training Program Adult and Child Foreign Body Airway Obstruction: Responsive Patient



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Procedure Yes No Comments Airway • Ask the victim, “Are you choking?” • Determine whether complete airway obstruction is present:

• If the victim can talk or is coughing, it is a partial airway obstruction. Encourage them to cough forcefully to dislodge the obstruction.

• If the victim cannot cough, has a very weak cough, or is cyanotic, treat the patient as if there is a severe airway obstruction and begin abdominal thrusts.

Perform abdominal thrusts • Position yourself behind the victim. • Make a fist, and place the thumb side of this fist against the midline of the patient’s abdomen

between waist and rib cage. • Grasp your properly positioned fist with your other hand and apply pressure inward and up

toward the patient’s head in a smooth, quick movement. Each thrust should be distinct and be delivered with the intent of relieving the airway obstruction.

• Give five abdominal thrusts.

Avoid the xiphoid process.

If patient is pregnant or obese position your fist and hand on the midline of the sternum three fingers above the xiphoid process.

Reassess • If the obstruction is not relieved after a series of five thrusts, reassess your position and the

patient’s airway. • Repeat the sequence of thrusts and assessments until the obstruction is relieved or the patient

loses consciousness.

Objective: The examinee will demonstrate the Heimlich maneuver for an obstructed airway on a responsive patient. Equipment: Adult CPR manikin or simulated patient.

Cabrillo College EMT Training Program Adult and Child Foreign Body Airway Obstruction: Unresponsive Patient



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Procedure Yes No Comments Airway • Gently shake and shout, “Are you OK?” • Activate EMS. • Open the airway with the headtilt/chinlift maneuver.

Activate EMS immediately for an adult

after one minute of resuscitation for a child.

Breathing • Look, listen and feel for breathingear over the mouth, watch for chest rise for 510 seconds. • Attempt to ventilate. (Airway is obstructed). • Reposition patient’s head. Reattempt to ventilate. (Air does not go in). Perform abdominal thrusts • Straddle patient’s thighs. • Place heel of one hand against the patient’s abdomen and well below the xiphoid process. • Place second hand directly on top of the first hand. • Press both hands onto the abdomen with quick, upward thrusts. Each thrust should be distinct

and be delivered with the intent of relieving the airway obstruction. • Give 5 abdominal thrusts.

If patient is pregnant or obese give chest thrusts similar to CPR chest compressions.

Finger Sweep • Open patient’s mouth. Perform a tonguejaw lift and finger sweep. Grasp both tongue and

lower jaw between the thumb and fingers. Lift the mandible. • Insert the index finger along the inside of the cheek and deeply sweep the patient’s throat. Repeat Sequence • Reattempt to ventilate the patient. If air doesn’t go in reposition the patient’s head and

reattempt to ventilate. Repeat 5 abdominal thrusts and finger sweep. Continue until successful. Reassess • After airway obstruction is removed, check for pulse and breathing. If patient has pulse and is

breathing place in recovery position. Objective: The examinee will demonstrate the Heimlich maneuver for an obstructed airway on an unconscious patient. Equipment: Adult CPR manikin, mat.

Cabrillo College EMT Training Program OneRescuer CPR with Automatic External Defibrillator



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Procedure Yes No Comments Analyze • Be sure no one is touching the patient during the “analyze phase”. • Analyze patient by pushing the analyze button if there is one, and follow voice prompts. Note:

some AEDs do not have an analyze button and analyze automatically.

Shock Advised • Be sure no one is touching the patient at the time shock is delivered. State, “I’m clear, you’re

clear, everyone clear!” as you observe the patient prior to patient being shocked. • Press SHOCK button. • Immediately initiate CPR beginning with chest compressions. Complete 5 rounds of chest

compressions and ventilations. • Return to Analyze

No Shock Advised • Check pulse.

• If no pulse initiate CPR beginning with chest compressions. Complete 5 rounds of chest compressions and ventilations. Return to Analyze.

• If patient has a pulse, check breathing. If breathing is adequate, provide oxygen via a non rebreather mask. If breathing is inadequate or absent, ventilate the patient at the appropriate rate.

Objective: The examinee will demonstrate proficiency performing CPR with an AED on a manikin. Equipment: Manikin, AED, BVM or pocket mask.

Cabrillo College EMT Training Program OneRescuer CPR with Automatic External Defibrillator


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You observed a person collapse on the floor. You arrive at the patient’s side with an AED. No one is performing CPR. It has been less than 2 minutes since the person collapsed.

Assess • Place patient in a supine position on a dry surface. • Check for responsiveness. • Activate EMS. • Open airway using head tiltchin lift. • Check breathing for 5 to 10 seconds. • Give 2 rescue breaths (1 second each) with BVM or pocket mask. • Check carotid pulse for 5 to 10 seconds. • Assess if patient is a candidate for the use of an AED. State to proctor, “AEDs may be used on

patients over 1 year of age who are unconscious, unresponsive with no pulse”.

Prepare AED • Turn on AED. Follow AED voice prompts. • Confirm electrodes are plugged in. • Place pads on patient’s chest. Sternum pad is placed

upper anterior right side of chest just below the clavicle. Apex pad is placed on the left side of the chest below the breast and toward the lateral aspect of the ribs as shown by the pad diagrams.


Cabrillo College EMT Training Program Infant One and TwoRescuer CPR



51


Check for response

Activate emergency response system

Open airway using headtilt/chinlift method

Assess breathing for 5 to 10 seconds

Give two breaths (one second each) with visible chest rise

Check brachial pulse

Locate CPR finger position

• Deliver first cycle of compressions at correct rate (100 compressions per minute) • Give two breaths (one second each) with visible chest rise • Repeat for a total of five cycles

Acceptable: 30 compressions between 15 and 23 seconds

Recheck for a pulse Proctor will act as a second rescuer and take over at airway

• Deliver first cycle of compressions using the thumbshand encircling the chest technique at the correct rate (100 per minute) and ratio (15:2)

• Pause to allow the proctor to give two breaths (one second each) • Repeat for a total of two cycles

Proctor states “After two minutes you assess the infant and there is a pulse, but the baby is not breathing. Demonstrate what you need to do.” Give breaths (one second each) at the correct rate (every three to five seconds) with the majority of ventilations resulting in visible chest rise.

Objective: The examinee will demonstrate proficiency performing infant one and tworescuer CPR. Equipment: Infant CPR manikin, BVM or pocket mask, second rescuer.

Cabrillo College EMT Training Program Adult and Child OneRescuer CPR



50


Check for response

Activate emergency response system and call for an AED

Open airway using headtilt/chinlift method

Assess breathing for 5 to 10 seconds

Give two breaths (one second each)

Check carotid pulse

Locate CPR hand position

Deliver first cycle of compressions at correct rate (100 compressions per minute) Acceptable: 30 compressions between 15 and 23 seconds


Deliver second cycle of compressions at correct rate and hand position


Deliver third cycle of compressions of adequate depth with full chest recoil


Objective: The examinee will demonstrate proficiency performing CPR. Equipment: CPR manikin, BVM or Pocket Mask.

Cabrillo College EMT Training Program Medical Patient AssessmentResponsive: Chest Pain



49

Procedure Yes No Comments Perform Focused Physical Exam

Look for signs of breathing difficulty, auscultate lung sounds, palpate chest (look, listen and feel) and check for JVD, surgical scars and pedal edema. Ask patient if they have nausea, have vomited or feel dizzy. Ask patient if they are taking medication for erectile dysfunction.

Obtain baseline vital signs.

Interventions Place patient in position of comfort, obtain medical direction or verbalize standing order for assisting patient with their own nitroglycerin if systolic BP is above 100 mmHg.

Transport with reassessment and detailed physical exam enroute.

Objective: The examinee will demonstrate proficiency in performing a medical assessment on a patient with cardiac chest pain. Equipment: Manikin or simulated patient.

Cabrillo College EMT Training Program Medical Patient AssessmentResponsive: Chest Pain


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Procedure Yes No Comments Scene Sizeup (5 questions) • Is the scene safe? What is the mechanism of injury or the nature of illness? What is the number

of patients? What additional resources do I need? Do I need to take Cspine precautions? Initial Assessment • Verbalize general impression of patient. (big sick or little sick) • Determine level of consciousness. (AVPU & A&OX4) • Determine chief complaint. ABCs • Manage problems associated with the airway, breathing and circulation. • Administer high concentration of oxygen, if necessary. Decide Patient priority for immediate transport. Chest Pain Assessment

OPQRST: Onset: “Did the symptoms come on suddenly or gradually?” Provocation: “Are there moments (such as during inhalation), or positions where the pain is better or worse?” Quality: “Describe the pain, what does it feel like?” Region/Radiation: “Point to where it hurts. Does the pain go anywhere else?” Severity: “On a scale of 1 to 10 with 10 being the worst pain you have ever felt, what number would you give this pain?” Time: “When did your chest pain begin?”

SAMPLE History Signs and symptoms: “What’s wrong?” Allergies: “Are you allergic to medications, foods, or environmentals?” Medications: “What medications are you currently taking (prescription, overthecounter, herbal supplements, or recreational)?” Past pertinent history: “Have you been having any medical problems? Have you been feeling ill, or had any recent surgery or injuries? Have you been seeing a doctor (what’s your doctor’s name)?” Last oral intake: “When did you last eat or drink? What did you have?” Events leading to present illness: “What sequence of events led up to today’s problem?”


Cabrillo College EMT Training Program Medical Patient Assessment



47

Procedure Yes No Comments Scene Safety and Sizeup (5 questions)

Is the scene safe? What is the Nature of Illness (NOI)? What is the number of patients? What additional resources do I need? Do I need to take Cspine precautions?

Initial Assessment • Verbalize general impression of patient. (big sick or little sick) • Determine level of consciousness. (AVPU & A&OX4) • Determine chief complaint. ABCs • Manage problems associated with the airway, breathing and circulation. • Administer high concentration of oxygen, if necessary. Decide Patient priority for immediate transport. Responsive Patient

• Determine the history of the present illness. • Gather a SAMPLE history. • Perform a Focused Physical Exam based on the chief complaint. • Obtain baseline vital signs. • Transport.

Unresponsive Patient • Perform a Rapid Physical Exam. • Obtain baseline vital signs. • If possible: (Ask family members or bystanders, look for evidence on scene, etc.)

§ Determine the history of the present illness. § Gather a SAMPLE history.

• Transport.

Remember AEIOUTIPS for determining possible causes of altered level of consciousness.

Perform Ongoing Assessment.

Objective: The examinee will demonstrate knowledge of the appropriate steps for a medical patient assessment.

Cabrillo College EMT Training Program Epinephrine AutoInjector



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Administration • Remove the cap from the autoinjector. • Expose the thigh area. Some autoinjectors will work through clothing. • Place autoinjector device on the lateral thigh midway between the knee and the waist. • Tell patient they may feel a stick from the needle. • In a smooth, direct, 90degree angle, push the injector firmly until you hear the device inject

the needle. • Hold for 10 seconds to allow medication to be delivered. • Remove autoinjector. • Rub the injection site for 10 seconds. • Dispose of the autoinjector appropriately.

The springloaded device needs a good amount of pressure against the thigh. Make sure you are pressing hard enough.

If at any time a needle sticks you or anyone, consult your policies and procedures immediately.


Objective: The examinee will demonstrate the proper administration of epinephrine via an autoinjector (EpiPen). Equipment: EpiPen trainer, patient.

Cabrillo College EMT Training Program Administration of Nitroglycerin



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Procedure Yes No Comments Preparation • Consult medical control. • Check medication for its expiration date, and ask the patient when the container was first

opened. Inquire about how the medication has been stored. • Find out when the patient last took nitro, and if they have taken any drugs for erectile

dysfunction in the last 24 hours. • Reconfirm the five rights of drug administration:

right patient, right drug, right dose, right route and right time. • Confirm patient’s systolic blood pressure is greater than 90 mm Hg. • Explain the procedure to the patient. • Remove the oxygen mask.

Do not administer nitroglycerin if systolic pressure is less than 90 mm Hg, or if patient has taken an erectile dysfunction drug in the last 24 hours.

Administration by Tablet • Ask patient to open mouth and to lift tongue. • Place tablet under the patient’s tongue. Ask them to let the nitro dissolve under their

tongue and to not swallow for a few minutes. Administration by Spray

• DO NOT shake canister. • Ask patient to open mouth and to lift tongue. • Spray on or under tongue • Ask patient to wait at least 10 seconds before swallowing.

Reassess • Retake the patient’s blood pressure within two minutes. • Monitor patient’s response to treatment. • If pain persists after five minutes or if systolic pressure drops to below 90 mm Hg consult with

medical control or local policies. • Some EMS systems allow multiple doses to be administered.

If patient becomes light headed, less responsive or their blood pressure drops, immediately place the patient in shock position.

Objective: The examinee will demonstrate the proper administration of nitroglycerin to a patient. Equipment: Nitroglycerin, sphygmomanometer, stethoscope, O2 mask, patient.

Cabrillo College EMT Training Program Administration of Glucose



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right patient, right drug, right dose, right route and right time. • Confirm the patient’s ability to swallow and the presence of a gag reflex. • Explain the procedure to the patient.

Administration • Open tube while keeping it clean. • Apply glucose by squeezing tube onto tongue depressor. • Insert tongue depressor with glucose into their mouth, between the cheek and the gum, or

under their tongue. • Remove the tongue depressor. • Confirm that the patient can swallow. • Reapply glucose to tongue depressor and continue the administration until the glucose is gone

from the tube. • Immediately discontinue administration if the patient loses the ability to swallow or becomes

unresponsive, and consult with medical control as soon as possible.

In some cases, the patient could selfadminister the glucose.


Objective: The examinee will demonstrate the proper administration of glucose to a patient. Equipment: Glucose, tongue depressor, patient.

Cabrillo College EMT Training Program Spine Immobilization Standing Patient



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Procedure Yes No Comments Prepare Patient • Direct second rescuer to maintain patient’s head in neutral, inline position from behind the

patient. • Explain the procedure to the patient. • Assess distal pulses and perfusion, motor function and sensation (PMS) in extremities. • Apply properly fitted cervical collar.

Maintain manual cspine until patient’s head is secured to the spine board.

Place Patient • Position immobilization device against patient’s back, between the arms of the rescuer holding

manual stabilization. • Two rescuers position themselves on either side, facing the patient, holding immobilization

device under the arms of the patient. • Lower the immobilization device by taking synchronous steps forward and extending arms

until the board reaches the ground. • Move patient to proper position on the device as a unit.

Rescuer holding cspine directs each movement of the patient while ensuring that the head remains in a neutral position to the board.

Secure Patient • Pad any voids between torso and the board as necessary. • Secure the patient to the spine board, placing straps across the upper chest, pelvis and ankles. • Evaluate and pad under the patient’s head as necessary. • Secure the patient’s head to the board using a “Head Bed” type device, finishing with tape

across the forehead, fastening the ends directly to the board. • Secure the arms of the patient to prevent injury.

Make sure the patient’s arms are left free when strapping the upper chest.

Reassess • Reassess distal pulses and perfusion, motor function and sensation (PMS) in extremities.

Objective: The examinee will demonstrate the proper takedown and spine immobilization of a standing patient. Equipment: Ccollar, long board, straps, headbed, tape.

Cabrillo College EMT Training Program Spine Immobilization Supine Patient



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Procedure Yes No Comments Prepare Patient • Direct second rescuer to maintain patient’s head in neutral, inline position. • Assess distal pulses and perfusion, motor function and sensation (PMS) in extremities. • Apply properly fitted cervical collar.

Maintain manual cspine until patient’s head is secured to the spine board.

Place Patient • Position a long spine board parallel to patient. • Roll patient onto their side without movement of the spine. • Pull the spine board under the patient. • Roll patient back to supine position on top of the spine board. • Move patient to proper position on the device as a unit.

Rescuer holding cspine directs each movement of the patient.

Secure Patient • Pad any voids between torso and the board as necessary. • Secure the patient to the spine board, placing straps across the upper chest, pelvis and ankles. • Evaluate and pad under the patient’s head as necessary. • Secure the patient’s head to the board using a “Head Bed” type device, finishing with tape

across the forehead, fastening the ends directly to the board. • Secure the arms of the patient to prevent injury.

Make sure the patient’s arms are left free when strapping the upper chest.

Reassess • Reassess distal pulses and perfusion, motor function and sensation (PMS) in extremities.

Objective: The examinee will demonstrate proper spine immobilization of a supine patient. Equipment: Ccollar, long board, straps, headbed, tape.

Cabrillo College EMT Training Program Lifting and Moving Patients



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Consider the patient to be moved, the need for additional assistance and the physical abilities of those available to help with the move. A plan must then be formulated and communicated.

Follow Proper Body Mechanic Rules • Correct feet position • Use your legs, not your back, to lift. • Never twist or turn. • Keep back straight, do no compensate when lifting with one hand. • Keep the weight close to your body. • Use a stair chair when carrying a patient on stairs.

Select the proper carry for the situation at hand.

Objective: The examinee will demonstrate proper lifting and moving of patients.

Cabrillo College EMT Training Program Helmet Removal



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Procedure Yes No Comments Stabilize the Patient • Approach the patient from front and instruct them not to move. • Direct second rescuer to maintain manual stabilization at the top of the patient’s head, holding

the helmet stable, with palms on the side of the helmet and fingers on the jaw. • Evaluate bilateral distal pulses and perfusion, motor function and sensation (PMS) in all

extremities.

Gain consent to treat the patient.

Remove Helmet • Open, remove or cut the chinstrap. • Assume manual stabilization from the second rescuer by placing one hand on the occiput

behind the patient’s head and another on the mandible. The second rescuer can now release manual stabilization to you.

• Direct the second rescuer to slowly remove the helmet by pulling out the sides so that they clear the ears.

Maintain Stabilization • Manual stabilization should be maintained throughout the entire process. • A cervical collar should be applied and full spinal immobilization completed when possible.

Reassess • Reassess bilateral distal pulses and perfusion, motor function and sensation (PMS) in all

extremities.

Objective: The examinee will demonstrate proper helmet removal. Equipment: Helmet, patient, ccollar.

Cabrillo College EMT Training Program Kendrick Extrication Device (KED)



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Procedure Yes No Comments Immobilizes patient’s head and neck from front or side. Introduces self. Requests permission to treat. Instructs helper to position self behind patient and take over manual Cspine. Assess for perfusion, motor function and sensation (PMS) • Checks for capillary refill time and radial pulse. • Asks patient to grip the index and middle fingers of each of your hands simultaneously. • Asks patient which finger is being touched as you apply pressure. Assesses neck and back for injury and pain and places Ccollar on patient • Palpates midline of neck for point tenderness and asks if they have any neck pain. • Palpates midline of back for point tenderness and asks if they have any back pain. • Measures and selects proper size of Ccollar. Secures collar in place. Places KED behind patient • Assist patient to lean forward from waist using one hand to support chest and directs helper to

maintain spinal alignment. • Slides KED into place and positions snuggly under armpits. Secures straps • Secures torso straps without excessive movement and without causing respiratory compromise. • Secures leg straps.

Order of torso straps is not important.

Pads and Secures head • Places padding in gaps between KED and patient’s head as needed. • Secures patient’s head to KED with forehead strap and chin strap. Reassess • Instructs helper to release patient’s head. Rechecks perfusion, motor function and sensation of

patient. • States: “While placing patient on long board they would be moved by supporting legs and

using KED side straps. Full backboard immobilization procedures using straps, head bed and tape would be used. Leg straps of KED would be loosened prior to backboard strapping.

Objective: The examinee will place and secure a KED on a sitting patient. Equipment: Simulated patient and KED device.

Cabrillo College EMT Training Program Bandaging and Splinting an Open Extremity Fracture



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Procedure Yes No Comments Prepare the Patient • Explain the splinting procedure to the patient. • Assess distal pulses and perfusion, motor function and sensation (PMS) prior to

immobilization. • Direct second rescuer to apply manual stabilization of the extremity without applying traction.

Expose affected area.

Dress the Wound • Apply appropriate dressing to the wound.

Immobilize the Injured Extremity • Measure splint to several inches beyond both joints above and below the injury. • Select appropriate splinting material. • Support fracture site while applying splint. • Pad splint where needed. • Secure splint in place above and below injure with cravats, cling wrap, or other fasteners.

Measure on opposite extremity if possible.

Be sure to support the bone ends while positioning the splint.

Reassess • Reassesses distal pulses and perfusion, motor function and sensation (PMS).

Objective: The examinee will demonstrate how to properly bandage and splint an open extremity fracture. Equipment: Splinting material, cravats, cling wrap, fasteners, patient.

Cabrillo College EMT Training Program Long Bone Immobilization



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Procedure Yes No Comments Prepare the Patient • Explain the splinting procedure to the patient. • Assess bilateral distal pulses and perfusion, motor function and sensation (PMS) prior to

immobilization. • Direct second rescuer to apply manual stabilization of the extremity.


Immobilize the Injured Extremity • Measure splint to several inches beyond both joints above and below the injury. • Select appropriate splinting material. • Position splint in place. • Secure splint in place with cravats, cling wrap, or other fasteners.

Measure on opposite extremity if possible.



Objective: The examinee will demonstrate how to properly immobilize an injured long bone. Equipment: Splinting material, cravats, cling wrap, fasteners, patient.

Cabrillo College EMT Training Program Joint Immobilization



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Procedure Yes No Comments Prepare the Patient • Explain the splinting procedure to the patient. • Assess distal pulses and perfusion, motor function and sensation (PMS) prior to

immobilization. • Direct second rescuer to apply manual stabilization of the bones adjacent to the injured joint.


Immobilize the Joint • Select appropriate splinting material. • Position splint in place under the injured joint. Pad as necessary. • Secure splint in place with cravats, cling wrap, or other fasteners.



Objective: The examinee will demonstrate how to properly immobilize an injured joint. Equipment: Splinting material, cravats, cling wrap, fasteners, patient.

Cabrillo College EMT Training Program Bleeding Control and Shock Management



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Apply direct pressure to the wound with 4 X 4s. Expose injury site.

Elevate extremity • Elevate the injury to above the level of the heart.

Pressure Dressing • Apply pressure dressing to the wound.

Pressure Point • Apply firm direct pressure and elevation while locating and applying pressure to arterial

pressure point.

Assess distal circulation to ensure bandage was not applied too tight.

The patient is showing signs of shock. What should you do? • Position patient supine with feet elevated. • Apply high flow oxygen. • Cover patient with blanket to prevent heat loss. • Prepare for immediate transport. Reassess • Check for presence of radial pulse. • Note skin signs of patient. • Check capillary refill time.

Objective: The examinee will demonstrate proficiency in controlling bleeding. Equipment: 4 X 4, cling wrap.

Cabrillo College EMT Training Program Neurological Exam



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Procedure Yes No Comments Cspine Precautions • Indicate that this would be done now if not done earlier (as needed). Assess Level of Consciousness (LOC) using AVPU • Is the patient alert? (A) Is the patient oriented? (O) Ask the patient:

“What is your name?” (A&Ox1), “Where are you?” (A&Ox2), “What time or day is it?” (A&Ox3), “What happened to you?” (A&Ox4)

• If not alert, is the patient responsive to: • Verbal stimuli? (V), Painful stimuli? (P), Unresponsive? (U)

Assess Pupils using PERL • Check for size. • Check for equality. • Check for reactivity to light. Assess Extremity Perfusion, Motor Function and Sensation (PMS) • Assess upper extremities for distal pulses (presence and equality), movement (presence and

equality of grip) as well as sensation in fingers, and capillary refill. • Assess lower extremities for distal pulses (presence and equality), movement (presence and

equality of strength) as well as sensation in toes, and capillary refill. Describe Findings Verbally • Level of consciousness • Pupils • Distal PMS

Objective: The examinee will demonstrate the ability to properly conduct a neurological exam and verbalize the results to the proctor. Equipment: Penlight, patient.

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Patient Report

When relieved by a higher medical authority or when transferring care, the lead EMT will give a full report on the patient to include:

• patient’s age • gender • what happened and chief complaint • actions taken by the SRT • SAMPLE information as necessary.

Report Examples

#1 (Medical patient) – “We were presented with a 59 year old female who’s chief complaint is dizziness, and who said she was, “feeling faint.” Patient has a history of low blood pressure and is currently seeing a doctor for it. She wasn’t doing anything unusual when the episode occurred. Patient states that she has no allergies that she is aware of. We took a full set of vitals and her blood pressure was 110/60 at 1015. We administered high flow 02 through a non‐ rebreather mask at 15 liters per minute. We gathered the patient’s medications and put them in this Ziploc baggie for you. Patient ate a normal breakfast and is not feeling nauseous. She agrees that it would be best for her to be transported to the hospital and be seen by a doctor. Full documentation is on the transfer of care worksheet. We’re ready to help you load the patient for transport.

#2 (Trauma patient) –We arrived on scene of a single vehicle accident; a car hit this telephone pole head on. We have one patient, the driver. There was no airbag deployment and he wasn’t wearing a seat belt. He’s unconscious and breathing, and has traumatic injuries to the head from hitting the windshield, and the chest from impacting the steering wheel. We’ve taken full c‐ spine precautions. Patient is immobilized on a back board and packaged for immediate transport. Patients pulse is weak and thready at 140 beats per minute. Breathing is shallow and rapid. We are assisting with respirations through a BVM on high flow 02 at 15 liters per minute. Full documentation is on the transfer of care worksheet. We’re ready to help you load the patient for transport.

32

Initial Patient Contact

• Unconscious patient o ABC’s o LOC (AVPU) o If trauma is suspected take initial c‐spine precautions o Determine chief complaint if possible o Introduce yourself to bystanders, family members, etc if appropriate, and let

them know: § Who you are (your name) § Your position (I’m an EMT or I’m an emergency medical technician or a

phrase that will denote your competence, credibility and authority.) § Why you are with the patient (“I’m here to help,” and/or, “someone

called us today,” etc.) § Did you see (the patient) lose consciousness? And person, place, time

and purpose or event if possible. o Unconscious patient intro example: “My name is _______, I’m an EMT‐medic

and I’m here to help. Did anyone see what happened? Does anyone know this person? Are you a family member? Do you know anything about this person’s medical history? OK. Please tell me what you know so we can help.”

o Update General Impression (“Big sick/little sick.”) o Prepare for transport (Criteria for immediate transport (“load and go”) are

unconscious patient, uncontrolled bleeding, complications of childbirth and severe spinal injuries.)

o Start SAMPLE, physical exam and look for medical alert bracelets or medallions o Treat patient as indicated during interview/assessment process

SRT Actions

The lead EMT is the primary authority and will be responsible for patient contact, obtaining information from the patient, and for directing the SRT. Typical assignments taken by SRT members and usually not by the lead EMT will include:

• Vital signs • Documentation ‐ Fill in the Transfer of Care worksheet by recording pertinent

information in all data fields including time of action for 02 administration, all vital signs, etc. Documenter will also prepare the Refusal of Service information sheet (AMA) but the lead EMT will present it to the patient.

• Airway management – Prepare 02 administration as directed by the lead EMT. • Trauma management – Prepare c‐spine precautions, back boarding and strapping as

directed by the lead EMT. • Communications – Interface with incoming ALS personnel and/or other contacts as

needed. (Dispatch, hospital, law enforcement, fire personnel, etc.)

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Patient Interview/Assessment and General Event Flow

On scene/scene survey

• BSI precautions (PPE) • Scene safety • Additional resources • Number of patients • Type of patient(s), medical or trauma. If trauma determine need for cervical spine

precautions

Pre‐contact impressions

• What is the nature of the event (trauma, (example‐vehicle accident) or medical (example‐seizure) or both (example‐vehicle accident with seizure)

• Visual impressions of the patient o Conscious/unconscious o ABC’s o Skin signs o “Big sick/little sick”

Initial Patient Contact

• Conscious patient o If trauma is suspected take initial c‐spine precautions while making introduction o Introduce yourself and let the patient know:

§ Who you are (your name, “Hi, my name is _______.”) § Your position (“I’m an EMT,” or “I’m an emergency medical technician,”

or a phrase that will denote your competence, credibility and authority.) § Why you are with the patient (“I’m here to help,” and/or, “you called us

today,” etc.) o Obtain chief complaint (“Why did you call us today?” “How can we help you

today?” “What happened?” Etc.) o Update General Impression (“Big sick/little sick.”) o Conscious patient intro example: “Hi, my name is _______, I’m an EMT‐medic

and I’m here to help you. Can you tell me why you called us? OK. I’m going to ask you a few basic questions so that we can continue to help you.”

o Level of Consciousness (LOC) § Person, place, time and purpose or event

o Start SAMPLE and physical exam o Prepare for transport (NOTE: Criteria for immediate transport (“load and go”)

are unconscious patient, uncontrolled bleeding, complications of childbirth and severe spinal injuries.)

o Treat patient as indicated during interview/assessment process

Cabrillo College EMT Training Program Application of a Cervical Collar



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Procedure Yes No Comments Approach • Approach the patient from the front, instructing them not to move. • Explain the procedure to the patient and gain consent to treat.

Stabilization • Maintain manual cervical stabilization. Have a second rescuer do this if possible.

Assessment • Inspect and palpate the neck and cervical spine. • Check for jugular vein distension (JVD), tracheal deviation and medic alert tag. • Inspect for stoma. • Evaluate pulses, motor function and sensation (PMS) in all extremities. • Measure the collar for a proper fit according to manufacturer’s instructions.

Application • Angle the collar for proper placement.

• If patient is supine, slide the collar between the neck and the ground first, and then wrap it around the front.

• If patient is sitting, slide the chin portion of the collar up the chest to the chin, then wrap the collar around the back of the neck.

• Fasten the collar in place. • Check for proper fit.

The collar should not hyperextend the neck or fit so snugly that it constricts the airway.

Reassess • Reassess pulses, motor function and sensation (PMS) in all extremities.

Maintain manual stabilization until patient is fully immobilized.

Objective: The examinee will demonstrate the proper application of a cervical collar. Equipment: Assorted sizes of cervical collar, patient, second rescuer.

Cabrillo College EMT Training Program Detailed Physical Exam



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Procedure Yes No Comments Assess the Chest • Palpate the clavicles. • Inspect the chest for DCAPBTLS plus crepitation, scars, and paradoxical motion. • Palpate the chest (barrel hoop and sternum press with edge of hand). • Auscultate for presence and equality of breath sounds. Assess the Abdomen • Inspect the abdomen for DCAPBTLS. • Palpate the 4 quadrants of the abdomen for distension, rigidity, guarding and pulsating masses. Assess the Pelvis • Inspect the pelvis for DCAPBTLS plus priapism, incontinence and bleeding. • Palpates the pelvis gently pressing on the front and sides (barrel hoop) checking for stability. • Check for outward rotation and shortening of each leg (sign of possible hip fracture).

Do not rock the pelvis hard.

Assess the lower extremities • Inspect and palpate the lower extremities. • Assess for pulses, perfusion, motor function and sensation of the lower extremities. Assess the upper extremities • Inspect and palpate the upper extremities. Checks for medic alert tag. • Assess for pulses, perfusion, motor function and sensation of the upper extremities. Assess the back and buttocks • Inspect and palpates the posterior torso and buttocks for DCAPBTLS.

Often done when log rolling the patient to a spine board.

Treat any injuries discovered on the detailed physical exam as appropriate.

Objective: The examinee will demonstrate proficiency in performing a detailed physical exam. Equipment: Patient or manikin, penlight, stethoscope, mat, shears for exposing injuries.

Cabrillo College EMT Training Program Detailed Physical Exam


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Procedure Yes No Comments • Scene SizeUp and Initial Assessment • Students states, “I would do a focused history and physical exam on a minor trauma patient

and a rapid trauma assessment on a major trauma patient”. Preassessment • Expose patient or injuries for assessment. • Direct crew to prepare backboard for patient transport (if needed). • Obtain SAMPLE history and vital signs as appropriate Detailed Physical Examination (DCAPBTLS)Student states what acronym stands for.

Assess the Head • Inspect and palpate the scalp and cranium for DCAPBTLS plus crepitation and bleeding. • Inspect the eyes for pupil size and reactivity, bleeding in the anterior eye chamber and signs of

raccoon eyes. • Inspect the ears and nose for bleeding or clear fluid drainage (CSF) • Inspect the back of the ears for bruising (Battle’s sign) • Inspect the mouth for loose or broken teeth, lacerations on the tongue, unusual odors and

listens for a noisy airway (snoring, strider and secretions sounds). Assess the neck • Inspect and palpates neck and cervical spine. • Check for jugular vein distension (JVD), tracheal deviation and medic alert tag. • Inspect for stoma. • Student verbalizes, “I would apply a cervical collar at this point of the physical exam if

appropriate”.


Cabrillo College EMT Training Program Pulse Oximetry



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Connect the sensor lead to the monitor and clip the sensor probe to the patient’s fingertip.

Turn on the pulse oximeter.

Observe for SpO2 reading and heart rate. Make sure the heart rate displayed on the screen is the same as the patient’s palpated pulse rate.

Reassess every five minutes.

Objective: The examinee will state the reasons for using pulse oximetry and demonstrate proficiency in using a pulse oximeter. Equipment: Pulse oximeter.

Cabrillo College EMT Training Program Sellick’s Maneuver



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Sellick’s Maneuver is a quick, effective way of preventing gastric distension and/or regurgitation in a patient who cannot protect his/her own airway. It also helps during manual ventilation and endotracheal tube intubation.

Position Patient • Ensure that the patient is in the supine position. • Place patient’s head in neutral position.

Locate Cricoid Cartilage • Palpate the depression inferior to the thyroid cartilage (Adam’s apple). • The projection just inferior to this depression is the cricoid cartilage. • Place the thumb and index finger of one hand on the anterior and lateral aspects of the cricoid

cartilage, just next to the midline.

Apply Pressure • Apply firm, but gentle posterior pressure. • More pressure is needed to prevent regurgitation than gastric distention.

Too much pressure must be avoided because it will occlude the airway.

Objective: The examinee will be able to explain why to use Sellick’s Maneuver as well as demonstrate the correct application of Sellick’s Maneuver. Equipment: Manikin.

Cabrillo College EMT Training Program Oxygen Administration



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Procedure Yes No Comments Assess • Assess patient’s need for oxygen by observing patient’s skin signs, pulse oximetry level and

breathing effort. Assemble • Connect yoke of the flowmeterregulator to O2 tank by aligning pins into appropriate spaces on

the tank valve. Check for “Oring” gasket. Handtighten the “T” screw on the oxygen regulator.

• Slowly open tank valve (use key if required) onehalf turn to charge the regulator. • Check pressure gauge in O2 tank to see that adequate O2 is present. Verbalize pressure in PSI. Nasal Cannula • Select nasal cannula and connect tubing to nipple of oxygen regulator. • Set flow rate at 16 LPM. • Place nasal cannula in manikin’s nose with nasal prongs curving downward. • Secure cannula by positioning tubing over the manikin’s ears. Bring remainder of tubing under

the manikin’s chin. Slide slip loop in place.

Instruct the patient to breathe normally while the cannula is in place.

Nonrebreather Mask • Select nonrebreather mask and connect tubing to nipple of oxygen regulator. • Set flow rate at 1215 LPM. • Fill mask reservoir by placing finger over port at top of bag. • Place mask over manikin’s nose and mouth with apex of mask over the bridge of nose. • Secure mask on manikin by positioning the elastic strap so that it rests above the manikin’s ear

and tighten strap as needed.

Instruct the patient to breathe normally while the mask is in place.

Reassess Airway/Ventilations

Objective: The examinee will demonstrate how to connect a flowmeterregulator to an O2 cylinder, turn it on and administer O2 via a nasal cannula and nonrebreather mask. Equipment: Adult airway manikin, O2 tank, flowmeterregulator, cylinder key, nasal cannula, nonrebreather mask.

Cabrillo College EMT Training Program Suctioning the Oropharynx



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Procedure Yes No Comments Assess • Open airway by tilting patient’s head back in the sniffing position. • Assess if patient’s airway is in need of suctioning.

Assemble • Assemble suction equipment by connecting rigid tip to tubing, then to suction source. • Ensure suction unit is working by turning it on, then off.

Airway • Measure depth of rigid suction tip insertion by measuring the distance from tip of earlobe to

side of nose following the curvature of the jaw. • Turn suction unit on. • Place patient on his or her side, or turn head to the side if possible. • Grasp lower jaw of patient and open the mouth wide. • Insert suction catheter to the measured depth. • Suction as catheter is withdrawn by placing your finger over the hole in the catheter tip. • Limit suctioning to 15 seconds. • Irrigate suction tip with solution as needed. • Repeat the above technique as needed.

Same measurement length as an NPA

Use pediatric setting for children and infants.

Limit child and infant suctioning to 5 seconds using flexible suction tube only.

Breathing • Ventilate apneic patient after suctioning or administer O2 as needed to a breathing patient.


Objective: The examinee will demonstrate proficiency in suctioning the oropharynx using a rigid suction tip. Equipment: Adult airway manikin, rigid suction tip, connective tubing, suction unit, irrigating solution and container.

Cabrillo College EMT Training Program Nasopharyngeal Airway



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Procedure Yes No Comments Measure Airway • Visually select airway diameter slightly smaller than the patient’s nostril. • Size airway by measuring from patient’s side of nostril to the earlobe or compare NPA external

diameter with the diameter of patient’s smallest finger. • Lubricate with water soluble lubricant. Insert • Gently push the tip of the nose upward • Insert NPA with bevel pointing toward septum, gently rotating the airway side to side while

advancing it. • At no time should the airway be forced into the nostril. • If patient begins to gag immediately remove the airway and prepare to suction as needed. • Flange or proximal ring should rest against the end of the nostril when NPA is placed properly. Reassess Airway/Ventilations

Objective: The examinee will demonstrate how to size and place a nasopharyngeal airway. Equipment: Adult airway manikin, a variety of nasopharyngeal airways, lubricant. Indications: Semiconscious or unconscious patient with a gag reflex unable to tolerate an OPA.

Cabrillo College EMT Training Program Oropharyngeal Airway



22

Procedure Yes No Comments Position Patient • Place the patient in supine position.

Measure Airway • Size airway from earlobe to corner of patient’s mouth or angle of jaw to midline of the lip. • Select proper size of oral airway.

Insert • Open patient’s mouth using the crossfinger technique. • Insert the airway with tip pointing toward roof of mouth until it reaches the base of the tongue. • Gently rotate airway 180 degrees. • Flange should rest against the outside of the lips.

If the patient begins to gag at any stage of this procedure immediately remove the airway.

Remember to gently insert the airway.


Objective: The examinee will demonstrate proficiency in sizing and placing an oropharyngeal airway. Equipment: Adult airway manikin, a variety of OPA sizes. Indications: Unconscious patient with no gag reflex.

Cabrillo College EMT Training Program Bag Valve Mask Ventilation, TwoPerson



21

Procedure Yes No Comments Assess • Assess patient’s breathing. Look, listen and feelear over mouth, watch for chest rise for 510

seconds. Assemble Equipment • Open oxygen source and ensure pressure is adequate. • Connect one end of oxygen tubing to flow meter of O2 cylinder and the other to the BVM. • Set flow meter to 15 LPM. • Attach mask to BVM.

Ensure the equipment is operational.

Airway • Open airway by tilting patient’s head back in the sniffing position. • Suction airway, if required. • Measure and insert an OPA.

Do not ventilate a patient with fluid in their pharynx.

Ventilation • First EMT:

• Position yourself at head of patient. • Position the mask on the patient and using the “EC” technique with each hand, seal the

mask while lifting the jaw (this holds the airway open). • Second EMT:

• Squeeze the bag slowly (1 second) while watching for chest rise. • Give one breath every five to six seconds (10 to 12 breaths per minute) for adults. • Give one breath every three to five seconds (12 to 20 breaths per minute) for children.

• Both EMTs: • Watch for chest rise on each ventilation.

If the patient has a mustache or beard, there are no differences in this procedure.

Reassess Airway /Ventilations

Objective: The examinee will demonstrate proficiency ventilating an apneic patient using a Bag Valve Mask attached to a supplemental O2 source, along with a second rescuer. Equipment: Adult airway manikin, BVM, OPA, O2 tank with regulator/flow meter, oxygen tubing, second rescuer.

Cabrillo College EMT Training Program Bag Valve Mask Ventilation



20

Procedure Yes No Comments Assess • Assess patient’s breathing. Look, listen and feelear over mouth, watch for chest rise for 510

seconds.

Assemble Equipment • Open oxygen source and ensure pressure is adequate. • Connect one end of oxygen tubing to flow meter of O2 cylinder and the other to the BVM. • Set flow meter to 15 LPM. • Attach mask to BVM.

Ensure the equipment is operational.

Airway • Open airway by tilting patient’s head back in the sniffing position. • Suction airway, if required. • Measure and insert an OPA.

Do not ventilate a patient with fluid in their pharynx.

Ventilation • Position yourself at head of patient. • Use the “EC” technique to seal the mask and maintain an open airway. • With your other hand, squeeze the bag slowly (1 second) while watching for chest rise. • Give one breath every five to six seconds (10 to 12 breaths per minute) for adults. • Give one breath every three to five seconds (12 to 20 breaths per minute) for children.

If the patient has a mustache or beard, there are no differences in this procedure.

Reassess Airway /Ventilations

Objective: The examinee will demonstrate proficiency ventilating an apneic patient using a Bag Valve Mask attached to a supplemental O2 source. Equipment: Adult airway manikin, BVM, OPA, O2 tank with regulator/flow meter, oxygen tubing.

Cabrillo College EMT Training Program Pocket Mask Ventilation



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Procedure Yes No Comments Assess • Assess patient’s breathing. Look, listen and feel ear over mouth, watch for chest rise for 510

seconds. Assemble • Push out dome of face piece. Attach oneway valve to mask, exhalation valve away from

“nose” end of mask. • Position mask over patient’s nose & mouth. Position yourself at head of patient. Airway • Open the airway by using the head tilt/chin lift or modified jaw thrust if Cspine precautions are

needed. • Insert an OPA or NPA as appropriate. • Connect oxygen tubing to pocket mask if there is an oxygen inlet. Some types of pocket masks

do not have an O2 inlet. • Center the pocket mask on the patient’s face so that the triangle is over the bridge of the

patient’s nose and the wider part is placed between the lower lip and the chin. Breathing • Seal mask by circling thumb & 1 st finger around top of mask and opening airway by 3 rd , 4 th &

5 th fingers lifting the jaw. Pull the jaw up towards the mask. • Blow slowly into valve over 12 seconds. Observe for chest rise. • Remove mouth and allow patient to exhale.

Ventilations should be 1 breath every 5 seconds for an adult. Children and infants should be ventilated at a rate of 1 breath over 35 seconds depending on their size.

Circulation • If the patient does not have a pulse, perform CPR as usual. If alone consider using the attached

head strap if there is one. This will help to maintain alignment of the mask on the patient. Reassess Airway/Ventilations

Objective: The examinee will demonstrate proficiency ventilating an apneic patient using a pocket mask. Equipment: Adult airway manikin, pocket mask. Special Instructions: To clean remove filter. Wash and scrub with soapy water. Rinse in clean water. Submerge for 10 minutes in 1:64 household bleach/water solution. Rinse. Air dry.

Cabrillo College EMT Training Program Jaw Thrust Maneuver



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Procedure Yes No Comments Positioning • Place the patient in the supine position. • Place yourself at the top of the patient’s head if possible.

If the patient is not supine, carefully keep the patient in a neutrally aligned position and roll them as a unit into the supine position.

Maneuver • Without moving the head and neck, carefully place one hand on either side of the patient’s

head near the orbits. • Place your thumbs just inferior to the eyes and lateral to the nose. • Place your fingers at the angle of the jaw below the ears. • Without moving the head and neck, using your index and middle fingers, pull the angle of

the jaw forward (jut the jaw).

Try not to close the patient’s mouth during maneuver.

Assess for breathing and ventilate as needed.

Objective: The examinee will demonstrate the proper method for the jaw thrust maneuver. Equipment: Manikin.

Cabrillo College EMT Training Program HeadTilt/ChinLift Maneuver



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Procedure Yes No Comments Positioning • Place the patient in the supine position. • Place yourself to the side of the patient if possible.

Maneuver • Place the palm of one hand on the patient’s forehead. • Place the fingers of your other hand under the bony part of the lower jaw near the chin. • While applying pressure down on the forehead, simultaneously using the fingers of the other

hand lift the jaw upward, bringing the chin forward. Do this until the teeth of the lower mouth almost touch the teeth of the upper.

Try not to close the patient’s mouth during maneuver.

Assess for breathing and ventilate as needed.

Objective: The examinee will demonstrate the proper method for the headtilt/chinlift maneuver. Equipment: Manikin.

Cabrillo College EMT Training Program Chest Auscultation



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Direct patient to breathe deeply through an open mouth.

Place stethoscope diaphragm directly on patient’s skin.

Listen • In a minimum of 4 fields anterior(front) and posterior (back): • Anterior

• 3 fingers breadth below the clavicle at the midclavicular line, on right and left sides • Just below the nipple line (6 th intercostals space) midaxillary, on right and left sides

• Posterior • Upper back, 3 fingers breadth below the shoulder (not over the scapular bone), on right

and left sides. • 3 fingers breadth below the scapular bone, on right and left sides.

Objective: The examinee will demonstrate proficiency in auscultating breath sounds. Equipment: Stethoscope, simulated patient.

Cabrillo College EMT Training Program Vital Signs



15

Procedure Yes No Comments Blood Pressure Palpated • With blood pressure cuff still in place, feel for the radial pulse. • Inflate the cuff to at least 10mm Hg over the point where the radial pulse ceases to be palpable. • Deflate cuff slowly. • Note when the radial pulse returns. This is the systolic blood pressure. • Report the systolic blood pressure over “P” for “palpated”.

Skin • Checks for overall color of the skin • Determine skin temperature by feeling the forehead with the back of the hand. • Determines skin moisture

Pupils • Note the size of the pupil before shining any light into the eyes. • Cover one eye while shining light into the other eye. • Note the reactivity and change in size of the pupil • Repeat the exam on the other eye. • Document PERL (pupils are equal and reactive to light) or pertinent negatives if pupils do not

respond normally.

Objective: The examinee will demonstrate how to take vital signs on a patient. Equipment: Blood pressure cuff (sphygmomanometer), stethoscope, penlight, patient.

Cabrillo College EMT Training Program Vital Signs


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Procedure Yes No Comments Respirations • Check for the presence or absence of breathing by watching for the rise and fall of the chest. • Observe the patient’s position (tripod position indicates respiratory difficulty). • Count the number of breaths in 30 seconds and multiply by 2 or in 15 seconds and multiply by

4 to determine the number of breaths per minute. • Report the rate, rhythm, and quality of breathing.

Pulse • Palpate the radial pulse with two fingers if the patient is conscious. Palpate the carotid pulse if

the patient is unconscious. For infants palpate the brachial pulse. • Count the number of beats in 15 seconds and multiply by 4. If pulse is slow or irregular count

the beats in 30 seconds and multiply by 2. • Report the rate, strength and regularity of the pulse.

Blood Pressure Auscultated • Apply blood pressure cuff 1” above the antecubital area. Palpate the brachial artery and place

the center of the bladder just above it. • Don’t place it over clothing. • Fit it snuggly. • Place the diaphragm of the stethoscope over the brachial artery. • Inflate the blood pressure cuff rapidly. • Deflate the cuff slowly and note when the heart beat is first heard and when it is no longer

heard. These two numbers are the systolic and diastolic numbers of the blood pressure. • Report the auscultated systolic and diastolic blood pressure.

Cuff should cover 2/3 of upper arm.

Procedure continues on the next page.

Cabrillo College EMT Training Program Initial Assessment



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Procedure Yes No Comments Scene Safety and Sizeup (5 questions) • Is the scene safe? Trauma patient (Mechanism of Injury (MOI)) or medical patient (Nature of

Illness (NOI))? What is the number of patients? What additional resources do I need? Do I need to take Cspine precautions?

Initial Assessment Overview • Verbalize general impression of patient. (big sick or little sick) • Determine level of consciousness. Is the patient alert, or responsive to verbal or painful stimuli,

or unresponsive? (AVPU) If the patient is alert, are they oriented to person, place, time and event? (A&OX4)

• Determine chief complaint. Airway • Is the airway open? If not open it with the headtilt/chinlift method or modified jaw thrust if

Cspine precautions are needed. (Demonstrate these two methods of opening the airway.) • Use suction as needed. • Insert OPA or NPA adjuncts if appropriate. Breathing • Assess the presence, rate, and quality of breathing. • Apply oxygen if needed here. Begin rescue breathing if patient is apneic. Circulation • Assess for the presence, rate, regularity and strength of the pulse. If no pulse begin CPR and

attach an AED. • Assess skin color, temperature and moisture condition. • Check for and control any major bleeding. • Initiate shock treatment if signs of shock are apparent. Decide Patient priority for immediate transport

Objective: The examinee will perform an initial assessment and verbalize through entire skill verbatim. Equipment: Manikin or simulated patient.

Cabrillo College EMT Training Program Body Substance Isolation (BSI)


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Procedure Yes No Comments Preparation

• Explain to patient the reasons for applying BSI. • Apply gloves. • Apply eye protection. • Apply mask, if appropriate. • Apply gown, if appropriate.

Patient Interaction • Provide appropriate assessment and treatment. • Consider changing gloves if they are to be worn for an extended period of time.

Change gloves immediately if they become damaged.

Cleanup • Gather any contaminated materials from the scene, and place in an appropriate disposal bag

or container. • Remove personal protection when there is no further risk of exposure. • Be careful not to contaminate yourself during removal of personal protection equipment. • Dispose all contaminated materials and gloves, masks and gowns in proper infection control

waste disposal container. • Wash hands as soon as possible with an approved infection control soap or other solution. • Document the incident.

If at any time you fell you may have been exposed to blood or body fluids, fill out appropriate forms provided to you by your agency, and contact your infection control coordinator. If you have been directly exposed, seek medical attention immediately. Consult your agency’s policies and procedures.

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10

9

Infant CPR 1 and 2 Person: “You are at a party with some friends off duty when a parent runs up to you with his infant and says, “My baby is not breathing! Help her!” The baby is limp and turning blue. Place the baby on a firm surface. Proceed with your assessment. (Student should work through the 1 rescuer infant CPR skills sheet beginning with assess for responsiveness and activate EMS. Demonstrate 5 cycles if 30:2 beginning with opening the airway and checking for breathing). The proctor now states, “After the 5 th cycle of compressions and ventilations you recheck for a pulse and still do not find one. The proctor will act as a second rescuer and take over at airway. Demonstrate the 2 thumbs‐hands encircling the chest technique of chest compressions and the correct ratio of compressions to ventilations that is preferred for 2‐rescuer infant CPR”. (Student should take over compressions and proctor should ventilate infant. Be sure that the 15:2 ratio is used for 2 person infant CPR). “Do 2 cycles of CPR”. The proctor then states, “After 2 minutes you assess the infant and there is a pulse, but the baby is not breathing. Demonstrate what you need to do. (Student should demonstrate rescue breathing, 1 breath every 3‐5 seconds with the majority of ventilations resulting in visible chest rise.)

Patient Assessment Medical: Proctor states, “Your patient complains of cardiac‐like chest pain. Assume the scene size‐up and initial assessment have been completed. What questions will you ask your patient as part of your chest pain assessment?” Student should answer according to OPQRST. Proctor asks, “What does SAMPLE stand for?” Student answers per skill sheet. Proctor asks, “What do you assess during your focused physical exam?” Student works through the physical exam and focused history questions on the skills sheet. Proctor asks, “What else do you do for a patient with suspected cardiac chest pain? Student states, “Obtain baseline vital signs, assist patient to take their own nitroglycerin if BP is above 100 systolic and they are not on ED medication, make transport decisions and consider doing a complete detailed physical exam.” Proctor states, “This completes the medical assessment.”

Sling and Swathe: You respond to a patient who has what appears to be a dislocated shoulder. The patient is self splinting the injury. There is no second rescuer. Demonstrate how to immobilize this injury using a sling and swathe. Assess for circulation, sensation and motor function in the injured extremity.

8

Proctor Statements for Final Skills

Hare Traction: You arrive on scene of a patient who is complaining of leg pain. The patient states the pain is 9 out of 10. The pain is accompanied by swelling and bruising to the middle section of the femur. There does not appear to be any hip or knee involvement in the injury. You suspect that the patient has an isolated closed mid‐shaft femur fracture. Place the hare traction splint on the patient to immobilize the possible fractured femur.

Emergency Childbirth: You arrive on scene of a patient who states she thinks she is about to give birth to a baby. After introducing yourself what assessment question should you ask to ascertain whether you should check to see if the baby is coming? (Answer: Do you feel the need to bare down or move your bowels?”) What 4 key questions would you like to ask if time permits? After the questions proceed with the necessary steps to deliver this woman’s baby. (Key point: After the head of the baby delivers be sure that the student checks for the presence or absence of the umbilical cord around the baby’s neck). Do not have student actually close the clamps on the cord but only demonstrate the landmarks to place them.

One‐Rescuer CPR with AED: “You are in a gym where a man goes suddenly unconscious while playing basketball. Assume the Emergency Response System has been activated. You are working at the gym and arrive within two minutes with an AED. You also have a pocket mask or BVM available. Demonstrate what you would do to treat this individual. (Student should work through the skill sheet.) “When you recheck for a pulse, you find one, but the patient is not breathing. Demonstrate what you need to do now”. (Student should demonstrate rescue breathing, 1 breath every 5‐6 seconds.) “Continue to demonstrate rescue breathing for 1 full minute”. (Student will give 10‐12 breaths in the minute time with the majority of them resulting in visible chest rise.) “The patient is now breathing on his own. What further treatment could you do?” (Student states, “Place the patient in recovery position and put them on a non‐rebreather mask at 15 liters per minute”.)

Bleeding Control and Shock Management: You have a patient who has a deep gash to their forearm that appears to be spurting bright red blood. Demonstrate how to control the bleeding. Student should hold pressure, elevate and demonstrate correct pressure point at the brachial artery. Student should then apply a pressure bandage using a 4X4 and cling or a triangular bandage. Proctor states, “If your patient is showing signs of shock what should you do?” Student should verbalize down the rest of the skill sheet. If student has not already stated, proctor asks, “What 3 things should you reassess during bleeding control and shock management?” Student should state, “Check for presence of radial pulse, observe skin signs and check for capillary refill time.”

7

Proctor Statements for Midterm Skills

Initial Assessment: An initial assessment is an EMT’s “bread and butter”. From memory verbalize down the initial assessment exactly as it is written on the skills sheet. Demonstrate how to open an airway with a head‐tilt, chin lift method and with a jaw thrust method if you suspect spinal injuries.

Patient Assessment Detailed Physical Exam: A detailed physical assessment begins with scene size‐up and initial assessment. Assume you have already completed these two steps. The assessment you complete for a minor versus major trauma is different. What is the difference? Student states, “I would do a focused history and physical exam on a minor trauma patient and a rapid trauma assessment on a major trauma patient”. Explain the pre‐assessment steps in the detailed physical exam. Student verbalizes down the 3 bullet points under pre‐assessment. State what the acronym DCAP‐BTLS stands for. Student states, “Deformity, contusions, abrasions, punctures (or penetrations), burns, tenderness, lacerations and swelling”. Continue to perform all assessment steps you would do to look for unknown injuries on a trauma patient. Student works down the head to toe and verbalizes all bullet points on the skill sheet. One bullet point missed throughout the entire exam is permissible but more than one constitutes a failure for this skill. At the end of the exam ask, “Is there anything else you would like to add?”

1 Person BVM: You have been asked to ventilate a non‐breathing patient. Measure and insert an OPA and then demonstrate ventilating an adult patient with a bag valve mask.

Oxygen Administration: In this station you need to assess patient’s need for oxygen, assemble the oxygen administration system, demonstrated how to administer oxygen to a patient with a nasal cannula and a non‐rebreather mask.

NPA and Suctioning: Demonstrate measuring and inserting an NPA. Assemble and demonstrate how to suction a patient with a rigid suction tip.

Vital Signs: Using the proctor demonstrate how to take a respiration rate, pulse rate and auscultated blood pressure. Verbalize how to take a palpated blood pressure. Student does not have to actually demonstrate palpated BP, only explain how to do it.

KED: You have a patient who has an isolated spinal injury in the neck and back. They are complaining of neck and back pain midline tenderness and feel numbness in both arms. Demonstrate assessing the patient for need for a KED and place KED correctly on the patient. Do not place the patient on the back board but verbalize what you would do if you wanted to fully immobilize the patient who is placed in a KED.

6

Patient Assessment Algorithm

Lab Schedule – Spring 2009

5

Lab 12 5/15 Review and Makeups from Lab 8 11

Students:

o Review as needed from SRT o Patient scenarios

Lab 13 5/22 Final Skills Review

Students:

• Final Skills Practice Open Lab o Patient Assessment Medical Chest Pain o OnePerson CPR with AED o Emergency Childbirth o Infant One and TwoRescuer CPR o Hare Traction Splint o Bleeding Control and Shock Management o Sling and Swathe Immobilization

Saturday 5/23 FINAL Skills Test 10:00A – 3:00P

• Final Skills Test o Patient Assessment Medical Chest Pain o OnePerson CPR with AED o Emergency Childbirth o Infant One and TwoRescuer CPR o Hare Traction Splint o Bleeding Control and Shock Management o Sling and Swathe Immobilization


4

NO LAB 4/10 NO LAB

Lab 9 4/24

Students:

• CPR 1 person adult/child • AED • 1 & 2 person CPR infant • FBAO – All ages – Conscious • FBAO all ages Unconscious • ETBVM Advanced Airway

Lab 10 – 5/1

Students:

• Emergency Childbirth • Hare Traction • Sager Traction • Sling and Swath • Bleeding/Shock management

Lab 11 – 5/8

Students:

• Trauma Patient Assessment – Significant MOI • Trauma Patient Assessment – No Significant MOI • Cspine standing position • Rapid Extrication (QT Video Only) • Rapid vehicle extrication scenarios • Trauma Patient Scenarios


3

***Initial Assessment Test – 3/24 and 3/26 – K. Hurst by appointment. Includes student/teacher conference, written midterm exam review and ridealong agency assignment.

Lab 7 3/27 – Midterm Skills Review

Students:

• Midterm Skills: o 1 person BVM (with OPA) o NPA and Suctioning o Oxygen administration o Vital Signs o KED o Patient Assessment Detailed Physical Exam

Saturday 3/28 MIDTERM Skills Test 10:00A – 3:00P

Students:

• Midterm Skills: o 1 person BVM (with OPA) o NPA and Suctioning o Oxygen administration o Vital Signs o KED o Patient Assessment Detailed Physical Exam

Lab 8 4/03

Students:

• View all medication administration QT videos • Administration of glucose • Assisting to give patient’s own nitroglycerin • Epi pen • Medical patient assessment (Unresponsive) • Medical patient assessment (Responsive) • AMR Presentation

Instructor:

• Patient Scenario: Medical Pt. Cardiac


2

Lab 4 ‐ 3/6

Students:

• Neuroassessment • Bleeding Control • Shock Management • Splinting • Bandaging • Quiz #3: Patient Assessment Algorithm, Initial Assessment Skill Sheet • Scenarios: Patient assessments

HMFRA ‐ Saturday 3/7

Lab 5 3/13

Students:

• KED • Helmet Removal • Lifting and Moving Patients (Skills sheet and video.) • Strapping and Spinal Immobilization • Backboard Use • Initial Pt. Assessment and Pt. Assessment Algorithm Student Conferences

WMDFRA ‐ Saturday 3/14

Lab 6 3/20 – Review and Makeups from Labs 1 5

Students:

• Review as needed from SRT • Review Initial Assessment Skill Sheet • Initial Assessment Patient scenarios • Makeup quizzes from PAA and IA Skill Sheet


1

Lab 1 2/13

Lab Orientation Review and Student Response Teams

• Scene sizeup and initial patient assessment. Pt. Assessment Algorithm • Equipment Checkoff and Patient documentation: Transfer of Care WS; Refusal of Service (AMA)

• Vital Signs o BP, Pulse, Respirations, Skin Signs, Pupillary Reaction o Chest Auscultation

• Scenarios: Introduction to patient assessment

Lab 2 2/20

Students:

• Head tilt/chin lift (Skills sheet and video.) • Jaw thrust maneuver (Skills sheet and video.) • All airway management skills (Skills sheet and video.)

o Using a Pocket Mask o Two Person BVM o Oropharyngeal airway o Nasopharyngeal airway o Oral suctioning o O2 Tank Assembly o Nonrebreather Mask o Nasal Cannula o Sellick’s Maneuver

• Quiz #1: Patient Assessment Algorithm, Initial Assessment Skill Sheet

Lab 3 ‐ 2/27

Students:

• Detailed Physical Exam (DCAPBTLS) • Rapid Trauma Exam • Cervical collars • SAMPLE with Vitals • Patient Interview • Scenarios: Patient assessments • Quiz #2: Patient Assessment Algorithm, Initial Assessment Skill Sheet

Table of Contents

ii

Lab 8 Skills ....................................................................................................................44 Administration of Glucose ........................................................................................44 Administration of Nitroglycerin ...............................................................................45 Epinephrine AutoInjector........................................................................................46 Medical Patient Assessment .....................................................................................47 Medical Patient AssessmentResponsive: Chest Pain................................................48

Lab 9 Skills ....................................................................................................................50 Adult and Child OneRescuer CPR...........................................................................50 Infant One and TwoRescuer CPR ..........................................................................51 OneRescuer CPR with AED....................................................................................52 Adult and Child Foreign Body Airway Obstruction: Unresponsive Patient ..............54 Adult and Child Foreign Body Airway Obstruction: Responsive Patient ..................55 Infant Foreign Body Airway Obstruction .................................................................56 Endotracheal Tube BVM Ventilation .......................................................................57 Suctioning Through an Endotracheal Tube..............................................................58 Artificial Ventilation of a Stoma Breather .................................................................59

Lab 10 Skills ..................................................................................................................60 Emergency Childbirth ..............................................................................................60 Hare Traction Splint.................................................................................................62 Sager Traction Splint ...............................................................................................63 Sling and Swathe Immobilization .............................................................................64 Bleeding Control and Shock Management ................................................................65

Lab 11 Skills ..................................................................................................................66 Trauma Patient Assessment .....................................................................................66

Additional Skills.............................................................................................................67 Administration of Nebulized Medication ..................................................................67 Administration of Activated Charcoal.......................................................................68 Metered Dose Inhaler...............................................................................................69 Insertion of Esophageal Combitube (ETC Airway)...................................................70 Insertion of Nasogastric Tube (NG Tube) ................................................................72 Avulsion (Complete) or Amputation .........................................................................73 Cooling Measures Infant ........................................................................................74 Impaled Objects – Penetrating Eye Injury................................................................75 Impaled Object Stabilization.....................................................................................76 Sucking Chest Wound ..............................................................................................77 Rapid Extrication .....................................................................................................78 Application of Soft Restraints ...................................................................................79

Vital Signs Check‐Off .....................................................................................................80 CPR Check‐Off...............................................................................................................81

Table of Contents

i

Lab Schedule.................................................................................................................. 1 Patient Assessment Algorithm ....................................................................................... 6 Proctor Statements for Midterm Skills ........................................................................... 7 Proctor Statements for Final Skills.................................................................................. 8 Removal of Contaminated Gloves .................................................................................10 Basic Skills Evaluation Summary Check‐Off....................................................................11 Body Substance Isolation ..............................................................................................12 Lab 1 Skills ....................................................................................................................13

Initial Assessment ....................................................................................................13 Vital Signs ................................................................................................................14 Chest Auscultation ...................................................................................................16

Lab 2 Skills ....................................................................................................................17 HeadTilt/ChinLift Maneuver ................................................................................17 Jaw Thrust Maneuver...............................................................................................18 Pocket Mask Ventilation ..........................................................................................19 Bag Valve Mask Ventilation .....................................................................................20 Bag Valve Mask Ventilation, TwoPerson................................................................21 Oropharyngeal Airway .............................................................................................22 Nasopharyngeal Airway ...........................................................................................23 Suctioning the Orophayrnx ......................................................................................24 Oxygen Administration ............................................................................................25 Sellick’s Maneuver....................................................................................................26 Pulse Oximetry.........................................................................................................27

Lab 3 Skills ....................................................................................................................28 Detailed Physical Exam............................................................................................28 Application of a Cervical Collar ................................................................................30

Patient Interview/Assessment and General Event Flow.................................................31 Lab 4 Skills ....................................................................................................................34

Neurological Exam ...................................................................................................34 Bleeding Control and Shock Management ................................................................35 Joint Immobilization.................................................................................................36 Long Bone Immobilization .......................................................................................37 Bandaging and Splinting an Open Extremity Fracture.............................................38

Lab 5 Skills ....................................................................................................................39 Kendrick Extrication Device (KED) .........................................................................39 Helmet Removal .......................................................................................................40 Lifting and Moving Patients.....................................................................................41 Spine Immobilization Supine Patient ........................................................................42 Spine Immobilization Standing Patient.....................................................................43

Documents

CPR CheckOff - Cabrillo College · Explain to the patient why you are doing this. ... Objective: The examinee will demonstrate proficiency in immobilizing and bandaging a patient