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CPR for EMTs
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*EXTREMELY IMPORTANT!!

Only check ( ✓ ) mark FAILED areas!

EMT student ID's are usually in this format: 123456FT-01. For refresher or skills only, place "CE" in this field

Note: Validation of a Student ID may take up to 30 seconds to complete. You may continue filling out this form while validation is in progress.

Safety of the Scene and Individuals
Verbalizes and properly addresses safety of the scene
Recognizes when a scene is unsafe
Verbalizes and properly addresses safety of self, others and the victim
Takes appropriate precautions (gloves, etc…)
Level of Responsiveness/Consciousness & Assessment
Checks to see if the victim is conscious
Verbalizes the victims level of responsiveness
Places/Ensures the victim is in the appropriate position
Compressions/Circulation
Checks for a pulse
Provides the appropriate number of chest compressions (if applicable)
Airway & Breathing
Properly opens the airway
Assesses the airway for foreign objects
Looks for breathing
Listens for breathing
Feels for breathing
Provides the appropriate number of breaths
Safety of the Scene and Individuals
Verbalizes and properly addresses safety of the scene
Recognizes when a scene is unsafe
Verbalizes and properly addresses safety of self, others and the victim
Takes appropriate precautions (gloves, etc…)
Level of Responsiveness/Consciousness & Assessment
Checks to see if the victim is conscious
Verbalizes the victims level of responsiveness
Determines the need for intervention
For Responsive Patient
For an Adult/Child: Ensures abdominal thrusts are performed in an effective manner; For an Infant: Provides 5 back blows followed by 5 chest thrusts in an alternating manner until the object is expelled or the person becomes unconscious
Note: If this criteria is marked as deficient, the student fails the evaluation.
For the Unresponsive Patient (Simulate/Ask: What would you do if the person becomes unconscious?)
For an Adult: Assists the patient to the ground in a gentle manner and verbalizes the need to perform CPR; For a Child/Infant: Assists the patient to the ground in a gentle manner (if applicable) and verbalizes the need to perform CPR.
Note: If this criteria is marked as deficient, the student fails the evaluation.
Continuation
Alerts 9-1-1
Verbalizes a continuous need for continuous care/assessment until help arrives

**A score of 80% or higher is required in each age group to successfully pass the evaluation. A student cannot receive
more than three (3) deficiencies in each area (e.g. adult, child or infant evaluated separately) to pass. Student may attempt this skill 3 times maximum before needing to schedule a separate CPR class. 

Administrative Section

Note: EMT Student Candidate Name (Not Refresher) will populate automatically below. If the name has not been populated or the name is incorrect, contact customer service to get the correct STUDENT ID NUMBER.
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