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

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Military Time Only (example: 1523)

Skills Section

Action

Points Possible

Points Awarded

Takes or verbalizes appropriate PPE precautions

1

Determines the scene/situation is safe

1

Checks patient responsiveness

1

Direct assistant to retrieve AED

1

Requests additional EMS assistance

1

Checks breathing and pulse simultaneously

1

NOTE: After checking responsiveness, then checking breathing and pulse for no more than 10 seconds,
examiner informs candidate, “The patient is unresponsive, apneic and pulseless.”

Immediately begins chest compressions [adequate depth and rate; allows the chest to recoil completely]

1

Performs 2 minutes of high-quality, 1-rescuer adult CPR
-Adequate depth and rate (1 point)
-Correct compression-to-ventilation ratio (1 point)
-Allows the chest to recoil completely (1 point)
-Adequate volumes for each breath (1 point)
-Minimal interruptions of no more than 10 seconds throughout (1 point)

5

NOTE: After 2 minutes (5 cycles), candidate assesses patient and second rescuer resumes compressions while
candidate operates AED.

Turns on power to AED

1

Follows prompts and correctly attaches AED to patient

1

Stops CPR and ensures all individuals are clear of the patient during rhythm analysis

1

Ensures that all individuals are clear of the patient and delivers shock from AED

1

Immediately directs rescuer to resume chest compressions

1

Military Time Only (example: 1523)

Critical Criteria Section

Critical Criteria

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.
Candidate:
Examiner:
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