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Candidate:
EMT student ID’s are usually in this format: 123456FT-01. For refresher or skills only, place “CE” in this field
Examiner:
Military Time Only (example: 1523)

Skills Section

Action

Points Possible

Points Awarded

Selects, checks, and assembles equipment Traction splint with all associated equipment (ankle hitch, straps, etc.)

1

Padding material

1

Splints femur Takes or verbalizes appropriate PPE precautions

1

Directs application of manual stabilization of the injured leg (not necessary when using a unipolar device [Sagar® or similar] that is immediately available)

1

Directs application of manual traction (not necessary when using a unipolar device,

1

Assesses motor, sensory, and distal circulation in the injured extremity

1

Prepares/adjusts the splint to proper length

1

Positions the splint at the injured leg

1

Applies proximal securing device (e.g., ischial strap)

1

Applies distal securing device (e.g., ankle hitch)

1

Applies appropriate mechanical traction

1

Positions/secures support straps

1

Re-evaluates proximal/distal securing devices

1

Reassesses motor, sensory, and circulatory functions in the injured extremity

1

Secures patient to the long backboard to immobilize the hip

1

Secures the traction splint/legs to the long backboard to prevent movement of the splint

1

Affective Accepts evaluation and criticism professionally

1

Shows willingness to learn

1

Interacts with simulated patient and other personnel in professional manner

1

Military Time Only (example: 1523)

Critical Criteria Section

Critical Criteria

Administrative Section

Clear Signature