Penetrating Chest Injury (California Only)

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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 appropriate PPE precautions

Point 1

Ensures the scene is safe

Point 2

Covers the open wound with a gloved hand

Point 3

Listens to Lung Sounds

Point 4

Places an appropriate chest seal such as occlusive dressing with 3 taped sides

Point 5

Consider priority (immediate) transport to a trauma facility

Point 6

Initiates steps to prevent heat loss from the patient

Point 7

Properly positions the patient

Point 8

Administers high concentration Oxygen

Point 9

Total Points (Out of 9)

Layout Result 3

Actual Time Ended:

Military Time Only (example: 1523)

Critical Criteria Section

Critical Criteria

Failure to take appropriate PPE precautions
Failure to administer high concentration oxygen
Failure to seal wound using correct procedures in a timely manner
Failure to indicate the need for immediate transportation
Failure to manage the patient as a competent EMT
Uses or orders a dangerous or inappropriate intervention
Failure to transport within 10 minutes

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

Skills Section

Critical Criteria Section

Administrative Section

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