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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 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

Clear Signature