NREMT Skill – Bleeding Control/Shock Management – Emergency Medical Services University, LLC

Bleeding Control/Shock Management

Please enable JavaScript in your browser to complete this form.

Candidate:

First

Last

Student ID:

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

Examiner:

First

Last

Date:

Actual Time Started

Military Time Only (example: 1523)

Skills Section

Action

Points Possible

Points Awarded

Takes or verbalizes appropriate PPE precautions

1

Point 1

Applies direct pressure to the wound

1

Point 2

Applies tourniquet

1

Point 3

Properly positions the patient

1

Point 4

Administers high concentration oxygen

1

Point 5

Initiates steps to prevent heat loss from the patient

1

Point 6

Indicates the need for immediate transportation

1

Point 7

Total Points (Out of 7)

Actual Time Ended

Military Time Only (example: 1523)

Point Started Actual

Critical Criteria Section

Critical Criteria

Failure to take or verbalize appropriate PPE precautions
Failure to administer high concentration oxygen
Failure to control hemorrhage using correct procedures in a timely manner
Failure to indicate the need for immediate transportation
Failure to manage the patient as a competent EMT
Exhibits unacceptable affect with patient or other personnel
Uses or orders a dangerous or inappropriate intervention

Notes

Administrative Section

Instructor State

Exam Location

Instructor Certification Number

Attempt 1 Result

Attempt 2 Result

Attempt 3 Result

Instructor Signature

Clear Signature

EMS University