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Under the direct supervision of a preceptor, the Basic EMT student will observe, participate and demonstrate the following skills. Please rate the student in each category listed, on the scale provided: 1 being poor, and 5 being outstanding. N indicates that the category is not applicable to the experience being evaluated. In the Comment section, please elaborate on both strong and weak performance areas, and include specific suggestions for continued development and improvement.

PREPARATION
Participate in vehicle/rig check
Receipt of dispatch information
Pre-arrival plan/preparation
Scene size-up/management
Initial patient assessment
PATIENT CONTACT
Chief complaint
History of present illness/injury
Past medical history
Medications
Allergies
Focused history and detail physical exam (rapid or focused examination
Ongoing assessment
VITAL SIGNS
Level of consciousness (AVPU)
Pulse rate & quality
Respiratory rate & quality
Blood pressure by auscultation/palpation
AIRWAY/BREATHING MANAGEMENT
Oral suctioning
Oral/nasal airway insertion
Oxygen therapy (nonrebreather mask or nasal cannula
Ventilatory assistance (BVM)
Chest compressions during CPR
Assessment of breath sounds
CIRCULATORY MANAGEMENT
Bleeding control measures
Bandaging
MAST application (if occasion arises)
SPLINTING – TRACTION/FIXED
Assessment of painful, swollen deformed extremity
Selection of appropriate device
Application of device
SPINAL IMMOBILIZATION
KED (or similar) application
Wooden shortboard application
Use of longboard
Standing Takedowns
ASSESSMENT OF MEDICAL PATIENTS
Initial assessment
Focused history and detailed physical exam
Ongoing assessment
Appropriate treatment
Assisting patient with medications
Nitro tablets/spray
Non-steroid inhalers
Oral glucose
EpiPen
LIFTS, MOVES AND CARRIES
Emergency/non-urgent moves
Patient transfer
Wheeled stretcher
Reeves stretcher
Stair chair
OTHER
Participates in run review
Assists with cleaning, restocking of vehicle
Prepares for next run
OBSERVATION ONLY
Documentation/communications with hospital
Any and all invasive and/or advanced skills
Clear Signature
Clear Signature

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