Naloxone Administration (California Only)
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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

Takes appropriate PPE precautions

1

Ensures the scene is safe

1

Completes a primary assessment of the patient

1

1

Completes a secondary asessment of an opiod overdose

1

Verbalizes the signs and symptoms of an opiod overdose

1

Verbalizes the criteria for assisting the patient with their medication

1

Verbalizes the mechanism of action for naloxone

1

SELECTS CORRECT MEDICATION BY IDENTIFYING

Right Patient

1

Right Medication

1

Right dosage/concentration

1

Right time

1

Right route

1

ALSO CHECKS MEDICATION FOR

Clarity

1

Expiration Date

1

VERBALIZES MEDICATION SPECIFIC INFORMATION

Verbalizes the onset of action and duration of naloxone

1

Verbalizes the indications for administration of naloxone

1

Verbalizes the contraindications for administration of naloxone

1

Verbalizes the side effects of naloxone

1

CONTINUED CARE, ADMINISTRATION AND DISPOSAL

Calls for an ALS support unit

 

1

Demonstrates safe and proper administration of naloxone

 

1

Verbalizes proper disposal of naloxone

 

1

Military Time Only (example: 1523)

Critical Criteria Section

Critical Criteria

Administrative Section

Clear Signature