Broward Public School
Lab and Clinical Binder
Lab and Clinical Binder
Section 1 – Lab Skills
Page 3
Section 2 – Lab Handouts
Code of ethics
DNRO form
START triage algorithm
JumpSTART triage algorithm
All Risk Triage Tag
Glasgow Coma Scale
APGAR Score
Rule of Nines
CPR and FBAO Comparison Chart
Jumpkit Inventory
Approved Abbreviations
Trauma Transport Form
Telemetry Report form
Page 148
Page 150
Page 151
Page 152
Page 153
Page 154
Page 155
Page 156
Page 157
Page 158
Page 160
Page 162
Page 164
Section 3 - Clinical Performance Skills
Page 166
Section 4 - Clinical Reporting Forms
Page 176
Section 5 - Clinical Attendance Forms
Page 179
Section 6 – Student Paperwork
HIPPA
72 Hour Reporting Policy
Media Release
Broward Health Required Documents
Town of Davie Ride Release
City of Pembroke Pine Ride Release
City of North Lauderdale Ride Release
Page 182
Page 183
Page 184
Page 185
Page 186
Page 187
Page 188
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
1
Broward Public School
Lab and Clinical Binder
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
2
Broward Public School
Lab and Clinical Binder
1. POWER LIFTING
Equipment:
None
Procedure:
1. Get as close to the object as you can.
2. Spread your legs shoulder width apart.
3. Bend your knees and squat down.
4. Lock your back into an upright position and tighten abdominal muscles.
5. When lifting with other students, one person should be coordinating the lift.
6. Lift up by using your legs.
7. Keeping your back locked upright position while completing the lifting motion.
Critical Criteria:
1. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
3
Broward Public School
Lab and Clinical Binder
2. CRADLE CARRY
Equipment:
None
Procedure:
1. Adjust the patient in supine position.
2. Student squats to the level of the patient.
3. Student places one arm under the patient’s legs.
4. Student places other arm under the patient’s back.
5. Stand up.
Critical Criteria:
1. Able to carry 10’.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
4
Broward Public School
Lab and Clinical Binder
3. EXTREMITY CARRY
Equipment:
None
Procedure:
1. Two students will work together to reposition the patient to a sitting position.
2. Student one will go behind the patient and squat down into a lifting position.
3. The student will then position his arms under the patient’s arms and grasp the
patient’s opposite wrist.
•
Student’s right hand with patient’s left wrist.
•
Student’s left hand with patient’s right wrist.
4. Student two will squat in between the patient’s legs and face the patient’s feet.
5. Student two will grab under the patient’s knees.
6. Student one will give the command to power lift and move the patient.
Critical Criteria:
1. Able to carry 10’.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
Equipment:
4. FIREFIGHTER’S CARRY
None
Procedure:
1. Adjust patient on his back, with arms laid along the torso, and the knees bent.
2. Student’s feet on the feet of the patient to hold in place.
3. Grasping the patient’s hands and lean back to use the weight to help lift the
patient.
4. As patient lefts up, duck your shoulder into the midsection and stand up.
5. One arm around patient’s leg and other arm holding patient’s arm.
Critical Criteria:
1. Able to carry 10 feet.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
6
Broward Public School
Lab and Clinical Binder
5. PACK STRAP CARRY
Equipment:
None
Procedure:
1. Adjust the patient so he is standing and facing the student.
2. Student needs to turn his / her back to the patient and squat down slightly.
3. Advise patient to place arms over the student’s shoulders.
4. Student will pull the patient’s onto his / her back, so that the armpits are
resting on his / her shoulders.
5. Hold the patient by the wrist.
6. Stand up.
Critical Criteria:
1. Able to carry 10’.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
7
Broward Public School
Lab and Clinical Binder
6. EMERGENCY ARM DRAG
Equipment:
None
Procedure:
1. Student will position the patient in the supine position.
2. Student will kneel at the patient’s head and face the patient.
3. Student will grab both of the patient’s wrists.
4. Student will pull backwards to a safe area.
5. Student will observe proper body mechanics.
Critical Criteria:
1. Able to drag for 10 feet.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
8
Broward Public School
Lab and Clinical Binder
7. EMERGENCY BLANKET DRAG
Equipment:
Blanket
Procedure:
1. Take the blanket next to patient.
2. Log roll patient away from the blanket and push the blanket next to the
patient’s back (get some of the blanket side under the patient).
3. Roll patient back to supine position and log roll patient toward the blanket.
4. Pull the blanket away from the patient and roll the patient back to supine
position.
5. Student will wrap the patient in the blanket.
6. Student will grasp the blanket under or alongside the head and neck.
7. Student will pull the patient backwards using the blanket to a safe area.
8. Student will observe proper body mechanics.
Critical Criteria:
1. Able to drag for 10 feet.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
9
Broward Public School
Lab and Clinical Binder
8. EMERGENCY CLOTHES DRAG
Equipment:
None
Procedure:
1. Student will position the patient in the supine position.
2. Student will kneel at the patient’s head and face the patient.
3. Student will grab the patient’s clothing (shirt), while supporting the victim’s
head in his/her forearms.
4. Student will pull backwards to a safe area.
5. Student will observe proper body mechanics.
Critical Criteria:
1. Able to drag for 10 feet.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
10
Broward Public School
Lab and Clinical Binder
9. EMERGENCY FIREFIGHTER’S DRAG
Equipment:
Cravat or item to tie patient’s hands
Procedure:
1. Students will reposition the patient to a supine position.
2. Student will tie the patient’s hands together with cravats or similar item.
3. The student will straddle the patient’s body and pass his/her head through the
patient’s arms.
4. Student will raise his/her upper body to allow the patient to be lifted off the
floor slightly.
5. Student will crawl on the hands and knees and drag the patient to a safe area.
6. Student will observe proper body mechanics.
Critical Criteria:
1. Able to drag for 10’.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
11
Broward Public School
Lab and Clinical Binder
10. EMERGENCY SHOULDER OR
ARM-TO-ARM DRAG
Equipment:
None
Procedure:
1. One or two students will work together to reposition the patient to a sitting
position.
2. Student one will go behind the patient and kneel down.
3. Position his / her arms under the patient’s arms and grasp the patient’s
opposite wrist.
•
Student’s right hand with patient’s left wrist
•
Student’s left hand with patient’s right wrist
4. Pull backwards to a safe area (crouching or standing position).
Critical Criteria:
1. Able to drag for 10 feet.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
12
Broward Public School
Lab and Clinical Binder
11. BLANKET LIFT TO STRETCHER
Equipment:
Sheet, blanket and stretcher.
Procedure:
1. Prepare stretcher in the appropriate direction and height level.
2. Take the blanket next to patient and roll the blanket lengthways for half of its
width.
3. Log roll patient away from the blanket and push the rolled section of blanket
next to the patient’s back.
4. Roll patient back to supine position and log roll patient toward the blanket.
5. Pull the rolled section of blanket away from the patient and roll the patient
back to supine position.
6. Roll both sides of the blanket next to the patient. Both sides of the sheet
should be rolled close to the patient’s body to provide handgrips for the
students.
7. Student on both sides of the patient will grab the rolled edge of the sheet and
lift on the command of the student at the patient’s head.
8. Students will gently move the patient to the stretcher.
9. Third student:
•
If patient is carried, third student should support stretcher to prevent
movement as the patient is lowered.
Or
•
If patient is on the bed and the stretcher is next to the bed, third student
should provide assist with pulling the patient onto the stretcher.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
11. BLANKET LIFT TO STRETCHER
10. Secure the patient to the stretcher with waist and leg straps.
11. Raise stretcher to normal height upon command of the person at the
stretcher’s feet.
Critical Criteria:
1. Prevents further aggravation / injury to the patient.
2. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
12. DIRECT GROUND LIFT TO STRETCHER
Equipment:
Stretcher
Procedure:
1. Prepare stretcher in the appropriate direction and height level.
2. First student uses their arms to support the head and shoulders.
3. Second student uses their arms to support the hip and legs.
4. On command of the student at the patient’s head, both students will lift in
unison and curl the patient toward their chest.
5. Slowly walk the patient into position over the stretcher and gently lower.
6. Third student should support stretcher to prevent movement as the patient is
lowered.
7. Secure the patient to the stretcher with waist and leg straps.
8. Raise stretcher to normal height upon command of the person at the
stretcher’s feet.
Critical Criteria:
1. Prevents further aggravation / injury to the patient.
2. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
13. EXTREMITY LIFT TO STRETCHER
Equipment:
Stretcher
Procedure:
1. Prepare stretcher in the appropriate direction and height level.
2. Two students will work together to reposition the patient to a sitting position.
3. Student one will go behind the patient and squat down into a lifting position.
4. Position his / her arms under the patient’s arms and grasp the patient’s opposite
wrist.
•
Student’s right hand with patient’s left wrist.
•
Student’s left hand with patient’s right wrist.
5. Student two will squat in between the patient’s legs and face the patient’s head.
6. Grab under the patient’s knees.
7. Student one will give the command to power lift and move the patient.
8. Students will then move the patient to the stretcher and gently lower.
9. Secure the patient to the stretcher with waist and leg straps.
10. Raise stretcher to normal height upon command of the person at the stretcher’s
feet.
Critical Criteria:
1. Prevents further aggravation / injury to the patient.
2. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
16
Broward Public School
Lab and Clinical Binder
14. WALKING ASSIST
Equipment:
None
Procedure:
1. Assist patient in standing position.
2. Student stands on the side of the patient.
3. Student wraps in inside hand around the patient’s waist.
4. Patient wraps arm around the student’s neck and the student grabs the
patient’s wrist with his / her outside hand.
5. Slowly beginning walking the patient.
Critical Criteria:
1. Able to carry 10’.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
17
Broward Public School
Lab and Clinical Binder
15. ADULT ONE-RESCUER CPR
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Check for scene safety.
3. Check Unresponsiveness.
•
Tap the victim or sternal rub.
•
Ask if the person is “all right” or “okay”.
4. Open airway - Hyperextend the neck.
•
Head tilt / chin lift - Place palm of one hand on forehead and the fingers of
other hand under the lower jaw to lift the chin and move the head back.
5. Check breathing.
•
Place near patient’s nose and mouth for 5 -10 seconds.
•
Look for chest rise, feel for breath on the cheek, and listen for breath.
6. Give 2 ventilations.
•
Exhale breath should take approximately 1 second each.
•
Look at chest rise.
7. Check carotid pulse.
•
Place 2 or 3 fingers on the Adam’s apple (windpipe) and slide down to the
groove between the Adam’s apple and neck muscle.
•
Check for 5 – 10 seconds.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
15. ADULT ONE-RESCUER CPR
8. 30 compressions.
•
Place heel of one hand in the center of the chest between the nipples.
Place the other hand on top of the first hand extended or interlace fingers.
•
Kneeling alongside victim, the compressions should be pushed “fast” at a
rate of at least 100 compressions per minute, should be pushed “hard” at a
depth of 1 ½ to 2 inches, and should allow chest to return to normal
position.
9. Repeat 2 ventilations and 30 compressions.
Critical Criteria:
1. Did not ventilate immediately after determining no respirations.
2. Did not locate pulse location.
3. Did not provide compressions at the correct depth and rate.
4. Did not allow for full chest recoil.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
19
Broward Public School
Lab and Clinical Binder
16. ADULT TWO-RESCUER CPR / AED
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Check for scene safety.
3. Student one checks unresponsiveness.
•
Tap the victim or sternal rub.
•
Ask if the person is “all right” or “okay”.
4. Student two goes to locate AED.
5. Student one opens airway - Hyperextend the neck.
•
Head tilt / chin lift - Place palm of one hand on forehead and the fingers of
other hand under the lower jaw to lift the chin and move the head back.
6. Student one checks breathing.
•
Place near patient’s nose and mouth for 5 -10 seconds.
•
Look for chest rise, feel for breath on the cheek, and listen for breath.
7. Student one gives 2 ventilations.
•
Exhale breath should take approximately 1 second each.
•
Look at chest rise.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
16. ADULT TWO-RESCUER CPR / AED
8. Student one checks carotid pulse.
•
Place 2 or 3 fingers on the Adam’s apple (windpipe) and slide down to the
groove between the Adam’s apple and neck muscle.
•
Check for 5 – 10 seconds.
9. Student one begins 30 compressions.
•
Place heel of one hand in the center of the chest between the nipples.
Place the other hand on top of the first hand extended or interlace fingers.
•
Kneeling alongside victim, the compressions should be pushed “fast” at a
rate of at least 100 compressions per minute, should be pushed “hard” at a
depth of 1 ½ to 2 inches, and should allow chest to return to normal
position.
•
Repeat 2 ventilations and 30 compressions.
10. Student two arrives with AED and applies A.E.D. pads to patient according to
manufacture recommendation without interrupting CPR.
•
Push "power" button.
•
Stop CPR when the AED prompts for automatically analyzing of rhythm or
student pushes "analyze" button.
•
If A.E.D. advises to push “shock” button, clear patient.
•
“Head clear, feet clear, and I’m clear”, push "shock" button.
11. Student two immediately resumes compressions and student one performs
synchronized ventilation.
• 30 compressions to 2 ventilations.
12. After 2 minutes of uninterrupted compressions, AED will prompt or
automatically check for pulse and “Analyze” patient’s rhythm.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
21
Broward Public School
Lab and Clinical Binder
16. ADULT TWO-RECUER CPR / AED
Critical Criteria:
1. Did not ventilate immediately after determining no respirations.
2. Did not locate pulse location.
3. Did not provide compressions at the correct depth and rate.
4. Did not allow for full chest recoil.
5. Did not apply pads in correct location.
6. Immediately resumes compressions after delivering AED defibrillation.
7. Determined everyone was not touching the patient prior to delivering the
defibrillation.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
22
Broward Public School
Lab and Clinical Binder
17. CHILD ONE-RESCUER CPR
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Check for scene safety.
3. Check Unresponsiveness.
•
Tap the victim or sternal rub.
•
Ask if the person is “all right” or “okay”.
4. Open airway - Hyperextend the neck.
•
Head tilt / chin lift - Place palm of one hand on forehead and the fingers of
other hand under the lower jaw to lift the chin and move the head back.
5. Check breathing.
•
Place near patient’s nose and mouth for 5 -10 seconds.
•
Look for chest rise, feel for breath on the cheek, and listen for breath.
6. Give 2 ventilations.
•
Exhale breath should take approximately 1 second each.
•
Look at chest rise.
7. Check carotid pulse.
•
Place 2 or 3 fingers on the Adam’s apple (windpipe) and slide down to the
groove between the Adam’s apple and neck muscle.
•
Check for 5 – 10 seconds.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
17. CHILD ONE-RESCUER CPR
8. 30 compressions.
•
Place heel of one hand on the center of the chest between the mid-nipple
line.
or
•
Use heel of one hand on the center of the chest between the mid-nipple
line and second hand on top of the first hand extended or interlace fingers.
•
Kneeling alongside victim, the compressions should be pushed “fast” at a
rate of at least 100 compressions per minute, should be pushed “hard” at a
depth of 1/3 to 1/2 the depth of the chest wall, and should allow chest to
return to normal position.
9. Repeat 2 ventilations and 30 compressions.
Critical Criteria:
1. Did not ventilate immediately after determining no respirations.
2. Did not locate pulse location.
3. Did not provide compressions at the correct depth and rate.
4. Did not allow for full chest recoil.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
24
Broward Public School
Lab and Clinical Binder
18. INFANT ONE-RESCUER CPR
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Check for scene safety.
3. Check Unresponsiveness.
•
Tap the victim or sternal rub.
•
Ask if the person is “all right” or “okay”.
4. Open airway – Neck in neutral position.
•
Head tilt / chin lift - Place palm of one hand on forehead and the fingers of
other hand under the lower jaw to lift the chin and move the head back.
5. Check breathing.
•
Place near patient’s nose and mouth for 5 -10 seconds.
•
Look for chest rise, feel for breath on the cheek, and listen for breath.
6. Give 2 ventilations.
•
Exhale breath should take approximately 1 second each.
•
Look at chest rise.
7. Check brachial pulse.
•
With the palm facing up, position the arm out and slightly bent at the
elbow. Take 2 or 3 fingers and place them midsection of the arm between
the bicep muscle and humerus bone.
•
Check for 5 – 10 seconds.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
18. INAFANT ONE-RESCUER CPR
8. 30 compressions.
•
Place 2 fingers on the center of the chest just below the mid-nipple line.
•
Kneeling alongside victim, the compressions should be pushed “fast” at a
rate of at least 100 compressions per minute, should be pushed “hard” at a
depth of 1/3 to 1/2 the depth of the chest wall, and should allow chest to
return to normal position.
9. Repeat 2 ventilations and 30 compressions.
Critical Criteria:
1. Did not ventilate immediately after determining no respirations.
2. Did not locate pulse location.
3. Did not provide compressions at the correct depth and rate.
4. Did not allow for full chest recoil.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
26
Broward Public School
Lab and Clinical Binder
19. INFANT TWO-RESCUER CPR
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Check for scene safety.
3. Student one check unresponsiveness.
•
Tap the victim or sternal rub.
•
Ask if the person is “all right” or “okay”.
4. Student one open airway – Neck in neutral position.
•
Head tilt / chin lift - Place palm of one hand on forehead and the fingers of
other hand under the lower jaw to lift the chin and move the head back.
5. Student one check breathing.
•
Place near patient’s nose and mouth for 5 -10 seconds.
•
Look for chest rise, feel for breath on the cheek, and listen for breath.
6. Student one gives 2 ventilations.
•
Exhale breath should take approximately 1 second each.
•
Look at chest rise.
7. Student two check brachial pulse.
•
With the palm facing up, position the arm out and slightly bent at the
elbow. Take 2 or 3 fingers and place them midsection of the arm between
the bicep muscle and humerus bone.
•
Check for 5 – 10 seconds.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
19. INFANT TWO-RESCUER CPR
8. Student two performs 15 compressions.
•
Place two thumbs at center of breast bone just below the mid-nipple line
and squeeze the infants posterior chest with the encircled fingers.
•
Kneeling alongside victim, the compressions should be pushed “fast” at a
rate of at least 100 compressions per minute, should be pushed “hard” at a
depth of 1/3 to 1/2 the depth of the chest wall, and should allow chest to
return to normal position.
9. Repeat 2 ventilations and 15 compressions.
Critical Criteria:
1. Did not ventilate immediately after determining no respirations.
2. Did not locate pulse location.
3. Did not provide compressions at the correct depth and rate.
4. Did not allow for full chest recoil.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
20. RECOVERY POSITION
Equipment:
None
Procedure:
1. Determine patient has no spinal injury.
2. Student kneels beside the victim and straightens the victim’s legs.
3. Student grabs the patient’s leg and shoulder to roll towards himself / herself.
4. Adjust top leg so that both hip and knee are bent at a right angle.
5. Adjust bottom arm to support patient’s head and prevent the mouth from
touching the ground.
6. Evaluates respiratory function for compromise.
Critical Criteria:
1. Prevents further aggravation / injury to the patient.
2. Prevents injury to self by using correct technique.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
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Broward Public School
Lab and Clinical Binder
21. ADULT CONSCIOUS / UNCONSCIOUS
FOREIGN BODY AIRWAY OBSTRUCTION
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Check for scene safety.
3. Determine patient is choking.
•
Can not speak, breath, and cough.
4. Confirm patient is choking; ask patient “Are you choking”.
•
Nods head yes.
•
Holds hands around neck in the “universal” sign.
5. Perform sub-abdominal thrusts:
•
Stand behind patient.
•
Position one foot forward and one foot back.
•
Position one arm around the patient’s abdominal area and make the hand
into a fist. Place the fist midway between the naval and xiphoid process
bone. Position the other arm around the patient’s abdominal area and
wrap it around the fist.
•
Pull hands inward and upward motion.
6. Continue sub-abdominal thrusts till:
•
Object comes out.
Or
•
Patient goes unconscious.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
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Lab and Clinical Binder
21. ADULT CONSCIOUS / UNCONSCIOUS
FOREIGN BODY AIRWAY OBSTRUCTION
7. Determine patient is unconscious and gently lower to the ground.
8. Visualize mouth for foreign body.
a. If object is seen, use a finger sweep to remove.
b. If no object seen, then proceed to next step.
9. Attempt to ventilate.
a. If blocked, reposition and ventilate again. Still blocked; then
proceed to next step.
b. If chest rises, determine if patient is breathing and circulation.
10. Provide 30 chest compressions.
•
Place heel of one hand in the center of the chest between the nipples.
Place the other hand on top of the first hand extended or interlace fingers.
•
Kneeling alongside victim, the compressions should be pushed “hard” at a
depth of 1 ½ to 2 inches, and should allow chest to return to normal
position.
11. Repeat steps 8 to 10 till object is removed.
Critical Criteria:
1. Improperly positioned hands for sub-abdominal thrusts.
2. When lowering unconscious patient to the ground, do not allow head to fall to
the ground.
3. Did not check for object prior to ventilation every time the cycle is repeated.
4. Did not provide compressions at the correct depth.
5. Did not allow for full chest recoil.
6. Evaluates breathing and circulation after object is removed.
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32
22. CHILD CONSCIOUS / UNCONSCIOUS FOREIGN
BODY AIRWAY OBSTRUCTION
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Check for scene safety.
3. Determine patient is choking.
•
Can not speak, breath, and cough.
4. Confirm patient is choking; ask patient “Are you choking”.
•
Nods head yes.
•
Holds hands around neck in the “universal” sign.
5. Perform sub-abdominal thrusts:
•
Stand or kneel behind patient.
•
If standing, position one foot forward and one foot back.
•
Position one arm around the patient’s abdominal area and make the hand
into a fist. Place the fist midway between the naval and xiphoid process
bone. Position the other arm around the patient’s abdominal area and
wrap it around the fist.
•
Pull hands inward and upward motion.
6. Continue sub-abdominal thrusts till:
•
Object comes out.
Or
•
Patient goes unconscious.
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22. CHILD CONSCIOUS / UNCONSCIOUS
FOREIGN BODY AIRWAY OBSTRUCTION
7. Determine patient is unconscious and gently lower to the ground.
8. Visualize mouth for foreign body.
a. If object is seen, use a finger sweep to remove.
b. If no object seen, then proceed to next step.
9. Attempt to ventilate.
c. If blocked, reposition and ventilate again. Still blocked; then
proceed to next step.
d. If chest rises, determine if patient is breathing and circulation.
10. Provide 30 chest compressions.
•
Place heel of one hand on the center of the chest between the mid-nipple
line.
Or
•
Use heel of one hand on the center of the chest between the mid-nipple
line and second hand on top of the first hand extended or interlace fingers.
•
Kneeling alongside victim, the compressions should be pushed “hard” at a
depth of 1/3 to 1/2 the depth of the chest wall, and should allow chest to
return to normal position.
11. Repeat steps 8 to 10 till object is removed.
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22. CHILD CONSCIOUS / UNCONSCIOUS
FOREIGN BODY AIRWAY OBSTRUCTION
Critical Criteria:
1. Improperly positioned hands for sub-abdominal thrusts.
2. When lowering unconscious patient to the ground, do not allow head to fall to
the ground.
3. Did not check for object prior to ventilation every time the cycle is repeated.
4. Did not provide compressions at the correct depth.
5. Did not allow for full chest recoil.
6. Evaluates breathing and circulation after object is removed.
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23. INFANT CONSCIOUS / UNCONSCIOUS FOREIGN
BODY AIRWAY OBSTRUCTION
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Check for scene safety.
3. Determine patient is choking.
•
Can not speak, breath, and cough.
4. Confirm patient is choking.
•
Holds hands around neck in the “universal” sign.
•
Skin color turning blue.
5. Perform 5 back slaps:
•
Cradle patient in one hand with the head in the palm. Position fingers in a
“V” formation to allow for head support and object removal.
•
Position patient in a downward direction and utilize the other hand to slap
between the shoulder blades.
6. Perform 5 chest thrusts:
•
Position patient into a supine position and place 2 fingers on the center of
the chest just below the mid-nipple line.
•
Compressions should be pushed “hard” at a depth of 1/3 to 1/2 the depth
of the chest wall, and should allow chest to return to normal position.
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23. INFANT CONSCIOUS / UNCONSCIOU
FOREIGN BODY AIRWAY OBSTRUCTION
7. Continue back slaps and chest thrust till:
•
Object comes out.
Or
•
Patient goes unconscious.
8. Determine patient is unconscious and gently lower to the ground.
9. Visualize mouth for foreign body.
e. If object is seen, use a finger sweep to remove.
f. If no object seen, then proceed to next step.
10. Attempt to ventilate.
g. If blocked, reposition and ventilate again. Still blocked; then
proceed to next step.
h. If chest rises, determine if patient is breathing and circulation.
11. Provide 5 back slaps and 5 chest thrusts.
12. Repeat steps 9 to 11 till object is removed
Critical Criteria:
1. Improperly positioned patient for back slaps and chest thrusts.
2. Did not check for object prior to ventilation every time the cycle is repeated.
3. Did not provide compressions at the correct depth.
4. Did not allow for full chest recoil.
5. Evaluates breathing and circulation after object is removed.
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24. PROPER GLOVE REMOVAL TECHNIQUE
Equipment:
Gloves
Procedure:
1.
Partially remove the first glove by pinching the glove at wrist and folding it
down part way (careful to only touch the outside of the glove).
2.
Apply the same technique to the second glove, but completely remove the glove
inside-out and off the hand.
3.
Grab the inside part of the glove on the first hand and completely removing the
glove inside-out.
4.
Dispose gloves in bio-hazard bag.
5.
Student washes hands by appropriate method.
Critical Criteria:
1. Correctly removes gloves.
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25. DIAGNOSTIC VITAL SIGNS
Pulse (Radial)
Equipment:
None
Procedure:
1. Locates the radial artery (anterior thumb side of wrist).
2. Palpate pulse using two fingers.
3. Counts number of beats
• 15 seconds multiplied by 4
• 30 seconds multiplied by 2
4. Determines quality
• Strong
• Weak
• Regular
• Irregular
Respirations
Equipment:
None
Procedure:
1. Observe rise and fall of patient’s chest
• 30 seconds multiply by 2
• 15 seconds multiply by 4
2. Determine quality
• Normal
• Shallow
• Labored
• Noisy
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25. DIAGNOSTIC VITAL SIGNS
Skin Perfusion
Equipment:
None
Procedure:
1. Feel patient’s skin to determine extreme temperatures
• Hot
• Warm
• Cool
• Cold
2. Feel patient’s skin to determine condition
• Dry
• Moist
3. Depress patient’s finger nail for blood return
• Normal < 2 seconds
• Abnormal > 2 seconds
Pupils
Equipment:
Pen light
Procedure:
1. Maneuver pen light from the lateral side of the eye and shine over the pupil.
2. Perform the same maneuver on the other eye.
3. Determine reactivity.
• Fixed
• Reactive
• Sluggish
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25. DIAGNOSTIC VITAL SIGNS
4. Determine equality
• Equal
• Unequal
5. Determine pupil size
• Dilated
• Constricted
• Normal
Auscultation of the Blood Pressure
Equipment:
Blood pressure cuff and stethoscope
Procedure:
1. Expose arm.
2. Apply the cuff around the arm (most cuffs have an indicator arrow that should
line up with the area of the brachial artery).
3. Palpate the brachial artery.
4. Place the stethoscope over the brachial artery.
5. Grasp the ball-pump, close the pressure control valve, and begin squeezing the
ball-pump.
6. Continue squeezing the ball-pump till at the desired pressure.
7. Slowly open the pressure control valve on the ball-pump and release air.
8. As the air releases from the blood pressure cuff, monitor the pressure gauge.
•
Systolic number - first sound of heart beat.
•
Diastolic number – no longer hearing the heart beat.
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25. DIAGNOSTIC VITAL SIGNS
9. Open the pressure control valve on the ball-pump all the way to release the rest of
the air out of the cuff
Palpation of the Blood Pressure
Equipment:
Blood pressure cuff
Procedure:
1. Expose arm.
2. Apply the cuff around the arm (most cuffs have an indicator arrow that should
line up with the area of the brachial artery).
3. Palpate the radial artery.
4. Grasp the ball-pump, close the pressure control valve, and begin squeezing the
ball-pump.
5. Continue squeezing the ball-pump till at the desired pressure.
6. Slowly open the pressure control valve on the ball-pump and release air.
7. As the air releases from the blood pressure cuff, monitor the pressure gauge.
•
Systolic number - first feel of a heartbeat.
•
Diastolic number – not able to obtain with palpation.
8. Open the pressure control valve on the ball-pump all the way to release the rest of
the air out of the cuff.
Oxygen Saturation
Equipment:
Pulse Oximetry device
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25. DIAGNOSTIC VITAL SIGNS
Procedure:
1. Choose the appropriate sensor probe for the patient’s age or size and connect to
device.
2. Prepare finger.
• Clean area of contaminates
• Use nail polish remover for painted nail
• Remove acrylic nail
3. Turn on device.
4. Compare displayed pulse rate with palpated radial rate.
Critical Criteria:
1. Assess all vital signs.
2. Uses all devices appropriately.
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26. SCENE SIZE-UP ASSESSMENT
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
•
Gloves.
•
Eye protection.
•
Mask.
•
Gowns.
•
Trauma sleeves.
2. Inspect the scene for safety (personal protection).
3. Determines the mechanism of injury or nature of illness.
4. Determines the number of patients.
5. Determines the need for additional resources.
6. Determines the need for spinal immobilization.
Critical Criteria:
1. Identifies the appropriate protection for the incident provided.
2. Identifies situations on the incident that would cause personal injury.
3. Determines the cause of the incident.
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27. INITIAL ASSESSMENT
Equipment:
None
Procedure:
1. Scene Size-up.
•
Take body substance isolation precautions.
•
Check for scene safety.
2. Student will perform an initial assessment.
3. Inspect general impression of the patient (visual assessment).
•
Overall appearance.
•
Level of distress.
•
Patient characteristics.
4. Student one introduces himself / herself to the patient and obtains consent
for patient care.
5. Determine chief complaint.
6. Determine mental status.
•
AVPU scale – Alert, Verbal, Pain, and Unresponsive.
•
Orientation - Alert to person, place, time, and event.
7. Assess airway.
•
Suspecting spinal injury - Student two kneels behind the head of the
patient and applies manual immobilization of head in a neutral in-line
position for trauma.
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27. INITIAL ASSESSMENT
8. Assess breathing.
9. Assess circulation.
10. Assess and control major external bleeding.
11. Assess perfusion.
•
Color.
•
Temperature.
•
Condition.
•
Capillary refill.
12. Identify priority and transport decisions.
Critical Criteria:
1. Identifies life threatening situations.
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28. FOCUSED HISTORY EXAM
Equipment:
Pen light, blood pressure cuff, stethoscope, and pulse oximeter.
Procedure:
1. Scene Size-up.
•
Take body substance isolation precautions.
•
Check for scene safety.
2. Initial Assessment.
3. Student will perform a focused history exam.
4. Baseline vital signs.
•
Pulse.
•
Respirations.
•
Blood Pressure.
•
Oxygen saturation.
•
Skin perfusion.
•
Pupils.
5. SAMPLE History.
•
Signs and symptoms – includes OPQRST for certain incidents.
•
Allergies.
•
Medications.
•
Pertinent past history.
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28. FOCUSED HISTORY EXAM
•
Last oral intake.
•
Events leading to the injury or illness.
6. Complete Rapid physical exam.
7. Reevaluate transport decision.
Critical Criteria:
1. Assess all vital signs.
2. Uses all devices appropriately.
3. Identifies all of the pertinent information from the patient.
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29. RAPID / PRIMARY PHYSICAL EXAM
Equipment:
Stethoscope
Procedure:
1. Scene Size-up.
•
Take body substance isolation precautions.
•
Check for scene safety.
2. Initial Assessment.
•
Suspecting spinal injury - Student two kneels behind the head of the
patient and applies manual immobilization of head in a neutral in-line
position.
3. Student one will be performing a rapid exam and should inspect for DCAP
BTLS:
•
Deformities
•
Contusions
•
Abrasions
•
Punctures/penetrations
•
Burns
•
Tenderness
•
Lacerations
•
Swelling
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29. RAPID / PRIMARY PHYSICAL EXAM
4. Palpate the head and neck.
•
Inspect for jugular vein distention.
•
Inspect for tracheal deviation.
•
Palpate for crepitus.
5. Suspected spinal injury - size and apply the appropriate cervical collar
6. Palpate the chest.
•
Auscultate breath sounds on both sides of the chest.
•
Inspect for symmetrical chest rise and fall.
•
Inspect for paradoxical motion.
•
Palpate for crepitus.
7. Palpate the abdomen in four quadrants.
•
Palpate for rigidity.
•
Inspect for distension.
8. Palpate the pelvis.
•
Compress downward and inward to identify any instability.
9. Palpate all four extremities.
•
Palpate distal pulses at the dorsalis pedis or posterior tibial, and radial.
•
Inspect for motor function with wiggling toes and fingers.
•
Inspect for sensory function with squeezing or pinching extremities.
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29. RAPID / PRIMARY PHYSICAL EXAM
10. With the assistance of other students, log roll patient.
•
Suspected spinal injury will incorporate the use of the backboard.
11. Assess the back.
12. Complete focused history exam.
13. Reevaluate transport decision.
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Immediately takes manual immobilization of the head and neck for trauma
patient.
3. Completes a quick and through assessment.
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30. DETAILED / SECONDARY PHYSICAL
EXAM
Equipment:
Pen light, stethoscope, and 4 x 4 gauze.
Procedure:
1. Scene Size-up.
•
Take body substance isolation precautions.
•
Check for scene safety.
2. Initial Assessment.
3. Perform focused history and rapid physical exam.
4. Student will be performing a detailed physical exam and should evaluate for
DCAP BTLS:
•
Deformities
•
Contusions
•
Abrasions
•
Punctures/penetrations
•
Burns
•
Tenderness
•
Lacerations
•
Swelling
5. Assess the head.
•
Inspect around the eyes and eyelids for redness.
•
Inspect the eyes for contacts.
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30. DETAILED / SECONDARY PHYSICAL
EXAM
•
Inspect the eyes for pupil function. Take pen light from the corner of the
eye and shine on to the pupil. Determine if the pupils are equal and
reactive.
•
Inspect behind the ears for Battle’s Signs (bruising).
•
Inspect the ear canal for drainage of blood or spinal fluid. Use 4x4 gauze
folded in fours to identify spinal fluid inside blood by a halo.
•
Palpate scalp for depressions of the skull.
•
Palpate areas of the face like zygomas, maxillae, and mandible for
instability.
•
Inspect the mouth for cyanosis around the lips, foreign body (includes
dentures or loose teeth), and unusual odors.
•
Inspect the nose.
6. Palpate the front and back of the neck.
•
Inspect for jugular vein distention.
•
Inspect for tracheal deviation.
•
Inspect skin for crepitus (crackling) under the skin.
7. Palpate the chest over the ribs.
•
Inspect for symmetrical chest rise and fall.
•
Inspect for paradoxical motion.
•
Auscultate anterior breath sounds at midaxillary and midclavicular area.
•
Auscultate posterior breath sounds at the bases and apices area.
•
Palpate for crepitus.
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30. DETAILED / SECONDARY PHYSICAL
EXAM
8. Palpate the abdomen in four quadrants.
•
Palpate for rigidity.
•
Inspect for distension.
9. Palpate the pelvis.
•
Compress downward and inward on the iliac crest to identify any
instability.
10. Palpate all four extremities.
•
Inspect for medical alert bracelets.
•
Palpate dorsalis pedis or posterior tibial pulse, and radial pulse.
•
Inspect for motor function with wiggling toes and fingers.
•
Inspect for sensory function with squeezing or pinching extremities.
11. With the assistance of other students, log roll patient.
12. Palpate the back.
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Did not neglect to assess any area of the patient.
3. Assessed appropriate areas for the type of mechanism of injury and chief
complaint.
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31. ONGOING ASSESSMENT
Equipment:
None
Procedure:
1. Scene Size-up.
•
Take body substance isolation precautions.
•
Check for scene safety.
2. Initial Assessment.
3. Perform focused history and rapid physical exam.
4. Perform a detailed physical exam.
5. Student will perform an ongoing assessment.
6. Repeat initial assessment.
7. Reassess vital signs.
8. Repeat focused assessment.
9. Check interventions.
Critical Criteria:
1. Evaluates the effectiveness of treatment measures.
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32. GLUCOMETER
Equipment:
Glucometer, test strip, alcohol prep, 4 x 4 gauze, sharps box and lancet.
Procedure:
1. Take body substance isolation precautions.
2. Open foil packet of the test strip and remove.
3. Insert test strip into meter.
4. Determine appropriate finger to obtain blood sample and use lancet to
puncture the skin.
5. Dispose lancet in sharps box.
6. Touch and hold the test strip tip in the drop of blood until meter beeps and
begins timer.
7. Remove test strip and dispose in red biohazard bag.
8. Place bandage on lanced site.
9. Read results on display.
Critical Criteria:
1. Fails to dispose of lancet in sharps box.
2. Fails to dispose of test strip in red biohazard bag.
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33. SPIKING INTRAVENOUS (IV) BAG
Equipment:
IV Solution bag and Drop set or tubing
Procedure:
1. Remove protective cover from the solution bag.
2. Remove the protective cover from the spike end of the tubing.
3. Slide the spike end of the tubing into the port on the solution bag.
4. Squeeze the drip chamber and fill solution to the fill line on the drip chamber.
5. Open the roller clamp wheel to allow the solution to flow through the tubing
and remove the air out of the tubing.
•
May need to take the protective cover at the end of the tubing to allow the
fluid to push out the air.
•
Re-attach the cover when done.
6. Shut the roller clamp wheel when all of the air is out of the tubing.
Critical Criteria:
1. Air bubbles left in the tubing.
2. Overfill drip chamber with fluid.
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34. LIMB LEAD PLACEMENT FOR
ECHOCARDIOGRAM (ECG / EKG)
Equipment:
Monitor, limb leads, electrode connecting wire, razor, and 4x4 gauze
Procedure:
1. Take body substance isolation precautions.
2. Turn monitor "On"
3. Prepare patient's skin for electrode application.
•
Remove excessive hair from the electrode sites (shaving).
•
Clean skin and dry it briskly with a towel or gauze.
4. Attach limb leads to electrode connecting cable.
5. Place Limb electrodes in the following location:
•
RA - Right arm, upper arm or upper chest near the shoulder.
•
LA - Left arm, upper arm, or upper chest near the shoulder.
•
RL - Right leg or lower abdominal quadrant near the hip.
•
LL - Upper leg or lower abdominal quadrant near the hip.
6. Press print to record ECG.
Critical Criteria:
1. Placed leads in wrong location.
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35. HOSPITAL TELEMETRY REPORT
Equipment:
Radio
Procedure:
1. Communicate to dispatch the patient priority level.
2. Connected to hospital.
3. Unit number.
4. Patient’s age and gender.
5. Patient chief complaint.
6. Brief history of the patient’s problem.
7. Brief description of physical findings and vital signs.
8. Care provided.
9. Requesting or not requesting any orders.
10. ETA to facility.
Critical Criteria:
1. Clearly speaks on the radio.
2. Provides a concise picture of the situation.
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36. MANUAL IN-LINE STABILIZATION
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Student one needs to evaluation the environment to determine the best
position to begin providing cervical immobilization.
•
Behind the patient in a vertical position.
•
Front of patient in a vertical position.
•
Behind the patient’s head in a horizontal position.
3. Place hands firmly around the base of the skull on either side.
4. Support lower jaw with index and long fingers and gently lift into neutral
position.
5. Student two applies cervical collar.
6. Secures to spinal device.
Critical Criteria:
1. Adjusted the head in a neutral position forcefully or rapidly.
2. Failure to maintain neutral position as patient moves.
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37. APPLYING A CERVICAL COLLAR (CCOLLAR)
Equipment:
Cervical collar
Procedure:
1. Take body substance isolation precautions.
2. Apply manual in-line stabilization.
3. Measure for proper collar size by placing one hand along the side of the
patient’s neck and determine length of neck.
4. Place the chin support onto the patient’s chin (When a patient is supine on the
ground, the collar should be slid under the neck prior to applying the chin
support).
5. Wrap the collar around the neck and secure.
6. Inspect for proper fit.
7. Maintain manual in-line stabilization till secured to spinal device.
Critical Criteria:
1. Release manual in-line stabilization prior to securing to spinal device.
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38. BACKBOARD IMMOBILIZATION – SUPINE
Equipment:
Long spine board, 4 sets of straps, commercial head immobilizer or towel roll, 2”
tape, and straps
Procedure:
1. Takes body substance isolation precautions.
2. Student one kneels behind the head of the patient and applies manual
immobilization of head in a neutral in-line position.
3. Student two will assess the head and neck.
4. Student two sizes and applies the appropriate cervical collar.
5. Student two continues with a rapid physical exam.
6. Position backboard next to patient with the straps positions to prevent being
stuck under patient or board.
7. Student two and/or three kneels to the opposite side of the backboard.
8. Student at the head of the patient will coordinate movement and will advise
when to begin the log roll.
9. On command, the student or students will roll patient toward them and keep
patient in a straight line.
10. Students will grab the backboard and pull tight against the patient’s back.
11. Students should expose the back area for abnormalities.
12. Patient is lowered in a straight line on command to the supine position.
13. Reposition patient by sliding patient in an upward motion (axial) on the
board.
14. Positions patient in line with cervical immobilization device.
15. Secure patient's body with straps in the following order:
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38. BACKBOARD IMMOBILIZATION SUPINE
•
Crossing straps on the upper torso area.
•
Secure head according to commercial head immobilization device.
Or
•
•
Towel roll on each side of head and secure with 2” tape across chin of
cervical collar and folded 2” tape across forehead.
Crossing straps on the abdominal area.
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Prevents injury to self by using correct technique.
3. Immediately takes manual immobilization of the head and neck.
4. Does not release manual immobilization till maintained mechanically.
5. Does not allow excessive movement of patient after secured with straps.
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39. BACKBOARD IMMOBILIZATION - STANDING
Equipment:
Long spine board, 4 sets of straps, commercial head immobilizer or towel roll, 2”
tape, and straps
Procedure:
1. Takes body substance isolation precautions.
2. Student one stands behind the patient and applies manual immobilization of
the head in a neutral in-line position.
3. Student two sizes and applies the appropriate cervical collar.
4. After applying cervical collar, the student two takes over manual
immobilization of the head from the front of the patient.
5. Student three prepares the backboard, exposes the back area for
abnormalities, and positions the backboard behind the patient.
6. Student one resumes manual immobilization of the head in a neural in-line
position from behind the patient.
7. Student two and Student three:
•
Each takes a side of the patient.
•
Presses the backboard against the back of the patient.
•
Each takes one hand and from the front of the patient, grabs under the
patient’s armpit.
•
Each takes other hand and grabs the handle of the backboard.
8. Patient is advised to cross arms and to relax as the backboard is lowered.
9. Student one gives command to begin slowly lowering the backboard.
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39. BACKBOARD IMMOBILIZATION STANDING
10. Reposition patient by sliding patient in an upward motion (axial) on the
board.
11. Positions patient in line with cervical immobilization device.
12. Secure patient's body with straps in the following order:
•
Crossing straps on the upper torso area.
•
Secure head according to commercial head immobilization device.
Or
•
•
Towel roll on each side of head and secure with 2” tape across chin of
cervical collar and folded 2” tape across forehead.
Crossing straps on the abdominal area
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Prevents injury to self by using correct technique.
3. Immediately takes manual immobilization of the head and neck.
4. Does not release manual immobilization till maintained mechanically.
5. Does not allow excessive movement of patient after secured with straps.
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40. BACKBOARD IMMOBILIZATION –
SEATED IN VEHICLE
Equipment:
Long spine board, 4 sets of straps, commercial head immobilizer or towel roll, 2”
tape, and straps
Procedure:
1. Takes body substance isolation precautions.
2. First student tries to position himself/herself in the backseat behind the
patient and applies manual immobilization of head in a neutral in-line
position (may require manually applying from the front or side of the patient).
3. Second student sizes and applies the appropriate cervical collar.
4. Third student prepares the backboard and positions the backboard on the
vehicle’s seat slightly under the patient’s buttocks.
•
Utilize the stretcher as support under the backboard.
Or
•
Student will support the head portion of the backboard
5. Second student upon command of the first student, will rotate the patient’s
torso so that the patient’s buttock is on the backboard and the patient’s back
is aligned with the backboard.
6. Expose the back area for abnormalities.
7. Second student will take over manual immobilization of the head till the first
student can reposition outside the vehicle and resume.
8. First student gives command to begin slowly lowering the backboard.
9. Reposition patient by sliding patient in an upward motion (axial) on the
board.
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40. BACKBOARD IMMOBILIZATION –
SEATED IN VEHICLE
10. Positions patient in line with cervical immobilization device.
11. Secure patient's body with straps in the following order:
•
Crossing straps on the upper torso area.
•
Secure head according to commercial head immobilization device.
Or
•
•
Towel roll on each side of head and secure with 2” tape across chin of
cervical collar and folded 2” tape across forehead.
Crossing straps on the abdominal area.
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Prevents injury to self by using correct technique.
3. Immediately takes manual immobilization of the head and neck.
4. Does not release manual immobilization till maintained mechanically.
5. Does not allow excessive movement of patient after secured with straps.
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41. BACKBOARD DIAMOND CARRY
Equipment:
Backboard, manikin, and straps
Procedure:
1. The 4 students will form a diamond shape around the backboard. One student at
the head, one at the feet, and one at each side.
2. All students will face inward to the patient.
3. Student at the patient’s head will give the command to perform a power lift to
raise the backboard.
4. When the backboard is completely lifted, the student at the foot will reposition to
face outward and hold the backboard from behind.
5. After the student at the feet is completed with repositioning, the students on the
side will face the patient’s feet and release the outer hand. The side students will
now hold the backboard with one hand.
6. Student at the patients head will give the command to move when everyone is
done repositioning.
Critical Criteria:
1. Able to drag for 10’.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
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42. BACKBOARD 4 POINT CARRY
Equipment:
Backboard, manikin, and straps
Procedure:
1. The four students will each take a corner of the backboard (two students on one
side of the patient and two students on the other side of the patient).
2. All students will face inward to the patient.
3. One of the students at the patient’s head will give the command to perform a
power lift to raise the backboard.
4. When the backboard is completely lifted, all four students will face the direction
of the patient’s feet and release the outer hand. The side students will now hold
the backboard with one hand.
5. Student at the patients head will give the command to move when everyone is
done repositioning.
Critical Criteria:
1. Able to drag for 10’.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
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43. STRETCHER LOADING INTO AMBULANCE
Equipment:
Stretcher, manikin, and ambulance
Procedure:
1. One student should be guiding the feet of the stretcher and one student should be
guiding the head of the stretcher.
2. Students will maneuver the stretcher to behind the ambulance and open the
doors (head of the stretcher should be going into the compartment first).
3. Student one at the feet will position the stretcher’s wheels at the head against the
compartment door opening.
•
Some ambulances have dump valves that lower the compartment to the height
of the stretcher’s wheels at the head.
•
Some ambulances require the second student to lift the stretcher’s wheels at
the head onto the floor of the ambulance.
4. Once the top head area wheels are on the compartment floor, student one will
release the wheel leg lock and push the stretcher into ambulance.
5. Student two will assist lifting the wheel undercarriage.
6. Student one will push the stretcher all the way into the compartment and secure
the stretcher to the mounting brackets.
Critical Criteria:
1. Stretcher does not drop to the ground.
2. Prevents further aggravation / injury to the patient.
3. Prevents injury to self by using correct technique.
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44. STRETCHER UNLOADING FROM THE
AMBULANCE
Equipment:
Stretcher, manikin, and ambulance
Procedure:
1. Student one will open the doors of the ambulance.
2. If dump valve present, activate the dump valve to lower the compartment closer
to the ground.
3. Student two should secure the stretcher for moving.
•
Secure equipment needed for the patient; for example, portable oxygen bottle
needs to be placed on the stretcher, disconnected from wall mount, and
secured to portable bottle.
•
Observe for any straps, hoses, or wires that can get caught and place on top of
the stretcher.
•
Observe patient’s extremities and make sure that they are centered on the
stretcher.
4. Student one should release the stretcher from the mounting bracket and prepare
for pulling out the stretcher.
5. Student two will exit the compartment and stand on the side of the stretcher to
assist with the removal from the ambulance.
•
Makes sure the stretcher’s wheel carriage is lowered down gently.
•
Makes sure the stretcher’s wheel legs are locked straight.
6. Student one will pull the stretcher out of the compartment enough to allow the
stretcher wheel carriage to drop and lock.
7. Student two will grab the head section of the stretcher and assist with a smooth
lowering to the ground.
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44. STRETCHER UNLOADING FROM THE
AMBULANCE
8. Once the stretcher is out of the compartment, student one will pull the stretcher
at the foot area and student two will push at the head area.
Critical Criteria:
1. Stretcher does not drop to the ground.
2. Equipment does not entangle or gets caught while removing the stretcher.
3. Prevents further aggravation / injury to the patient.
4. Prevents injury to self by using correct technique.
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45. STAIR CHAIR
Equipment:
Stair chair and stretcher
Procedure:
1. Assemble stair chair into the chair formation.
2. Assist patient to the stair chair.
3. Secure patient with chair straps.
4. Advise patient to keep arms crossed or hold on to side of chair.
5. One student grabs handles at the back of the chair, second student grabs the
handles at the feet of the chair, and third student “backs-up” the second student
down the stairs.
6. Third student places one hand on the back of student at the feet to brace as the
student descends the stairs.
7. Patient is carried down the stairs feet first.
8. Patient is transferred to stretcher.
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Prevents injury to self by using correct technique.
3. Uses a student to backup the student going down the stairs first.
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46. FLEXIBLE STRETCHER
Equipment:
Reeves Sleeve or Ferno 131
Procedure:
1. Utilize the appropriate lift technique to assist the patient onto the flexible
stretcher.
2. Student will secure patient with the device straps and make sure that they are
tight enough to not allow the patient to move.
3. Students will prepare to lift and carry:
•
Two students – one at the head and one at the feet.
•
Four students – two students on each side.
•
Six students – three students on each side.
4. Students will perform a power lift on the command of the student positioned
at the patient’s head.
5. Students will carry at arms length.
6. Stretcher is lowered upon command.
Critical Criteria:
1. Able to carry 10 feet.
2. Moves patient in a safe and effective manner.
3. Prevents injury to self by using correct technique.
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47. PORTABLE OXYGEN CYLINDER SETUP
Equipment:
Portable oxygen bottle and oxygen regulator
Procedure:
1. Student identifies the appropriate cylinder by checking label / tag and not just
the color of the tank.
2. Removes the protective seal.
3. Check regulator and cylinder valve assembles to make sure it is free of foreign
materials like dirt, oil, grease, etc.
4. Check washer/gasket is in good condition (Should replace with every new
bottle).
5. Align the regulator so that the pins fit snugly into the correct holes on the
valve stem and hand tighten the regulator.
6. Open the cylinder valve (counter-clockwise rotation).
7. Check for leaks.
8. Verify full bottle from the regulator gauge.
9. Attach oxygen connective tubing to the regulator.
10. Turns the flow valve to the appropriate volume rate.
Critical Criteria:
1. Adjust flow rate to the appropriate amount for the attached device.
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48. BAG - VALVE – MASK (BVM)
Two-Person - BVM
Equipment:
Bag valve device (BVD), portable oxygen cylinder, and oxygen regulator.
Procedure:
1. Take body substance isolation precautions.
2. Open patient’s airway or confirms patient’s airway is open.
•
Head tilt / chin lift with no spinal injury suspected.
•
Jaw thrust for suspected spinal injury.
3. Student determines a need to manually ventilate by patient’s condition and/or
oxygen saturation reading.
4. Assembles the BVD with correct mask size.
5. Sets up the oxygen delivery system.
6. Attaches the BVD to the oxygen regulator.
7. Adjusts flow 15 liters per minute.
8. Student will verify oxygen is flowing through the BVD by listening and feeling
oxygen movement.
9. Student one:
•
Positions directly above the victim’s head.
•
Place the mask on the victim’s face, using the bridge of the nose as a guide
for correct position.
•
Use the E-C clamp technique to hold the mask place with both hands.
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48. BAG – VALVE – MASK (BVM)
•
Use the thumb and index finger of one hand to make a “C”, pressing the
edges of the mask to the face.
•
Use the remaining 3 fingers form an “E” to lift the angles of the jaw.
10. Student two:
•
Squeeze the bag over one second long, while watching for chest rise (may
need to squeeze bag against leg for increased volume).
•
Applies continuous cricoid pressure.
11. Ventilation rate:
•
Adult – 10 to 12 breaths per minute.
•
Child – 12 to 20 breaths per minute.
•
Infant – 12 to 20 breaths per minute.
12. Insert oral or nasal airway.
One-Person - BVM
Equipment:
Bag valve device (BVD)
Procedure:
1. Take body substance isolation precautions.
2. Open patient’s airway or confirms patient’s airway is open.
•
Head tilt / chin lift with no spinal injury suspected.
•
Jaw thrust for suspected spinal injury.
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48. BAG – VALVE - MASK
3. Student determines a need to manually ventilate by patient’s condition and/or
oxygen saturation reading.
4. Assembles the BVD with correct mask size.
5. Sets up the oxygen delivery system.
6. Attaches the BVD to the oxygen regulator.
7. Adjusts flow 15 liters per minute.
8. Student will verify oxygen is flowing through the BVD by listening and feeling
oxygen movement.
9. Place the mask on the victim’s face, using the bridge of the nose as a guide for
correct position.
10. Use the E-C clamp technique to hold the mask place.
•
Use the thumb and index finger of one hand to make a “C”, pressing the
edges of the mask to the face.
•
Use the remaining 3 fingers form an “E” to lift the angles of the jaw.
•
Squeeze the bag over one second long, while watching for chest rise (may
need to squeeze bag against leg for increased volume).
11. Ventilation rate:
•
Adult – 10 to 12 breaths per minute.
•
Child – 12 to 20 breaths per minute.
•
Infant – 12 to 20 breaths per minute.
12. Insert oral or nasal airway.
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48. BAG – VALVE – MASK (BVM)
Critical Criteria:
1.
Maintains proper face to mask seal.
2.
Oxygen flow rate set correctly.
3.
Two-person maneuver, one student maintains continuous cricoid pressure
during ventilation.
4.
Monitors effect of treatment.
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49. MOUTH TO MASK VENTILATION WITH
SUPPLEMENTAL OXYGEN
Equipment:
Face mask, one-way valve, portable oxygen cylinder, and oxygen regulator.
Procedure:
1. Take body substance isolation precautions.
2. Open patient’s airway or confirms patient’s airway is open.
•
Head tilt / chin lift with no spinal injury suspected.
•
Jaw thrust for suspected spinal injury.
3. Student determines a need to manually ventilate by patient’s condition and/or
oxygen saturation reading.
4. Assembles the appropriate mask size with one-way valve.
5. Sets up the oxygen delivery system.
6. Attaches the mask to the oxygen regulator.
7. Adjusts flow 15 liters per minute.
8. Student will verify oxygen is flowing through the mask by listening and feeling
oxygen movement.
9. Place the mask on the victim’s face, using the bridge of the nose as a guide for
correct position.
10. Use the E-C clamp technique to hold the mask place.
•
Use the thumb and index finger of one hand to make a “C”, pressing the
edges of the mask to the face.
•
Use the remaining 3 fingers form an “E” to lift the angles of the jaw.
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49. MOTH TO MASK VENTILATION WITH
SUPPLEMENTAL OXYGEN
•
Ventilate through the one-way valve, while watching for chest rise.
11. Ventilation rate:
•
Adult – 10 to 12 breaths per minute.
•
Child – 12 to 20 breaths per minute.
•
Infant – 12 to 20 breaths per minute.
12. Insert an oral or nasal airway.
Critical Criteria:
1. Maintains proper face to mask seal.
2. Oxygen flow rate set correctly.
3. Monitors effect of treatment.
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50. NON-REBREATHING FACE MASK
Equipment:
Portable oxygen cylinder, oxygen regulator, and non-rebreathing face mask
Procedure:
1. Takes body substance isolation precautions.
2. Student determines a need for oxygen therapy by patient’s condition and
oxygen saturation reading.
3. Sets up the oxygen delivery system.
4. Attaches the non-rebreathing face mask to the oxygen regulator.
5. Adjusts flow of 10 to 15 liters per minute.
6. Student will verify oxygen is flowing through the non-rebreathing face mask
by listening and feeling oxygen movement.
•
Reservoir bag should be expanded and it may require the student to inflate
by holding a finger over the rubber valve gasket.
7. Student will begin applying the non-rebreathing face mask to the patient.
•
Pulls the elastic head band around the patient’s head.
•
Maintain a seal may require the need to pull the elastic straps to secure the
mask against the face.
•
Gently adjusts the metal nosepiece to conform to the patient’s nose.
8. Re-evaluates patient condition and oxygen saturation reading.
Critical Criteria:
1. Correctly applies the non-rebreathing face mask.
2. Oxygen flow rate set correctly.
3. Monitors effect of treatment.
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51. NASAL CANNULA
Equipment:
Portable oxygen cylinder, oxygen regulator, and nasal cannula
Procedure:
1. Takes body substance isolation precautions.
2. Student determines a need for oxygen therapy by patient’s condition and
oxygen saturation reading.
3. Sets up the oxygen delivery system.
4. Attaches the nasal cannula to the oxygen regulator.
5. Adjusts flow 1 to 6 liters per minute.
6. Student will verify oxygen is flowing through the nasal prongs by listening and
feeling oxygen movement.
7. Student will begin applying the nasal cannula to the patient.
•
Nasal prongs into patient’s nostrils with bevel facing inward and
downward.
•
Tubing wrapped around each ear.
•
Tighten or loosen the loop by adjusting the tubing ring.
8. Re-evaluates patient condition and oxygen saturation reading.
Critical Criteria:
1. Correctly applies the nasal cannula.
2. Oxygen flow rate set correctly.
3. Monitors effect of treatment.
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52. OROPHARYNGEAL (OPA) INSERTION
Equipment:
Oropharyngeal, Bag-valve-mask device, and oxygen source with oxygen supply
tubing.
Procedure:
1. Takes body substance isolation precautions.
2. Determine the patient is unable to maintain an open airway.
3. Determine proper size (corner of mouth to earlobe)
4. Student will hyperextend the neck and open the patient's mouth by using
crossed finger technique.
5. Insert Oropharyngeal:
•
Method 1 – insert with the tip facing the side of the mouth. Rotate 90
degrees when the tip approaches the posterior wall of the pharynx (back of
the tongue).
Or
•
Method 2 – insert with the tip facing the roof of the patient’s mouth.
Rotate 180 degrees when the tip approaches the posterior wall of pharynx
(back of the tongue).
6. Remove if patient begins to gag and consider nasopharyngeal.
7. Ventilation with BVM.
Critical Criteria:
1. Determines the patient is unable to maintain an open airway.
2. Selects appropriate size OPA.
3. Inserts in a manner that is not create injury to the patient.
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53. NASOPHARYNGEAL (NPA) INSERTION
Equipment:
Nasopharyngeal, Bag-valve-mask device, oxygen source with oxygen supply
tubing, and water-soluble lubricant
(Optional Lidocaine gel and Neo-Synephrine).
Procedure:
1. Takes body substance isolation precautions.
2. Determine the patient is unable to maintain an open airway.
3. Determine proper size by measuring the nostril to the earlobe.
4. Lubricate with a water-soluble lubricant.
•
(Optional Lidocaine gel)
5. Position patient's head in a neutral position, inspects nose, and selects larger
nostril.
•
(Optional spray Neo-Synephrine into nasopharynx)
6. Insert Nasopharyngeal with bevel facing nasal septum.
7. Student should stop insertion if resistance is met and consider insertion into
the other nostril.
8. Insert till flange rests against the nostril.
9. Ventilation with BVM.
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53. NASOPHARYNGEAL (NPA) INSERTION
Critical Criteria:
1. Determine the patient is unable to maintain an open airway.
2. Selects the appropriate size NPA.
3. Uses appropriate lubricant.
4. Inserts with bevel facing the septum.
5. Inserts in a manner that is not create injury to the patient.
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54. SELLICK MANUEVER
Equipment:
None.
Procedure:
1. Visualize the cricoid cartilage.
2. Palpate to confirm location.
3. Apply firm downward pressure to the cricoid ring with your thumb and index
finger on either side.
4. Continue pressure till airway is secured with commercial device.
Critical Criteria:
1. Release pressure prior to securing airway.
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55. COMBITUBE
Equipment:
Combitube, 140 cc syringe, 15 cc syringe, water-soluble gel, ITD, BVM, oxygen
source with oxygen supply tubing, securing device, and stethoscope.
Procedure:
1. Takes body substance isolation precaution.
2. Assure a patent airway and ventilate with 100% O2 before attempting
placement of the Combitube.
3. Assess for contraindications:
•
•
•
•
Patients under 16 years of age and/or under five feet tall.
Patients who are conscious or who have an intact gag reflex.
Patients with known esophageal disease (esophageal varices, alcoholics,
etc.).
Patients who have ingested caustic substances.
4. Prepare Combitube for insertion by lubricating distal end with water-soluble
gel.
5. Maintain neck in a neutral, semi-flexed position (only if there is no chance of
cervical injury).
6. Lift the tongue and mandible anteriorly with one hand.
•
CAUTION: When facial trauma has resulted in sharp, broken teeth or
dentures, remove dentures and exercise extreme caution when passing the
Combitube into the mouth to prevent the cuff from tearing.
7. With the other hand, hold the Combitube so that it curves in the same
direction as the natural curvature of the pharynx. Insert the tip into the
mouth and advance gently until the printed ring is aligned with the teeth.
•
CAUTION: DO NOT FORCE THE COMBITUBE. If the tube does not
advance easily, redirect it or withdraw and reinsert.
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55. COMBITUBE
8. Inflate line 1, the blue pilot balloon leading to the pharyngeal balloon with
100cc of air using the 140cc syringe.
•
This may cause the Combitube to move slightly from the patient's mouth.
9. Inflate line 2, the white pilot balloon leading to the distal cuff with
approximately 15cc of air using the 20cc syringe.
10. Confirms placement:
•
Begin ventilation through the longer blue connecting tube. If auscultation
of breath sounds is positive and auscultation of gastric insufflation is
negative, continue ventilation.
•
If auscultation of breath sounds is negative and gastric insufflation is
positive, immediately begin ventilation through the shorter clear
connecting tube. Confirm tracheal ventilation by auscultation of breath
sounds and absence of gastric insufflation.
•
Attach end-tidal CO2 monitoring device.
11. Secure Combitube with commercial device.
12. Monitor SpO2 with pulse oximeter.
13. Provide 100% O2 with positive pressure oxygen or bag-valve-device.
14. Attach Impedance Threshold Device (ITD) or Resq-pod.
15. Monitor for changes in breathing or airway status.
Critical Criteria:
1. Did not insert Combitube to proper depth.
2. Did not inflate both cuffs with proper amounts.
3. Did not confirm successful placement.
4. Inserted the device in a manner that was dangerous to the patient.
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56. KING TUBE
Equipment:
King LTS-D tube, water soluble gel, ITD, 80cc syringe, BVD, oxygen source with
oxygen supply tubing, securing device, and stethoscope.
Procedure:
1. Takes body substance isolation precaution.
2. Assure a patent airway and ventilate with 100% O2 before attempting
placement of the King device.
3. Assembles and checks equipment.
4. Lubricates tip of tube with a water-soluble gel.
5. Places patient's head in neutral position.
6. Apply Tongue jaw-lift maneuver with one hand while passing the tube with
the other hand. Insert device at 45-90 degree angle and rotate to midline as it
passes the tongue.
7. Advance till gastric access lumen is aligned with teeth or gums.
8. Inflate pharyngeal cuff with recommended volume for the tube size.
9. Confirms placement:
•
Negative epigastric sounds.
•
Positive bilateral breath sounds.
•
Attach end-tidal CO2 monitoring device.
10. Secure King device with commercial device.
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56. KING TUBE
11. Monitor SpO2 with pulse oximeter.
12. Provide 100% O2 with positive pressure oxygen or bag-valve-device.
13. Attach Impedance Threshold Device (ITD) or Resq-pod.
14. Monitor for changes in breathing or airway status.
Critical Criteria:
1. Did not inflate cuff with proper amounts.
2. Did not confirm successful placement.
3. Inserted the device in a manner that was dangerous to the patient.
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57. LARYNGEAL MASK AIRWAY (LMA)
Equipment:
Laryngeal mask, appropriate syringe for cuff inflation, water-soluble gel, ITD,
securing device, stethoscope, BVD, and oxygen source with oxygen supply tubing.
Procedure:
1. Takes body substance isolation precaution.
2. Assure a patent airway and ventilate with 100% O2 before attempting
placement of the laryngeal mask.
3. Tightly deflate the cuff so that it forms a smooth "spoon-shape." Lubricate the
posterior surface of the mask with water-soluble lubricant.
4. With the head extended and the neck flexed, carefully flatten the laryngeal
mask tip against the hard palate.
5. Advance the mask until definite resistance is felt at the base of the
hypopharynx.
6. Without holding the tube, inflate the cuff to manufacturer recommended
volume.
7. Confirms placement:
•
Negative epigastric sounds.
•
Positive bilateral breath sounds.
•
Attach end-tidal CO2 monitoring device.
8. Secure laryngeal mask with commercial device.
9. Monitor SpO2 with pulse oximeter.
10. Provide 100% O2 with positive pressure oxygen or bag-valve-device.
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57. LARYNGEAL MASK AIRWAY (LMA)
11. Attach Impedance Threshold Device (ITD) or Resq-pod.
12. Monitor for changes in breathing or airway status.
Critical Criteria:
1. Did not inflate cuff with proper amounts.
2. Did not confirm successful placement.
3. Inserted the device in a manner that was dangerous to the patient.
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58. AIRWAY SUCTIONING
Equipment:
Portable suction unit, tonsil-tip catheter, and whistle-tip catheter
Procedure:
1. Takes body substance isolation precautions.
2. Determines the need to suction patient’s airway.
3. Chooses the appropriate catheter and places it on the suction hose.
•
Tonsil-tip catheter is better suited for gastric content and thick secretions
due to larger diameter.
•
Whistle-tip catheter is better suited for low to medium suction or nasal
suctioning.
4. Make sure the suctioning unit is properly assembled, turns the unit “on”, and
tests the suction by occluding the catheter.
5. Open patient's mouth with cross-finger maneuver.
•
Tonsil-tip catheter measure corner of the mouth to the earlobe to
determine depth of insertion.
6. Insert catheter and suction no longer than 15 seconds.
•
•
Suction while withdrawing.
Patient that continues to vomit or obstructed airway may require longer
suction time.
7. Student should place suction tip in the water bottle to clear the tubing (if
necessary).
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58. AIRWAY SUCTIONING
Critical Criteria:
1. Determine patient is unable to maintain open airway.
2. Suction unit is properly assembled.
3. Assures presence of suction.
4. Inserting the suction to the measured depth.
5. Suctions while withdrawing.
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59. EPI-PEN AUTOINJECTOR ADMINISTRATION
Equipment:
Epi-pen autoinjector
Procedure:
1. Take body substance isolation precautions.
2. Check for right medication.
3. Check for right patient.
4. Check expiration date.
5. If possible, check cloudiness and discoloration.
6. Grasp device with the tip pointing downward (hold like a pen).
7. Remove auto-injector activation cap.
8. Identify the injection site on the lateral portion of thigh, midway between
waist and knee.
9. Push auto-injector at a perpendicular angle to the thigh and hold firmly
against site until injector activates.
10. Hold in place until medication is fully injected for a minimum of 10 seconds.
11. Dispose of injector in biohazard container.
Critical Criteria:
1. Injects in wrong location.
2. Bounces after injection or removes too quickly.
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60. NITROGLYCERIN ADMINISTRATION
Equipment:
Nitroglycerin tablet or metered spray
Procedure:
1. Take body substance isolation precautions.
2. Verify patient has blood pressure greater than 100 mmHg systolic.
3. Check for right medication.
4. Check for right patient.
5. Check expiration date.
6. Verify number of doses previously taken by the patient.
7. Position patient in semi-fowler position.
8. Ask patient to lift tongue.
9. Place tablet or spray metered dose under the tongue.
10. Recheck blood pressure after 5 minutes.
Critical Criteria:
1. Do not let patient chew or swallow nitroglycerin tablets.
2. Failure to assess blood pressure before and after administration.
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61. METERED DOSE INHALER
ADMINISTRATION
Equipment:
Metered dosed inhaler
Procedure:
1. Take body substance isolation precautions.
2. Check for right medication.
3. Check for right patient.
4. Check expiration date.
5. Verify number of doses previously taken by the patient.
6. Make sure the inhaler is at room temperature.
7. Shake inhaler.
8. If administering oxygen therapy with face mask, then stop and remove from
patient’s face.
9. Ask patient to exhale deeply before placing lips around opening of the inhaler.
10. Have the patient inhale deeply and depress the inhaler.
11. Instruct patient to hold breath for as long as comfortable.
12. Reapply oxygen therapy.
Critical Criteria:
1. Assisted with metered dosed inhaler for the wrong situation.
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62. ORAL GLUCOSE ADMINISTRATION
Equipment:
Oral glucose
Procedure:
1. Take body substance isolation precautions.
2. Utilize glucometer to determine blood glucose levels.
3. Determine patient can swallow and is able to protect his/her airway.
4. Check expiration date.
5. Squeeze glucose gel on tongue depressor.
6. Direct patient to open mouth and insert tongue depressor between cheek and
gum.
7. After glucose gel is dissolved, repeat with another dose till the tube is emptied.
8. Repeat blood glucose level check after 5 minutes.
Critical Criteria:
1. Determines to administer glucose with blood glucose less than 60.
2. Administered to patient that is unable to follow direction and swallow.
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63. INTRAMUSCULAR (IM) INJECTION
Equipment:
Desired medication, appropriate size syringe, 21 gauge needle, alcohol prep, and
bio-hazard sharp box.
Procedure:
1. Take body substance isolation precautions.
2. Check expiration date.
3. Check cloudiness.
4. Check discoloration.
5. Check for allergies.
6. Expose injection site of deltoid region.
7. Clean site with alcohol prep.
8. Spread skin taut between thumb and index finger.
•
If patient has minimal fat mass, than squeeze the site.
•
If pediatric patient, than preferred to use anterior thigh at middle 1/3 and
squeeze the site.
9. Insert 21 gauge or smaller with 1-1 1/2 inch needle at 90 degree angle.
10. Aspirate for blood and if seen, then stop procedure.
11. Inject medication slowly.
12. Remove needle and dispose in bio-hazard sharps box.
13. Apply pressure to site with gentle massage and cover site with Band-Aid.
Critical Criteria:
1. Did not aspirate prior to injection.
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64. SUBCUTANAEOUS (SUB-Q) INJECTION
Equipment:
Desired medication, appropriate size syringe, 25 gauge needle, alcohol prep, and
bio-hazard sharp box.
Procedure:
1. Take body substance isolation precautions.
2. Check expiration date.
3. Check cloudiness.
4. Check discoloration.
5. Check for allergies.
6. Expose injection site of deltoid region.
7. Clean site with alcohol prep.
8. Pinch site between thumb and index finger.
9. Insert 25 gauge or smaller with 5/8 inch needle at a 45 or 90 degree angle and
bevel up.
10. Aspirate for blood and if seen, then stop procedure.
11. Inject medication slowly.
12. Remove needle and dispose in bio-hazard sharps box.
13. Apply pressure to site with gentle massage and cover site with Band-Aid.
Critical Criteria:
1. Did not aspirate prior to injection.
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65. PREHOSPITAL STROKE EXAM –
CINCINNATI STROKE SCALE
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Facial droop – Student will have the patient smile or show his or her teeth.
•
Determine normal - Both sides of face move equally.
•
Determine abnormal - One side or both sides of face does not move.
3. Arm drift – Student will have the patient close his/her eyes and hold his/her
arms straight out in front for about 10 seconds.
•
Determine normal - Both arms move equally or not at all.
•
Determine abnormal - One arm drifts down compared with the other side.
4. Speech – Student will have the patient say, "You can't teach an old dog new
tricks”.
•
Determine normal - Patient uses correct words with no slurring.
•
Determine abnormal - Slurred words, inappropriate words, or mute.
Critical Criteria:
1. Able to determine abnormal responses.
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66. EXPANDED STROKE EXAM – MIAMI
EMERGENCY NEUROLOGICAL DEFICIT SCALE
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Level of Consciousness.
•
Alert.
•
Verbal.
•
Pain.
•
Unresponsive.
3. Speech – Student will have the patient say, "You can't teach an old dog new
tricks”.
•
Determine normal - Patient uses correct words with no slurring.
•
Determine abnormal - Slurred words, inappropriate words, or mute.
4. Question – Age.
•
Determine long term memory.
5. Question – Month.
•
Determine short term memory.
6. Commands – Open and close eyes.
•
Determine normal – opens and closes eyes.
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66. EXPANDED STROKE EXAM - MIAMI
EMERGENCY NEUROLOGICAL DEFICIT
SCALE
•
Determine abnormal – does not open and close eyes.
7. Facial droop – Student will have the patient smile or show his/her teeth.
•
Determine normal - Both sides of face move equally.
•
Determine abnormal - One side or both sides of face does not move.
8. Visual fields – Student takes both hands and places them in the
upper quadrant of the patient’s visual fields. The student will
wiggle fingers of one hand and ask patient to point or state which
side he/she saw movement. Student will test a both upper and
lower quadrant fields.
• Determine normal – views movement in all four quadrants.
• Determine abnormal – does not view movement in any
quadrant.
9. Horizontal gaze – Student will have the patient face forward and
track his/her index finger with the patient’s eyes only. Student will
move finger horizontally from one side of the patient to the other
side of the patient slowly. It may be required to hold the patient’s
chin to prevent the patient’s head from moving.
• Determine normal – follows the finger to both sides.
• Determine abnormal – unable to follow the finger completely in
one direction or has unequal eye movement.
10. Arm drift – Student will have the patient close his/her eyes and hold his/her
arms straight out in front for about 10 seconds.
•
Determine normal - Both arms move equally or not at all.
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66. EXPANDED STROKE EXAM - MIAMI
EMERGENCY NEUROLOGICAL DEFICIT
SCALE
•
Determine abnormal - One arm drifts down compared with the other side.
11. Leg drift – Student will have the patient keep his/her eyes open
and lift one leg at a time.
• Determine normal – lift with ease.
• Determine abnormal – unable to lift or show weakness with the
lift.
12.Sensory – Student will have the patient close his/her eyes. The
student will instruct the patient to determine which arm or leg that
is being touched and if the sensation feels the same.
• Determine normal – equally senses touch on both arms and
legs.
• Determine abnormal – does not sense the touch in an area or
the touch feels different when comparing the arms or legs.
13.Coordination of the arms – Student will hold out his/her index
finger and ask the patient to do the same. The patient will be
instructed to touch his/her nose and to then touch the student’s
finger. The patient should then repeat with the other hand.
• Determine normal – able to touch both locations.
• Determine abnormal – difficulty to move smoothly and touch
the intended target.
14.Coordination of the legs – Student will position with legs side by
side. The student will instruct the patient to lift a leg and bend it
to have the heel to the knee. The patient will then slide the heel
down the shin, and repeat with the other leg.
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66. EXPANDED STROKE EXAM - MIAMI
EMERGENCY NEUROLOGICAL DEFICIT
SCALE
• Determine normal – able to move legs to intended areas.
• Determine abnormal – difficulty to move leg smoothly.
Critical Criteria:
1. Able to determine abnormal responses.
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67. CHILDBIRTH
Equipment:
OB kit with absorbent pads, sterile gloves, 2 clamps, scalpel, and blue bulb
syringe.
Procedure:
1. Take body substance isolation precautions which include sterile gloves.
2. Assemble equipment and maintain a sterile field.
3. Place towels and/or absorbent pads on the floor around the delivery area to
soak up fluids released from delivery.
4. Drape sterile sheets on patient’s abdomen, under buttocks, and over each
thigh.
5. Allow the mother to push the head out with the contractions. Student should
place hand on the baby’s head as it presents to prevent explosive birth.
6. Support baby’s head as it delivers.
•
If amniotic sac has not broken, use dull instrument to puncture it.
7. Student should check to see for cord wrapped around the baby’s neck.
•
If cord is present, gently lift over the baby’s head without pulling hard on
the cord. When unable to remove, than clamp and cut the cord.
8. Utilize blue bulb syringe to suction the mouth of fluid.
9. Utilize blue bulb syringe to suction the nose of fluid.
10. Continue to support the head as the shoulders deliver.
11. Once the delivered, hold the baby firmly and place the neck in neutral
position.
12. Dry off the baby and wrap in a blanket or towel. Make sure to cover the top of
the baby’s head.
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67. CHILDBIRTH
13. Place first clamps for the umbilical cord about 4 fingers width from the body
and place the second clamp 2 to 4 inches from the first clamp.
14. Cut the cord between the clamps.
15. Determine the baby’s APGAR score at 1 minute and 5 minutes after birth.
16. If excessive bleeding occurs, massage the abdomen at the fundus of the uterus
to assist with controlling bleeding.
17. Allow placenta to deliver itself and secure in bag.
Critical Criteria:
1.
Did not suction mouth before nose.
2.
Unable to determine APGAR score.
3.
Able to recognize complications and respond with correct actions.
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68. CHILDBIRTH COMPLICATIONS
Equipment:
OB kit with absorbent pads, sterile gloves, 2 clamps, scalpel, and blue bulb
syringe.
Prolapsed Cord:
Procedure:
1. Take body substance isolation precautions which include sterile gloves.
2. Place the patient in a position that removes pressure from the cord.
•
Head down.
Or
•
Pelvis elevated.
3. Administer high flow oxygen to patient.
4. Instruct patient to not push during contractions.
5. Student will utilize a sterile glove to insert several fingers into the vagina to
gently push the baby off the cord and maintain cord pulsation.
6. Maintain visible port of cord with moist sterile dressing.
7. Transport immediately.
Limb Presentation:
Procedure:
1. Take body substance isolation precautions which include sterile gloves.
2. Place the patient in a position that removes pressure from the cord.
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68. CHILDBIRTH COMPLICATIONS
•
Head down.
Or
•
Pelvis elevated.
3. Administer high flow oxygen to patient.
4. Transport immediately.
Breech Birth:
Procedure:
1. Take body substance isolation precautions which include sterile gloves.
2. Place the patient in a position that removes pressure from the cord.
•
Head down.
Or
•
Pelvis elevated.
3. Administer high flow oxygen to patient.
4. Transport immediately.
5. If the buttock passed through the vagina, than position the patient for
delivery.
6. Assemble equipment and maintain a sterile field.
7. Place towels and/or absorbent pads on the floor around the delivery area to
soak up fluids released from delivery.
8. Drape sterile sheets on patient’s abdomen, under buttocks, and over each
thigh.
9. Student should place hand on the baby’s buttock as it presents to prevent
explosive birth.
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68. CHILDBIRTH COMPLICATIONS
10. After legs and buttocks deliver, student should support the trunk by letting
the legs dangle over his/her arm.
11. During head delivery, place a gloved hand into the patient’s vagina with your
palm facing the baby’s face. Make a “V” with your index and middle fingers
on either side of the baby’s nose. Push the vaginal wall away from the baby’s
face until the head delivers.
Critical Criteria:
1. Able to recognize complications and respond with correct actions.
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69. PATIENT ASSESSMENT / MANAGEMENT
- MEDICAL
Equipment:
Blood pressure cuff, stethoscope, pulse oximeter, and pen light.
Procedure:
Scene Size-up:
1. Take body substance isolation precautions.
2. Inspect the scene for safety (personal protection).
3. Determines the nature of the illness.
4. Determines the number of patients.
5. Determines the need for additional resources.
6. Determines the need for spinal immobilization.
Initial Assessment:
7. Inspect general impression of the patient (visual assessment).
8. Student one introduces himself / herself to the patient and obtains consent
for patient care.
9. Determine chief complaint.
10. Determine mental status.
11. Assess airway.
12. Assess breathing – provides oxygen therapy and assures adequate ventilation.
13. Assess circulation – Assess pulse.
14. Assess and control major external bleeding.
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69. PATIENT ASSESSMENT / MANAGEMENT
- MEDICAL
15. Assess perfusion.
16. Identify priority and transport decisions.
Focused History and Rapid Assessment:
17. SAMPLE History – signs and symptoms.
•
Respiratory – onset, provokes, quality, radiates, severity, time,
interventions.
•
Cardiac – onset, provokes, quality, radiates, severity, time, interventions.
•
Altered Mental Status – description of the episode, onset, duration,
associated symptoms, evidence of trauma, interventions, seizures, fever.
•
Allergic reaction – history of allergies, what were you exposed to, how
were you exposed, effects, progression, interventions.
•
Poisoning/overdose – substance, when did you ingest/become exposed,
how much did you ingest, over what time period, interventions, estimated
weight.
•
Environmental Emergency – source, environment, duration, loss of
consciousness, effects general or local.
•
Obstetrics – are you pregnant, how long have you been pregnant, pain or
contractions, bleeding or discharge, do you feel the need to push, last
menstrual period.
•
Behavioral – how do you feel, determine suicidal tendencies, is the patient
a threat to self or others, is there a medical problem, interventions.
18. Allergies.
19. Medications.
20. Past pertinent history.
21. Last oral intake.
22. Events leading to present.
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69. PATIENT ASSESSMENT / MANAGEMENT
- MEDICAL
23. Inspect for DCAP BTLS:
•
Palpate the head and neck.
•
Suspected spinal injury - size and apply the appropriate cervical collar
•
Palpate the chest.
•
Palpate the abdomen in four quadrants.
•
Palpate the pelvis.
•
Palpate all four extremities.
•
With the assistance of other students, log roll patient.
•
Assess the back.
24. Baseline vital signs.
25. Interventions obtain medical direction or verbalize standing orders for
medication interventions.
26. Transport (re-evaluate transport decisions).
27. Verbalize the consideration for completing detailed exam.
Performs on-going assessment:
28. Repeat initial assessment.
29. Reassess vital signs.
30. Repeat focused assessment.
31. Check interventions.
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69. PATIENT ASSESSMENT / MANAGEMENT
- MEDICAL
Critical Criteria:
1. Did not take or verbalize body substance isolation precaution.
2. Did not determine scene safety.
3. Did not obtain medical direction or verbalize standing orders for medical
interventions.
4. Did not provide high concentration of oxygen.
5. Did not find, or manage problems associated with airway, breathing,
hemorrhage, or shock.
6. Did not differentiate patient’s need for transportation versus continued
assessment at the scene.
7. Did other detailed physical examination before assessing airway, breathing,
and circulation.
8. Did not ask questions about the present illness.
9. Administered a dangerous or inappropriate intervention.
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70. SCOOP STRETCHER
Equipment:
Scoop Stretcher
Procedure:
1. Takes body substance isolation precautions.
2. Separate the frame of the scoop stretcher at the top by depressing the catch
device and applying outward pressure.
3. Repeat depressing the bottom catch device to complete separation.
4. Place one half next to the patient to evaluate the appropriate length.
5. Adjust the length by sliding the lower end out of the upper end and locking it
into position with the locking peg.
6. Place one half of the scoop stretcher on each side of the patient.
7. Place half of the scoop stretcher under the patient by having the second
student gently roll the patient away (careful not to pinch the patient).
8. Place the second half under the patient.
9. Take the foot end and connect the device together.
10. Take the head end and connect the device together.
11. Make sure the device ends locked together.
12. Secure with straps.
13. Use proper lifting technique.
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Prevents injury to self by using correct technique.
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71. PNEUMATIC ANTI-SHOCK GARMENT
FOR SPLINTING
Equipment:
Pneumatic anti-shock garment, and backboard
Procedure:
1. Take body substance isolation precautions.
2. Expose injured area.
3. Evaluate distal pulse, motor function, and sensory function.
4. Put patient on PASG while in supine position. Top of the PASG should be just
below the lowest rib.
5. Aligns the extremity. Do not align joint injury, if resistance is met.
6. Lay PASG on backboard and logroll patient onto backboard.
Or
•
PASG folded method: Required PASG to be folded so that the velcro does
not stick. After patient is on backboard, the leg sections are pulled down
and the abdominal section remains in position. The abdominal section is
unfolded and wrapped first.
•
PASG unfolded method: Requires PASG to be open on the backboard.
Patient is rolled onto the backboard and PASG. The abdominal section is
wrapped first.
7. Wrap left and right leg with velcro straps.
8. Attach foot pump assembly and make sure the valves are shut off.
9. Inflate appropriate section for splinting till firm. DO NOT INFLATE TILL
VELCRO MAKES A TEARING SOUND.
10. Re-evaluate distal pulse, motor function, and sensory function.
Critical Criteria:
1. Inflate in the incorrect order.
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72. CONTROLLING EPISTAXIS – NOSE
BLEED
Equipment:
Gauze and ice pack
Procedure:
1. Take body substance isolation precautions.
2. Instruct the patient to sit while leaning forward and head tilted forward.
3. Instruct the patient to pinch patient’s nostrils together.
4. Still bleeding, apply ice at the bridge of the nose.
5. Still bleeding, transport.
Critical Criteria:
1. Failure to position patient correctly and allowing blood to drip in the back of
the throat.
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73. CONTROLLING EXTERNAL BLEEDING TO
AN EXTREMITY
Equipment:
4 x 4 gauze and roller bandage.
Procedure:
1. Take body substance isolation precautions.
2. Take gauze and apply direct pressure to bleeding site.
3. Still bleeding, elevate extremity by 6 inches.
4. Still bleeding, apply pressure dressing. Utilize roller bandage to stretch tight
over the dressing site.
5. Still bleeding, add more gauze and apply a tighter second roller bandage.
6. Still bleeding, apply arterial pressure point.
Critical Criteria:
1. Failure to apply correctly.
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74. HARE TRACTION SPLINT
Equipment:
Hare traction splint
Procedure:
1. Take body substance isolation precautions.
2. Expose injured area.
3. Student one stabilizes the affected leg.
4. Student two:
•
Checks distal pulse, motor function, and sensory function.
•
Place the splint next to the uninjured leg and adjust to the proper length
from the top of the patient’s pelvis to 6-8 inches past the ankle.
•
Attach the ankle hitch about the foot and ankle.
•
Manually applies gentle in-line traction to the ankle hitch.
i. Open fracture with PMS keep sterile.
ii. Open fracture with (-) PMS pull traction.
5. Student one:
•
Slide the splint into position under the injured leg.
•
Place the ischial pad against the iliac crest.
•
Fasten the ischial strap.
•
Connect the loops of the ankle hitch to the end of the splint.
6. Tighten the ratchet and release manual traction. Continue to pull till:
•
Patient has relief of pain and muscle spasms.
7. Secure with straps.
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74. HARE TRACTION SPLINT
8. Re-evaluate distal pulse, motor function, and sensory function.
9. Secure patient to long spinal board.
Critical Criteria:
1. No loss of traction at any point.
2. Did not reassess distal pulse, motor function, and sensory function.
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75. SAGER TRACTION SPLINT
Equipment:
Sager traction splint
Procedure:
1. Take body substance isolation precautions.
2. Expose injured area.
3. Student one applies manual traction of the affected leg.
4. Student two checks distal pulse, motor function, and sensory function.
5. Position Sager traction splint between the patient's legs.
6. Adjust the splint to the distance slightly past the patient’s ankle.
7. Apply the abductor bridle (thigh strap) around the upper thigh of the
fractured limb.
•
Push the ischial perineal cushion gently down while pulling the thigh strap
snugly.
8. Apply the Malleolar Harness (ankle harness) and attach to traction handle.
9. Place one hand on padded shaft and other hand on traction handle while
gently extending.
10. Pull traction handle and release manual traction. Continue to pull till:
•
Maximum of 7kg (15lbs) for one femur fracture.
•
Maximum of 14kg for bilateral femur fractures.
•
Patient has relief of pain and muscle spasms.
11. Secure with large elastic leg cravats.
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75. SAGER TRACTION SPLINT
12. Re-evaluate distal pulse, motor function, and sensory function.
13. Secure patient to long spinal board.
Critical Criteria:
1. No loss of traction at any point.
2. Did not reassess distal pulse, motor function, and sensory function.
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76. APPLYING AN AIR SPLINT
Equipment:
Air splint.
Procedure:
1. Take body substance isolation precautions.
2. Expose injured area.
3. Evaluate distal pulse, motor function, and sensory function.
4. Student one aligns extremity, stabilizes, and supports the extremity.
•
Do not align joint injury, if resistance is met. Utilize another device.
5. Student two:
•
Place arm through the splint and grasp the patient’s hand or foot.
•
Apply gentle traction while sliding the splint into position.
•
Inflate splint by mouth to a point that a slight dent can be made into the
plastic when pressed with a finger.
6. Re-evaluate distal pulse, motor function, and sensory function.
Critical Criteria:
1. Securely attaches the device and prevents movement.
2. Did not reassess distal pulse, motor function, and sensory function.
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77. APPLYING A RIGID SPLINT
Equipment:
Long or small wood planks, tape, wrap, and padding material.
Procedure:
1. Take body substance isolation precautions.
2. Expose injured area.
3. Evaluate distal pulse, motor function, and sensory function.
4. Student one aligns extremity, stabilizes, and supports the extremity.
•
Do not align joint injury, if resistance is met.
5. Student two acquires the appropriate length wood planks and provides
padding to ensure even contact with splint.
•
Place wood on each side of the injury.
•
Place wood under the injury.
6. Secure extremity to rigid splint.
•
Long bone injury – immobilize the joint above and joint below the injury.
•
Joint injury – immobilize the bone above and bone below the injury.
7. Re-evaluate distal pulse, motor function, and sensory function.
Critical Criteria:
1. Securely attaches the device and prevents movement.
2. Did not reassess distal pulse, motor function, and sensory function.
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78. APPLYING A VACUUM SPLINT
Equipment:
Vacuum splint.
Procedure:
1. Take body substance isolation precautions.
2. Expose injured area.
3. Evaluate distal pulse, motor function, and sensory function.
4. Student one aligns extremity, stabilizes, and supports the extremity.
•
Do not align joint injury, if resistance is met.
5. Student two:
•
Wraps and secures the vacuum splint around the extremity.
•
Draws the air out of the splint with the pump.
6. Re-evaluate distal pulse, motor function, and sensory function.
Critical Criteria:
1. Securely attaches the device and prevents movement.
2. Did not reassess distal pulse, motor function, and sensory function.
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79. SPLINTING THE HAND AND WRIST
Equipment:
Small board, tape, roller bandage, and padding material.
Procedure:
1. Take body substance isolation precautions.
2. Expose injured area.
3. Evaluate distal pulse, motor function, and sensory function.
4. Student one aligns extremity, stabilizes, and supports the extremity.
5. Student two:
•
Places soft roller bandage in the palm.
•
Applies small board on the palmar side.
•
Secure hand to board with the fingers exposed.
6. Re-evaluate distal pulse, motor function, and sensory function.
Critical Criteria:
1. Securely attaches the device and prevents movement.
2. Did not reassess distal pulse, motor function, and sensory function.
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80. SLING AND SWATHE
Equipment:
Triangle bandage and ace wrap.
Procedure:
1. Take body substance isolation precautions.
2. Expose injured area.
3. Determine patient has a fractured clavicle, fractured scapula, or
acromioclavicular joint separation.
4. Evaluate distal pulse, motor function, and sensory function.
5. Instruct patient to stabilize and supports the extremity by having the arm
slightly bent and held against his/her chest.
6. Open triangle bandage and place a knot in one corner of the triangle.
7. Place the knotted portion on the injured arm’s elbow.
8. Take the two other ends and tie together around the patient’s neck.
9. Utilize triangle bandage or ace wrap to bind the swathe against the chest by
wrapping around the arm and chest wall.
10. Re-evaluate distal pulse, motor function, and sensory function.
Critical Criteria:
1. Securely attaches the device and prevents movement.
2. Did not reassess distal pulse, motor function, and sensory function.
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81. REMOVING A FOREIGN OBJECT FROM THE EYE
Equipment:
Irrigation equipment and cotton tip applicator
Procedure:
1. Take body substance isolation precautions.
2. Perform irrigation of the affected eye with normal saline and flushing from
nose outward.
•
Flush using a faucet spray from a sink or shower.
•
Flush using bottle of normal saline or sterile water.
•
Flush using a basin filled with water.
•
Flush using nasal cannula tubing.
3. Patient still has foreign object under eyelid.
•
Instruct patient to look down and grasp upper lashes to pull away from the
eye.
•
Place cotton tip applicator on the outer surface in the middle of the upper
lid.
•
Fold the eye lid back by pulling forward and up over the applicator.
•
Gently remove object from eye lid with moistened sterile applicator.
Critical Criteria:
1. Flushed foreign object toward other eye.
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82. MORGAN LENS
Equipment:
Morgan lens, Normal Saline bag,10 drop administration set, and towel.
Procedure:
1. Remove contact lenses.
2. Have the patient look down, insert edge of the lens under the upper lid. Have
the patient look up, retract the lower lid.
3. Release lower lid over the lens.
4. Connect Morgan lens to a bag of normal saline and a 10 drop
administration set. Open administration set to desired flow rate.
5. Tape tube and adaptor to patient's forehead to prevent accidental lens
removal.
6. Absorb outflow with towels.
7. Removal: Have patient look up. Retract lower lid behind interior border
of the lens. Hold position. Have patient look down, retract upper lid and
slide lens out.
Critical Criteria:
1. Incorrectly insert device.
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83. EVISCERATION
Equipment:
Sterile gauze, sterile water, aluminum foil, and tape
Procedure:
1. Take body substance isolation precautions.
2. Do not touch or move exposed organs.
3. Cover organs with sterile gauze moistened with sterile water.
4. Cover moistened sterile gauze with sterile bulky dressing or occlusive dressing
like aluminum foil.
5. Secure dressing with tape.
Critical Criteria:
1. Inability to stabilize and protect exposed organs.
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84. STABLIZING AN IMPALED OBJECT
Equipment:
Gauze, tape, and items to provide rigid support.
Procedure:
1. Take body substance isolation precautions.
2. Control hemorrhaging..
3. Apply bulky dressing around the object.
4. Secure dressing in place with tape or wraps.
5. Evaluate effectiveness of stabilizing.
Critical Criteria:
1. Inability to stabilize object.
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85. SUCKING CHEST WOUND
Equipment:
Vaseline gauze, aluminum foil, Ashman chest seal, and tape.
Procedure:
1. Take body substance isolation precautions.
2. Determine patient has a sucking chest wound.
•
Make a one way valve by applying a square section of Vaseline gauze foil or
aluminum foil over the hole in the patient’s chest. Tape to 3 sides to make
flutter valve.
Or
•
Apply Ashman Chest Seal device
3. Re-evaluate lung sounds.
Critical Criteria:
1. Inability to create flutter valve.
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86. TREATING SHOCK
Equipment:
Gauze, bandages, and splinting equipment.
Procedure:
1. Perform scene size-up.
•
Take body substance isolation precautions.
•
Check for scene safety.
2. Position patient supine.
3. Perform initial assessment.
4. Control all external bleeding sites with gauze and bandages.
5. Perform focused history and rapid physical exam.
6. Splint bone and joint injuries.
7. Maintain normal body temperature with blankets.
8. Elevate legs into trendelenburg position about 6 to 12 inches.
9. Perform detailed physical exam.
10. Perform ongoing assessment.
Critical Criteria:
1. Did not perform blood pressure, after treatment.
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87. SHORT BOARD SPINAL IMMOBILIZATION
Equipment:
Short backboard, long back board, cervical collar, straps
Procedure:
1. Takes body substance isolation precaution.
2. Manual immobilization of head in a neutral in-line position.
3. Size and apply appropriate cervical collar.
4. Insert short backboard at a 45 degree angle behind the patient while limiting
patient movement (Device should be centered in the back).
5. Connect and adjust torso straps.
6. Secure head to short backboard.
7. Move and secure patient to long spine board.
•
Crossing straps on the upper torso area.
•
Crossing straps on the abdominal area.
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Prevents injury to self by using correct technique.
3. Immediately takes manual immobilization of the head and neck.
4. Does not release manual immobilization till maintained mechanically.
5. Does not allow excessive movement of patient after secured with straps.
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88. KENDRICK EXTRICATION DEVICE (KED)
Equipment:
KED, Cervical Collar, long spine board, and 4 backboard straps.
Procedure:
Tonight
My
Baby
Looks
Hot
-
Top strap
Middle strap
Bottom strap
Leg straps
Head straps
1. Takes body substance isolation precaution.
2. Manual immobilization of head in a neutral in-line position.
3. Size and apply appropriate cervical collar.
4. Insert device at a 45 degree angle behind the patient while limiting patient
movement (Device should be centered in the back).
5. Connect and adjust torso straps (Top Green strap, Middle Yellow strap, and
bottom Red strap).
6. Connect and adjust groin straps (Attach to same side or cross strap).
7. Place pad behind patient's head to fill any void spaces.
8. Position head flaps, and fasten the forehead and chin straps.
9. After removal from confined space, place patient on long backboard.
10. Loosen top torso green strap and leg straps.
11. Secure patient's body by:
•
Crossing straps on the upper torso area.
•
Crossing straps on the abdominal area.
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88. KENDRICK EXTRICATION DEVICE (KED)
Critical Criteria:
1. Moves the patient in a safe and effective manner.
2. Prevents injury to self by using correct technique.
3. Immediately takes manual immobilization of the head and neck.
4. Does not release manual immobilization till maintained mechanically.
5. Does not allow excessive movement of patient after secured with straps.
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89. BASKET STRETCHER
Equipment:
Basket stretcher
Procedure:
1. Move patient into the basket:
•
If patient has suspected spinal injury, patient should be appropriately
placed on backboard.
Or
•
If no suspected spinal injury, patient will lifted into the basket with the
appropriate lift technique.
2. Student will secure patient with the device straps and make sure that they are
tight enough to not allow the patient to move.
3. Students will prepare to lift and carry:
•
Two students – one at the head and one at the feet.
•
Four students – two students on each side.
•
Six students – three students on each side.
4. Students will perform a power lift on the command of the student positioned
at the patient’s head.
5. Students will carry at arms length.
6. Stretcher is lowered upon command.
Critical Criteria:
1. Able to carry 10’.
2. Moves patient in a safe and effective manner.
3. Prevents injury to self by using correct technique.
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90. INFANT IMMOBILIZATION – IN A CAR SEAT
Equipment:
Tape, towels, pads, cervical collar.
Procedure:
1. Take body substance isolation precautions.
2. Apply manual in-line stabilization.
3. Apply cervical collar.
4. Roll towels or pads to support alongside the infant’s head.
5. Secure rolls and head with tape.
6. Secure car seat to stretcher.
Critical Criteria:
1. Immediately takes manual immobilization of the head and neck.
2. Does not release manual immobilization till maintained mechanically.
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91. REMOVING A FOOTBALL HELMET
Equipment:
Tool to remove face mask.
Procedure:
1. Take body substance isolation precautions.
2. Apply manual in-line stabilization.
3. Determine the need to remove the helmet face mask.
•
Respirator management
•
Initiate care to facial injuries
4. Student one places one hand on the mandible (thumb on one side and the
fingers on the other side) and the other hand under the patient’s head at the
occipital area.
5. Student two removing face mask.
•
Cutting tool to remove tabs
Or
•
Remove facemask screws
6. Evaluate the ability to perform respirator management. Remove entire
helmet when not able to gain access to the airway or unable to remove in a
timely manner.
•
Cut or loosen chin strap.
•
Student one places one hand on the mandible (thumb on one side and the
fingers on the other side) and the other hand under the patient’s head at
the occipital area.
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91. REMOVING A FOOTBALL HELMET
•
Student two moves the helmet laterally to the ears and may need to tilt
forward to finish removal.
•
Student two applies manual in-line stabilization.
7. Apply cervical collar.
8. Secure to spinal device.
Critical Criteria:
1. Remove helmet with no respirator management compromise.
2. Failure to stabilize the head and neck.
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92. REMOVING A FULL FACE HELMET
Equipment:
None
Procedure:
1. Take body substance isolation precautions.
2. Student one applies manual in-line stabilization by placing hands on each side
of the helmet with the fingers on the victim’s mandible.
3. Student two cuts or loosens the straps.
4. Student two transfers manual in-line stabilization by placing one hand on the
mandible (thumb on one side and the fingers on the other side) and the other
hand under the patient’s head at the occipital area.
5. Student one:
•
Should inspect for glasses and remove.
•
Laterally move helmet to clear the ears.
•
Tilt helmet backwards to raise over the nose and remove.
•
Applies manual in-line stabilization.
6. Apply cervical collar.
7. Secure to spinal device.
Critical Criteria:
1. Failure to stabilize the head and neck.
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93. PATIENT ASSESSMENT / MANAGEMENT TRAUMA
Equipment:
Blood pressure cuff, stethoscope, pulse oximeter, and pen light.
Procedure:
Scene Size-up:
1. Take body substance isolation precautions.
2. Inspect the scene for safety (personal protection).
3. Determines the mechanism of injury.
4. Determines the number of patients.
5. Determines the need for additional resources.
6. Determines the need for spinal immobilization.
Initial Assessment:
7. Inspect general impression of the patient (visual assessment).
8. Student one introduces himself / herself to the patient and obtains consent
for patient care.
9. Determine chief complaint.
10. Determine mental status.
11. Assess airway and student two performs manual in-line cervical
immobilization.
12. Assess breathing – provides oxygen therapy and assures adequate ventilation.
13. Assess circulation – Assess pulse.
14. Assess and control major external bleeding.
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93. PATIENT ASSESSMENT / MANAGEMENT TRAUMA
15. Assess perfusion.
16. Identify priority and transport decisions.
Focused History and Rapid Assessment:
17. Inspect for DCAP BTLS:
•
Palpate the head and neck.
•
Suspected spinal injury - size and apply the appropriate cervical collar
•
Palpate the chest.
•
Palpate the abdomen in four quadrants.
•
Palpate the pelvis.
•
Palpate all four extremities.
•
With the assistance of other students, log roll patient.
•
Assess the back.
18. Baseline vital signs.
19. SAMPLE History.
Performs detailed physical exam:
20. Assess the head.
•
Inspect around the eyes and eyelids for redness.
•
Inspect the eyes for contacts.
•
Inspect the eyes for pupil function. Take pen light from the corner of the
eye and shine on to the pupil. Determine if the pupils are equal and
reactive.
•
Inspect behind the ears for Battle’s Signs (bruising).
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93. PATIENT ASSESSMENT / MANAGEMENT TRAUMA
•
Inspect the ear canal for drainage of blood or spinal fluid. Use 4x4 gauze folded
in fours to identify spinal fluid inside blood by a halo.
•
Palpate scalp for depressions of the skull.
•
Palpate areas of the face like zygomas, maxillae, and mandible for instability.
•
Inspect the mouth for cyanosis around the lips, foreign body (includes dentures
or loose teeth), and unusual odors.
•
Inspect the nose.
21. Palpate the front and back of the neck.
•
Inspect for jugular vein distention.
•
Inspect for tracheal deviation.
•
Inspect skin for crepitus (crackling) under the skin.
22. Palpate the chest over the ribs.
•
Inspect for symmetrical chest rise and fall.
•
Inspect for paradoxical motion.
•
Auscultate anterior breath sounds at midaxillary and midclavicular area.
•
Auscultate posterior breath sounds at the bases and apices area.
•
Palpate for crepitus.
23. Palpate the abdomen in four quadrants.
•
Palpate for rigidity.
•
Inspect for distension.
24. Palpate the pelvis.
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145
93. PATIENT ASSESSMENT / MANAGEMENT TRAUMA
•
Compress downward and inward on the iliac crest to identify any
instability.
24. Palpate all four extremities.
•
Inspect for medical alert bracelets.
•
Palpate dorsalis pedis or posterior tibial pulse, and radial pulse.
•
Inspect for motor function with wiggling toes and fingers.
•
Inspect for sensory function with squeezing or pinching extremities.
25. With the assistance of other students, log roll patient.
26. Palpate the back.
27. Manages secondary injuries and wounds appropriately.
Performs on-going assessment:
28. Repeat initial assessment.
29. Reassess vital signs.
30. Repeat focused assessment.
31. Check interventions.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
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Broward Public School
Lab and Clinical Binder
93. PATIENT ASSESSMENT / MANAGEMENT TRAUMA
Critical Criteria:
1. Did not take or verbalize body substance isolation precaution.
2. Did not determine scene safety.
3. Did not asses for spinal protection.
4. Did not provide for spinal protection when indicated.
5. Did not provide high concentration of oxygen.
6. Did not find, or manage problems associated with airway, breathing,
hemorrhage, or shock.
7. Did not differentiate patient’s need for transportation versus continued
assessment at the scene.
8. Did other detailed physical examination before assessing airway, breathing,
and circulation.
9. Did not transport patient within 10 minute time limit.
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
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Lab and Clinical Binder
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Lab and Clinical Binder
*EMS CODE OF ETHICS*
As adopted by the National Association of EMTs
Professional status as an Emergency Medical Technician and Emergency Medical
Technician-Paramedic is maintained and enriched by the willingness of the
individual practitioner to accept and fulfill obligations to society, other medical
professionals, and the profession of Emergency Medical Technician. As an
Emergency Medical Technician-Paramedic, I solemnly pledge myself to the
following code of professional ethics:
A fundamental responsibility of the Emergency Medical Technician is to conserve
life, to alleviate suffering, to promote health, to do no harm, and to encourage the
quality and equal availability of emergency medical care.
The Emergency Medical Technician provides services based on human need, with
respect for human dignity, unrestricted by consideration of nationality, race
creed, color, or status.
The Emergency Medical Technician does not use professional knowledge and
skills in any enterprise detrimental to the public well being.
The Emergency Medical Technician respects and holds in confidence all
information of a confidential nature obtained in the course of professional work
unless required by law to divulge such information.
The Emergency Medical Technician, as a citizen, understands and upholds the
law and performs the duties of citizenship; as a professional, the Emergency
Medical Technician has the never-ending responsibility to work with concerned
citizens and other health care professionals in promoting a high standard of
emergency medical care to all people.
The Emergency Medical Technician shall maintain professional competence and
demonstrate concern for the competence of other members of the Emergency
Medical Services health care team.
An Emergency Medical Technician assumes responsibility in defining and
upholding standards of professional practice and education.
The Emergency Medical Technician assumes responsibility for individual
professional actions and judgment, both in dependent and independent
emergency functions, and knows and upholds the laws which affect the practice
of the Emergency Medical Technician.
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*EMS CODE OF ETHICS*
An Emergency Medical Technician has the responsibility to be aware of and
participate in matters of legislation affecting the Emergency Medical Service
System.
The Emergency Medical Technician, or groups of Emergency Medical
Technicians, who advertise professional service, do so in conformity with the
dignity of the profession.
The Emergency Medical Technician has an obligation to protect the public by not
delegating to a person less qualified, any service which requires the professional
competence of an Emergency Medical Technician
The Emergency Medical Technician will work harmoniously with and sustain
confidence in Emergency Medical Technician associates, the nurses, the
physicians, and other members of the Emergency Medical Services health care
team.
The Emergency Medical Technician refuses to participate in unethical
procedures, and assumes the responsibility to expose incompetence or unethical
conduct of others to the appropriate authority in a proper and professional
manner.
________________________________________
Written by: Charles Gillespie M.D.
Adopted by: The National Association of Emergency Medical Technicians, 1978.
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State of Florida
DO NOT RESUSCITATE ORDER (DNRO)
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START Triage
GREEN YELLOW RED BLACK -
Walking Wounded
Delayed
Immediate
Deceased
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Jump START – Pediatric Triangle
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All Risk Triage Tags
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Glasgow Coma Score
Eye Opening
Spontaneous
4
To Loud Voice
3
To Pain
2
None
1
Verbal Response
Orientated
Confused,
Disorientated
5
4
Inappropriate words
3
Incomprehensible sounds
2
None
1
Best Motor Response
Obeys
6
Localizes
5
Withdraws (flexion)
Abnormal flexion
posturing
4
Extension posturing
2
None
1
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Lab and Clinical Binder
155
APGAR Score
Test
0 Points
1 Point
2 Points
Activity (Muscle Tone)
Absent
Arms & legs
extended
Active movement
with flexed arms &
legs
Pulse (Heart Rate)
Absent
Below 100 bpm
Above 100 bpm
Grimace (Response
No Response
Facial grimace
Sneeze, cough,
pulls away
Appearance (Skin Color)
Blue-gray, pale all
over
Pink body and
blue extremities
Normal over entire
body – Completely
pink
Respiration (Breathing)
Absent
Slow, irregular
Good, crying
Stimulation or Reflex
Irritability)
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
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Rule of Nines
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157
CPR and FBAO Chart
Adult
Child
Infant
Age
Lone Rescuer Calling
911
9 years and older
1 to 8 years old
under 1 year old
After determining
unresponsiveness
After 2 minutes of CPR
Opening the Airway
Hyperextended with
head tilt and chin lift
Hyperextended with head
tilt and chin lift
After 2 minutes of CPR
Neutral or Sniffing
position with head tilt
and chin lift
Rescue Breathing
1 breath / 5-6 seconds
1 breath / 3-5 seconds
1 breath / 3-5 seconds
Pulse Check
Compression
Landmarks
Carotid Artery
Carotid Artery
Brachial Artery
Center of the chest
between the nipples
Center of the chest
between the nipples
Just below the nipple
line
Compressin Method
2 hands with heel of
one hand on top of the
other
Compression Depth
1 1/2 to 2 Inches
Heel of 1 hand or 2 hands
on top of the other
1/3 to 1/2 depth of the
chest
1 Rescuer - 2 fingers
or
2 Rescuers - 2 thumbs
encircling the chest
1/3 to 1/2 depth of the
chest
Compressions/minute
100
100
100
Compressions/respirations
30/2 one person
30/2 two person
Cycle of CPR
5 times of 30
compressions / 2
ventilations
or
2 minutes of CPR
30/2 one person
15/2 two person
5 times of 30
compressions / 2
ventilations
or
2 minutes of CPR
or
10 times of 15
compressions / 2
ventilations
30/2 one person
15/2 two person
5 times of 30
compressions / 2
ventilations
or
2 minutes of CPR
or
10 times of 15
compressions / 2
ventilations
FBAO - Conscious
Abdominal thrusts
Abdominal thrusts
5 back slaps and 5 chest
thrusts
Look for object
ventilate twice
30 chest thrusts
Witnessed Arrest Immediately
Defibrillation
or
Unwitnessed Arrest - 2
minutes of CPR then
Defibrillation
Look for object
ventilate twice
30 chest thrusts
Witnessed Arrest Immediately
Defibrillation
or
Unwitnessed Arrest - 2
minutes of CPR then
Defibrillation
FBAO - Unconscious
Applying the AED
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
Look for object
ventilate twice
30 chest thrusts
AED not recommended
Broward Public School
Lab and Clinical Binder
Jump Kit Inventory
Outer Pouch #3
Outer Pouch #3
Trauma
Trauma
Center Pouch
Pouch #1 #1
Center
Airway
Airway
End
Pouch #2
Airway
End
Pouch
#2
Airway
OuterPouch
Pouch #4 #4
Outer
Diagnosis Equipment
Diagnosis Equipment
Airway Roll
Center Pouch #1
Airway
1. Oxygen cylinder and regulator
2. Hand held V-Vac suction
3. Airway roll
4. Side one (in order):
a. Sharp box
b. pediatric NRB
c. 3 pairs of safety glasses
d. 3 pairs of trauma sleeves
e. 3 HEPA Masks
f. 3 Universal gowns
g. 1 Convience bag
h. ResQpod
5. Side two (in order):
a. Nebulizer
b. 2 Adult NRB
c. 2 Adult NC
d. Easy Cap CO2
e. Tube holder
Back pocket 1
• King tube
• 60cc syringe
Back pocket 2
• 140cc syringe
• 20cc syringe
Back pocket 3
• Combitube
Back pocket 4
• LMA tube
• 30ml syringe
Front Left side holders (in order):
• Adult Magil Forceps
• Pediatric Magil Forceps
• Assorted OPAs
• Assorted NPAs
• 4 packages of Lubrication jelly
• Bite block/stick
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Jump Kit Inventory
Outer Pouch #3
Outer Pouch #3
Trauma
Trauma
End
Pouch #2
Airway
Center Pouch
Pouch #1 #1
Center
Airway
Airway
End
Pouch
#2
Airway
OuterPouch
Pouch #4 #4
Outer
Diagnosis Equipment
Diagnosis Equipment
End Pouch #2
Airway
1. Adult BVM with mask and tubing
Outer Pouch #4
Diagnosis Equipment
Outer Pouch #3
Trauma
1.
2.
3.
4.
5.
6.
Burn sheet
2 Multi-Trauma dressing
5 sterile 4x4s
2 Icepacks
1 red bag
Back wall (in order):
a. Stack of non-sterile 4x4
b. 2 triangular bandages
c. 1 Blood stopper
d. 1 Ring cutter
e. 1 Trauma shear
f. 1 – ace bandage
g. 2 – 4” kling
h. 2 inch tape
1. Pulse oximeter
2. Stethoscope w/ safety seal
3. Back straps (in order):
• Tympanic thermometer
• glucometer and lancet
device
• oral glucose
• penlight
• Adult BP cuff
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Lab and Clinical Binder
Approved Abbreviations
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
AAOx3 – Alert and orientated times person, place, and time/date
abd – abdomen
ac – before meals
AMI – acute myocardial infraction
amt – amount
ant – anterior
ASA – Aspirin
BM – bowel movement
BP – blood pressure
BS – blood sugar
BVM – Bag valve mask
CA – cancer
CC – chief complaint
CHF – congestive heart failure
CNS – central nervous system
c/o – complaining of
COPD – chronic obstructive pulmonary disease
DNR – do not resuscitate
DOA – dead on arrival
ECG – electrocardiogram
EENT – eye, ear, nose, and throat
EKG – electrocardiogram
ETA – estimated time of arrival
Fx – fracture
H/A - headache
HEENT – head, eyes, ears, nose, and throat
HTN – hypertension
HX – history
IM – intramuscular
IV – intravenous
IVP – intravenous push
kg – kilogram
LLQ – left lower quadrant
LOC – level of consciousness
LR – lactated ringers
Lt – left
LUQ – left upper quadrant
mcg - microgram
mg – milligram
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
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Lab and Clinical Binder
Approved Abbreviations
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
MI – myocardial infarction
ml – milliliter
NC – nasal cannula
NPO – nothing by mouth
NRB – non-rebreather mask
NS – normal saline
NTG – nitroglycerin
OD – overdose
pc – after meals
PERL – pupils equal and reactive to light
po – by mouth
PRN – whenever necessary or as needed
PTA – prior to arrival
RLQ – right lower quadrant
RUQ – right upper quadrant
SOB – short of breath
TKO – to keep open
Y/O – years old
V.S. – vital signs
w/o – without
WNL – within normal limits
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2600 SW 71 Terrace
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Trauma Telemetry - CUTT REPORT
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Trauma Telemetry – CUTT Report
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Telemetry Report – Med-Com Report
Rescue Unit: ________
Patient Age: ________
Gender: __________
Chief Complaint:
___________________________________________________
Signs and Symptoms/Physical Findings:
___________________________________________________
___________________________________________________
Medical History:
___________________________________________________
Medications:
___________________________________________________
___________________________________________________
Allergies:
___________________________________________________
Vital Signs
BP: _______ Pulse: _______ Respirations: _______
SAO2: _______ GCS: _______ Temperature: _______
Treatment Provided:
ETA to Facility:
__________________________________________________
* Make Copies *
Broward Public Schools – McFatter Technical College/Broward Fire Academy
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166
CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Patient Movement
Perform cradle carry
Perform extremity carry
Perform firefighter carry
Perform pack strap carry
Perform backboard 4 point carry
Perform backboard diamond carry
Perform walking assist
Perform arm drag
Perform blanket drag
Perform clothes drag
Perform firefighter's drag
Perform shoulder or arm to arm drag
Perform blanket lift
Perform direct ground lift
Perform stretcher loading into
ambulance
Perform stretcher unloading from
ambulance
Perform stretcher raise
Perform stretcher lower
Perform stretcher adjust back rest
Apply flexible stretcher
Apply scoop stretcher
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CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Airway and Breathing Equipment and Procedures
Apply basket stretcher
Apply stair chair
Perform Bag valve mask ventilations
Apply non-rebreather
Apply nasal cannula
Setup nebulizer
Setup C-PAP
Setup portable oxygen cylinder
Perform yankare suctioning
Perform whistle tip suctioning of the
mouth
Perform whistle tip suctioning through
device
Setup portable suction unit
Insert oropharyngeal
Insert nasopharyngeal
Perform sellick maneuver
Insert combitube
Insert King tube
Insert Laryngeal mask airway
Perform assisted breathing
Setup pulse oximetry
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168
CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Setup capnographer
Determine respirations rate
Auscultate respirations - rhonchi
Auscultate respirations - wheezing
Auscultate respirations - rales
Auscultate respiration - stridor
Auscultate respirations - normal
Observe endotracheal intubation
Observe nasotracheal intubation
Observe pleural decompression
Observe cricothyroidotomy
Observe needle cricothyroidotomy
Observe automatic respirator setup
Observe nasagastric tube insertion
Circulation Equipment and Procedures
Perform CPR on Adult
Perform CPR on Pediatric
Perform CPR on Infant
Setup AED
Setup monitor for 4 lead ECG
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169
CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Setup monitor for 12 lead ECG
Setup IV bag
Auscultate blood pressure
Palpate blood pressure
Palpate capillary refill
Observe IV administration
Observe adult IO administration
Observe pediatric IO administration
Observe defibrillation
Observe pacing
Observe synchronized cardioversion
Observe ECG transmission to hospital
Observe mechanical CPR device setup
Trauma Equipment and Procedures
Apply vacuum splint
Apply rigid splint
Apply sager splint
Apply hare splint
Apply PASG
Apply air splint
Apply Sam splint
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170
CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Apply short spinal board
Apply kendrick extrication device
Apply cardboard splint
Apply pillow splint
Apply sling and swathe splint
Apply cervical collar on adult
Apply cervical collar on child
Apply backboard standing
Apply backboard seated in vehicle
Apply backboard supine
Apply backboard in the water
Apply manual cervical immobilization
Apply immobilization to an impaled
object
Apply removal technique to a foreign
object of the eye
Apply flushing to eye from chemical
burn
Apply direct pressure to soft tissue
injury
Apply elevation technique to soft tissue
injury
Apply pressure point technique to soft
tissue injury
Apply dressing to an evisceration
Apply dressing to a sucking chest
wound
Perform full face helmet removal
Perform football helmet stabilization
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CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Other Equipment and Procedures
Perform glucose test
Observe nitrous oxide administration
Observe physical restraint application
Observe blood draw
Observe morgan lens therapy
Medication Administration
Administer epi-pen autoinjector
Administer nitroglycerin
Administer metered dosed inhaler
Administer oral glucose
Adminster subcutaneous injection
Administer intramuscular injection
Assessment / Exams
Perform initial assessment
Perform focused history exam
Perform rapid physical exam
Perform detailed physical exam
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CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Perform Cincinnati stroke exam
Perform MEND stroke exam
Perform START triage assessment
Perform JumpSTART triage assessment
Perform Trauma Alert Assessment
Perform High Index Assessment
Perform Cardiac Alert Assessment
Perform pupil assessment
Perform APGAR assessment
Perform burn assessment
Perform Glasgow coma scale score
Medical Incidents
Observe obstructed airway emergency
Oberseve asthma emergency
Observe chronic obstructive pulmonary
disease emergency
Observe pulmonary edema emergency
Observe pneumonia emergency
Observe cardiac shock emergency
Observe cardiac dysrhythmia
emergency
Observe acute coronary syndrome
emergency
Observe hypertensive emergency
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173
CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
Observe altered mental status
emergency
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Observe violent behavior emergency
Observe seizure emergency
Observe stroke emergency
Observe syncopal episode emergency
Observe bite emergency
Observe sting emergency
Observe poisoning emergency
Observe drug overdose emergency
Observe normal labor delivery
emergency
Observe complicated labor delivery
emergency
Observe allergic reaction emergency
Observe diabetic emergency
Observe non-traumatic abdominal
emergency
Observe non-traumatic chest
emergency
Trauma Incidents
Observe dive injury emergency
Observe cold related emergency
Observe heat related emergency
Observe near drowning emergency
Observe electrical emergency
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174
CLINICAL PERFORMANCE SKILLS
CHECK OFF SHEET
SKILL
DATE
RESCUE UNIT
NUMBER /
HOSPITAL
PARAMEDIC /
INSTRUCTOR (PRINT)
Observe head injury emergency
Observe spinal injury emergency
Observe eye injury emergency
Observe chest injury emergency
Observe abdominal injury emergency
Observe extremity injury emergency
Observe burn injury emergency
Telemetry
Perform medical incident telemetry
Perform trauma incident telemetry
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McFatter Technical Center /
Broward Fire Academy
Clinical Report Form
Student Name:_______________ Date:__________ Report Number:___
Department:_______________ Rescue Unit Number:________
Incident Type: Trauma / Medical Age:_____ Gender: Male / Female
SUBJECTIVE
What the person tells you
•
Chief Complaint
•
S-A-M-P-L-E
•
O-P-Q-R-S-T
•
Signs/symptoms
Allergies
Medications
Last Meal
Event leading to
illness/injury
Onset
Provocation
Quality
Radiate/Region
Severity 1-10
Time
Pertinent
Negatives
CP
NV
LOC
SOB
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177
OBJECTIVE
What you found
Scene Size-up
Age, kg, position
• Physical Exam
• NEURO (GCS)
• SKIN
• HEAD
• NECK
• BACK
• CHEST
• ABD
• PELVIS
• LOW EXTREM
• UPR EXTREM
• SECONDARY
ASSESSMENT
Possible Diagnosis
PLAN
•
•
•
•
Treatment
Provided to pt
Effects/Changes
in patient
condition –
Secondary
Assessment
Destination
Transfer care to
Nurse or Dr
Time
Blood Pressure
Pulse
Respirations
SaO2 %
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
Glucose / Temp
Broward Public School
Lab and Clinical Binder
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
178
Broward Public School
Lab and Clinical Binder
179
CLINICAL ATTENDANCE ROSTER
NAME:__________________________________________
CLASS:__________________________________________
Date
Date
Hospital
Time Time Total
In
Out Hours
Instructor
(Print)
Instructor
(Signature)
Department / Unit #
Time Time Total
In
Out Hours
Lead Paramedic
(Print)
Lead Paramedic
(Signature)
Instructor Feedback:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
Broward Public School
Lab and Clinical Binder
EMS Student Field Evaluation
Emergency Medical Technician
Preceptor:
We appreciate you allowing our student to ride with your agency to observe the daily
operations. This opportunity will provide them with time to practice their skills and
assessments during their scheduled field ride times. Please provide any comments and
feedback regarding their actions during this time. Each student has been provided with a
skills performance sheet to track their performance while in the field setting.
Student Name: __________
Place a X in the
corresponding column
Arrived/Left on time during
the scheduled times
Groomed and wearing the
correct uniform during the
scheduled time
Showed respect and
professionalism to all
patients and team members
Actively showed enthusiasm
and participated in all daily
activities/functions
Demonstrated skills and
assessments correctly and
had a willingness to learn
Satisfactory
Date: __________ Unit Number: _____
Unsatisfactory
Feedback/ Comments
Student Strengths:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Areas of Improvement:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Additional Comments:
________________________________________________________________
________________________________________________________________
________________________________________________________________
Preceptor Name: _______________
Preceptor Signature: _______________
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
180
Broward Public School
Lab and Clinical Binder
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
181
Broward Public School
Lab and Clinical Binder
HIPAA
Health Insurance Portability and Accountability Act 1996
Acknowledgement of Training
The Federal Government requires that all Healthcare Employees,
Healthcare Agencies, Healthcare Volunteers, and Healthcare
Students to complete training on HIPAA patient privacy.
I acknowledge and understand that patient information is
confidential and should not be shared.
I acknowledge that I have received HIPAA training, understand
patient privacy, and will abide by the rules and regulation regarding
to HIPAA.
Participant Name (Print):
_______________________________________________
Participant Name (Signature):
_______________________________________________
Date of Training:
_______________________________________________
Class number: ___________
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
182
Broward Public School
Lab and Clinical Binder
72 Hour Report Agreement Letter
Date: ________
I acknowledge that I have 72 hours (3 days) from the start of the ride
time to complete any reports and electronically send to the designated
instructor. Any report that is received beyond the 72 hour timeline will
not be accepted for the required 5 reports for the program. I further
acknowledge that I must request additional rescue ride hours if short
the 5 reports. Failure to complete the 5 reports prior to the completion
of the course could mean a delay in receiving an EMT course
completion certificate on the last day of class. Finally, I understand
that the rescue ride reports count for a grade. Any report graded as
unsatisfactory will be allowed to redo the report once. The student has
72 hours after receiving the failed report electronically by the
instructor to correct and resubmit. The resubmitted report will count
for final grade. Any resubmitted report with a second unsatisfactory
will be considered failing that graded portion of the class and could be
subjected for administrative withdraw.
Student (Print):
_____________________________________________________
Student Name (Signature):
_____________________________________________________
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
183
Broward Public School
Lab and Clinical Binder
MEDIA RELEASE
Date: ____________________________
I hereby give permission to the School Board of Broward County, Florida to
make audio and/or visual recordings or photographs of me and to use these
finished materials for educational purposes and/or to promote the positive
aspects of the Broward County Schools through communication media such as
newspaper and television. I further realize that all such uses and distribution
by the Broward County School Board shall be within their sole discretion.
Name (print)
Signature
Address
City
State
Zip Code
Registered Program:
Health Science Core (HSC)
Emergency Medical Technician – Basic (EMT-B)
Firefighter Minimum Standards
Emergency Vehicle Operations
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
184
Broward Public School
Lab and Clinical Binder
http://www.browardhealth.org/?id=1646&sid=1
1.
Annual Risk Management Course
2.
Broward Health Orientation & Exam
3.
Aspirations Precautions Education Packet
4.
Code of Conduct
5.
Data Security Form
6.
Flu Vaccination Course
7.
Hand Hygiene
8.
HIPAA/Compliance Program & Exam
9.
Student Influenza Declination Form
10. SBAR
11. Stroke Awareness
12. Student Responsibility Form
13. Team Collaboration Course
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
185
Broward Public School
Lab and Clinical Binder
Town of Davie Fire Rescue Department
Release and Hold Harmless
Request for Permission to Ride as an Observer and Hold Harmless
Agreement
The undersigned being over the age of eighteen (18) does hereby request the Town of Davie, Broward
County, Florida for permission to ride as an observer only in an authorized Town of Davie motor vehicle
unit.
IN CONSIDERATION of the permission granted __________________________ by the
Town of Davie to ride as an observer with the Town of Davie Fire Rescue Department and any related
events and activities, I, the undersigned for myself, my heirs, assigns and administrators, HEREBY
RELEASE, WAIVE AND FOREVER DISCHARGE THE TOWN OF DAVIE AND
ITS AGENTS, OFFICERS AND EMPLOYEES from all liability to the undersigned, my
heirs, assigns and administrators, of and from all claims and demands, actions and causes of action,
damages, losses and liabilities, costs, expenses and compensation on account of the death or injury to
myself or my property, and any and all know and unknown, foreseen and unforeseen damages and
consequence thereof caused by or arising out of my participation in the Leadership Program for the Town
of Davie.
This observation is for the purpose of my educational benefit. If permission is granted, I hereby
agree to obey, at all times, all instructors, orders and commands given to me by unit members in command
of any vehicle in which I may be riding. I fully realize and appreciate the basic nature of Emergency
Medical work and the possibility that a situation will arise which might result in my being exposed to the
danger of physical harm or injury, including but not limited to motor vehicle accidents through negligence
of third parties or the Town of Davie, I nevertheless, freely accept these risks.
I HAVE CAREFULLY READ THE FOREGOING RELEASE AND
WAIVER AND KNOW THE CONTENTS THEREOF AND HAVE SIGNED THIS
RELEASE AND WAIVER AS MY OWN FREE ACT.
This release and Waiver contains the entire agreement between the undersigned and the Town of
Davie and the terms of this Release and Waiver are contractual and not mere recital.
I expressly agree that this Release and Waiver is intended to be as broad and as inclusive as
permitted by law of the State of Florida, and that if any portion, thereof is held invalid, it is agreed that the
balance shall notwithstanding, continue in full force and effect.
Name: ___________________________________________________________
Age: ___________ Phone:__________________________________________
Address:_________________________________________________________
_________________________________________________________________
Driver’s License Number: ___________________________________________
Signature: ________________________________________________________
STATE OF FLORIDA
COUNTY OF
I, an officer authorized to take acknowledgements, hereby certify that this __________ day of
___________________, 20______, personally appeared before me ________________________, to me
well known to be the person described in and who executed the foregoing release, and acknowledged to me
that he/she executed the same freely and voluntarily for the uses and purpose therein.
_______________________________
Notary Public
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
186
Broward Public School
Lab and Clinical Binder
CITY OF PEMBROKE PINES
FIRE DEPARTMENT
LIABILITIY RELEASE AND INDEMNIFICATION
I, ________________________________, on this ____ day of ______________,
20____, request the permission of the City of Pembroke Pines Fire Department
to accompany the Paramedics on the Fire Department Emergency Medical
Rescue Vehicles of this City, during the course of emergency transportation and
emergency medical services, as performed by them, and for other duties which
they perform.
I realize the granting of this request by the City may include my accompanying
the above on vehicle owned and operated by the City. I further realize that the
City is allowing me to accompany the Paramedics at my own request and with
considerable benefit to me. In consideration of the granting of this request, I
hereby agree to:
1. Discharge the City of Pembroke Pines, a municipal corporation, in
Broward County, Florida, its successors and assigns, from any and all
claims, demands, damages, actions and causes of action, present and
future, whatsoever which I may have as a result of any injuries which may
occur during my accompanying of the Paramedics, as described above;
2. Indemnify the City of Pembroke Pines, its successors and assigns from
any and all loss, liability or damages which may occur due to my
participation in this program and accompanying of the Paramedics as
described above;
3. Agree to pay all attorneys fees and cost which may be incurred by
litigation arising from this release and indemnification and the matter
described herein.
________________________________
Witness
______________________________
Signature of Rider
________________________________ _______________________________
Witness
Date
Broward Public Schools – McFatter Technical College/Broward Fire Academy
2600 SW 71 Terrace
Davie, FL 33314
754-321-1300
187