Lab and Clinical Binder - Broward County Public Schools. Book store... · Lab and Clinical Binder 1 Broward Public Sch ools – McFatter Technical College/Broward Fire Academy 2600

Broward Public School Lab and Clinical Binder

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Broward Public Schools – McFatter Technical College/Broward Fire Academy 2600 SW 71 Terrace Davie, FL 33314 754-321-1300

Lab and Clinical Binder

Section 1 – Lab Skills Page 3 Section 2 – Lab Handouts

Code of ethics Page 148 DNRO form Page 150 START triage algorithm Page 151 JumpSTART triage algorithm Page 152 All Risk Triage Tag Page 153 Glasgow Coma Scale Page 154 APGAR Score Page 155 Rule of Nines Page 156 CPR and FBAO Comparison Chart Page 157 Jumpkit Inventory Page 158 Approved Abbreviations Page 160 Trauma Transport Form Page 162 Telemetry Report form Page 164

Section 3 - Clinical Performance Skills Page 166

Section 4 - Clinical Reporting Forms Page 176 Section 5 - Clinical Attendance Forms Page 179 Section 6 – Student Paperwork

HIPPA Page 182 72 Hour Reporting Policy Page 183 Media Release Page 184 Broward Health Required Documents Page 185 Town of Davie Ride Release Page 186 City of Pembroke Pine Ride Release Page 187 City of North Lauderdale Ride Release Page 188


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1. POWER LIFTING

Equipment: None

Procedure:

1. Get as close to the object as you can. 2. Spread your legs shoulder width apart. 3. Bend your knees and squat down. 4. Lock your back into an upright position and tighten abdominal muscles. 5. When lifting with other students, one person should be coordinating the lift. 6. Lift up by using your legs. 7. Keeping your back locked upright position while completing the lifting motion.

Critical Criteria:

1. Prevents injury to self by using correct technique.


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2. CRADLE CARRY

Equipment:

None Procedure: 1. Adjust the patient in supine position.

2. Student squats to the level of the patient.

3. Student places one arm under the patient’s legs.

4. Student places other arm under the patient’s back.

5. Stand up. Critical Criteria: 1. Able to carry 10’. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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3. EXTREMITY CARRY

Equipment: None Procedure: 1. Two students will work together to reposition the patient to a sitting position. 2. Student one will go behind the patient and squat down into a lifting position.

3. The student will then position his arms under the patient’s arms and grasp the

patient’s opposite wrist. • Student’s right hand with patient’s left wrist. • Student’s left hand with patient’s right wrist.

4. Student two will squat in between the patient’s legs and face the patient’s feet. 5. Student two will grab under the patient’s knees.

6. Student one will give the command to power lift and move the patient.

Critical Criteria: 1. Able to carry 10’. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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4. FIREFIGHTER’S CARRY Equipment:

None Procedure: 1. Adjust patient on his back, with arms laid along the torso, and the knees bent.

2. Student’s feet on the feet of the patient to hold in place.

3. Grasping the patient’s hands and lean back to use the weight to help lift the

patient.

4. As patient lefts up, duck your shoulder into the midsection and stand up.

5. One arm around patient’s leg and other arm holding patient’s arm. Critical Criteria: 1. Able to carry 10 feet. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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5. PACK STRAP CARRY Equipment:

None Procedure: 1. Adjust the patient so he is standing and facing the student.

2. Student needs to turn his / her back to the patient and squat down slightly. 3. Advise patient to place arms over the student’s shoulders.

4. Student will pull the patient’s onto his / her back, so that the armpits are

resting on his / her shoulders.

5. Hold the patient by the wrist.

6. Stand up. Critical Criteria: 1. Able to carry 10’. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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6. EMERGENCY ARM DRAG

Equipment:

None Procedure: 1. Student will position the patient in the supine position. 2. Student will kneel at the patient’s head and face the patient. 3. Student will grab both of the patient’s wrists. 4. Student will pull backwards to a safe area. 5. Student will observe proper body mechanics. Critical Criteria: 1. Able to drag for 10 feet. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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7. EMERGENCY BLANKET DRAG Equipment:

Blanket Procedure: 1. Take the blanket next to patient. 2. Log roll patient away from the blanket and push the blanket next to the

patient’s back (get some of the blanket side under the patient). 3. Roll patient back to supine position and log roll patient toward the blanket. 4. Pull the blanket away from the patient and roll the patient back to supine

position. 5. Student will wrap the patient in the blanket. 6. Student will grasp the blanket under or alongside the head and neck. 7. Student will pull the patient backwards using the blanket to a safe area. 8. Student will observe proper body mechanics. Critical Criteria: 1. Able to drag for 10 feet. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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8. EMERGENCY CLOTHES DRAG Equipment:

None Procedure: 1. Student will position the patient in the supine position. 2. Student will kneel at the patient’s head and face the patient. 3. Student will grab the patient’s clothing (shirt), while supporting the victim’s

head in his/her forearms. 4. Student will pull backwards to a safe area. 5. Student will observe proper body mechanics. Critical Criteria: 1. Able to drag for 10 feet. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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9. EMERGENCY FIREFIGHTER’S DRAG Equipment:

Cravat or item to tie patient’s hands Procedure: 1. Students will reposition the patient to a supine position. 2. Student will tie the patient’s hands together with cravats or similar item. 3. The student will straddle the patient’s body and pass his/her head through the

patient’s arms. 4. Student will raise his/her upper body to allow the patient to be lifted off the

floor slightly. 5. Student will crawl on the hands and knees and drag the patient to a safe area. 6. Student will observe proper body mechanics. Critical Criteria: 1. Able to drag for 10’. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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10. EMERGENCY SHOULDER OR ARM-TO-ARM DRAG

Equipment:

None Procedure: 1. One or two students will work together to reposition the patient to a sitting

position. 2. Student one will go behind the patient and kneel down. 3. Position his / her arms under the patient’s arms and grasp the patient’s

opposite wrist.

• Student’s right hand with patient’s left wrist • Student’s left hand with patient’s right wrist

4. Pull backwards to a safe area (crouching or standing position). Critical Criteria: 1. Able to drag for 10 feet.

2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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11. BLANKET LIFT TO STRETCHER Equipment:

Sheet, blanket and stretcher. Procedure: 1. Prepare stretcher in the appropriate direction and height level. 2. Take the blanket next to patient and roll the blanket lengthways for half of its

width. 3. Log roll patient away from the blanket and push the rolled section of blanket

next to the patient’s back. 4. Roll patient back to supine position and log roll patient toward the blanket. 5. Pull the rolled section of blanket away from the patient and roll the patient

back to supine position. 6. Roll both sides of the blanket next to the patient. Both sides of the sheet

should be rolled close to the patient’s body to provide handgrips for the students.

7. Student on both sides of the patient will grab the rolled edge of the sheet and

lift on the command of the student at the patient’s head. 8. Students will gently move the patient to the stretcher. 9. Third student:

• If patient is carried, third student should support stretcher to prevent movement as the patient is lowered.

Or

• If patient is on the bed and the stretcher is next to the bed, third student should provide assist with pulling the patient onto the stretcher.


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11. BLANKET LIFT TO STRETCHER 10. Secure the patient to the stretcher with waist and leg straps. 11. Raise stretcher to normal height upon command of the person at the

stretcher’s feet. Critical Criteria: 1. Prevents further aggravation / injury to the patient. 2. Prevents injury to self by using correct technique.


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12. DIRECT GROUND LIFT TO STRETCHER Equipment:

Stretcher Procedure: 1. Prepare stretcher in the appropriate direction and height level. 2. First student uses their arms to support the head and shoulders. 3. Second student uses their arms to support the hip and legs. 4. On command of the student at the patient’s head, both students will lift in

unison and curl the patient toward their chest. 5. Slowly walk the patient into position over the stretcher and gently lower. 6. Third student should support stretcher to prevent movement as the patient is

lowered. 7. Secure the patient to the stretcher with waist and leg straps. 8. Raise stretcher to normal height upon command of the person at the

stretcher’s feet. Critical Criteria: 1. Prevents further aggravation / injury to the patient. 2. Prevents injury to self by using correct technique.


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13. EXTREMITY LIFT TO STRETCHER

Equipment: Stretcher Procedure: 1. Prepare stretcher in the appropriate direction and height level. 2. Two students will work together to reposition the patient to a sitting position. 3. Student one will go behind the patient and squat down into a lifting position. 4. Position his / her arms under the patient’s arms and grasp the patient’s opposite

wrist.

• Student’s right hand with patient’s left wrist. • Student’s left hand with patient’s right wrist.

5. Student two will squat in between the patient’s legs and face the patient’s head. 6. Grab under the patient’s knees. 7. Student one will give the command to power lift and move the patient. 8. Students will then move the patient to the stretcher and gently lower. 9. Secure the patient to the stretcher with waist and leg straps. 10. Raise stretcher to normal height upon command of the person at the stretcher’s

feet.

Critical Criteria: 1. Prevents further aggravation / injury to the patient. 2. Prevents injury to self by using correct technique.


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14. WALKING ASSIST Equipment:

None Procedure: 1. Assist patient in standing position. 2. Student stands on the side of the patient. 3. Student wraps in inside hand around the patient’s waist. 4. Patient wraps arm around the student’s neck and the student grabs the

patient’s wrist with his / her outside hand. 5. Slowly beginning walking the patient. Critical Criteria: 1. Able to carry 10’. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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15. ADULT ONE-RESCUER CPR Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Check for scene safety. 3. Check Unresponsiveness.

• Tap the victim or sternal rub. • Ask if the person is “all right” or “okay”.

4. Open airway - Hyperextend the neck.

• Head tilt / chin lift - Place palm of one hand on forehead and the fingers of other hand under the lower jaw to lift the chin and move the head back.

5. Check breathing.

• Place near patient’s nose and mouth for 5 -10 seconds. • Look for chest rise, feel for breath on the cheek, and listen for breath.

6. Give 2 ventilations.

• Exhale breath should take approximately 1 second each. • Look at chest rise.

7. Check carotid pulse.

• Place 2 or 3 fingers on the Adam’s apple (windpipe) and slide down to the groove between the Adam’s apple and neck muscle.

• Check for 5 – 10 seconds.


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15. ADULT ONE-RESCUER CPR 8. 30 compressions.

• Place heel of one hand in the center of the chest between the nipples. Place the other hand on top of the first hand extended or interlace fingers.

• Kneeling alongside victim, the compressions should be pushed “fast” at a

rate of at least 100 compressions per minute, should be pushed “hard” at a depth of 1 ½ to 2 inches, and should allow chest to return to normal position.

9. Repeat 2 ventilations and 30 compressions. Critical Criteria: 1. Did not ventilate immediately after determining no respirations. 2. Did not locate pulse location. 3. Did not provide compressions at the correct depth and rate. 4. Did not allow for full chest recoil.


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16. ADULT TWO-RESCUER CPR / AED Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Check for scene safety. 3. Student one checks unresponsiveness.


4. Student two goes to locate AED. 5. Student one opens airway - Hyperextend the neck.


6. Student one checks breathing.

• Place near patient’s nose and mouth for 5 -10 seconds.

• Look for chest rise, feel for breath on the cheek, and listen for breath. 7. Student one gives 2 ventilations.



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16. ADULT TWO-RESCUER CPR / AED 8. Student one checks carotid pulse.



9. Student one begins 30 compressions.



rate of at least 100 compressions per minute, should be pushed “hard” at a depth of 1 ½ to 2 inches, and should allow chest to return to normal position.

• Repeat 2 ventilations and 30 compressions.

10. Student two arrives with AED and applies A.E.D. pads to patient according to

manufacture recommendation without interrupting CPR. • Push "power" button. • Stop CPR when the AED prompts for automatically analyzing of rhythm or

student pushes "analyze" button. • If A.E.D. advises to push “shock” button, clear patient.

• “Head clear, feet clear, and I’m clear”, push "shock" button.

11. Student two immediately resumes compressions and student one performs

synchronized ventilation.

• 30 compressions to 2 ventilations. 12. After 2 minutes of uninterrupted compressions, AED will prompt or

automatically check for pulse and “Analyze” patient’s rhythm.


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16. ADULT TWO-RECUER CPR / AED Critical Criteria: 1. Did not ventilate immediately after determining no respirations. 2. Did not locate pulse location. 3. Did not provide compressions at the correct depth and rate. 4. Did not allow for full chest recoil. 5. Did not apply pads in correct location. 6. Immediately resumes compressions after delivering AED defibrillation. 7. Determined everyone was not touching the patient prior to delivering the

defibrillation.


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17. CHILD ONE-RESCUER CPR Equipment:

None

Procedure: 1. Take body substance isolation precautions. 2. Check for scene safety. 3. Check Unresponsiveness.


4. Open airway - Hyperextend the neck.


5. Check breathing.




7. Check carotid pulse.




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17. CHILD ONE-RESCUER CPR

8. 30 compressions.

• Place heel of one hand on the center of the chest between the mid-nipple line.

or

• Use heel of one hand on the center of the chest between the mid-nipple line and second hand on top of the first hand extended or interlace fingers.

• Kneeling alongside victim, the compressions should be pushed “fast” at a rate of at least 100 compressions per minute, should be pushed “hard” at a depth of 1/3 to 1/2 the depth of the chest wall, and should allow chest to return to normal position.



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18. INFANT ONE-RESCUER CPR Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Check for scene safety. 3. Check Unresponsiveness.


4. Open airway – Neck in neutral position.


5. Check breathing.




7. Check brachial pulse.

• With the palm facing up, position the arm out and slightly bent at the elbow. Take 2 or 3 fingers and place them midsection of the arm between the bicep muscle and humerus bone.



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18. INAFANT ONE-RESCUER CPR 8. 30 compressions.

• Place 2 fingers on the center of the chest just below the mid-nipple line. • Kneeling alongside victim, the compressions should be pushed “fast” at a

rate of at least 100 compressions per minute, should be pushed “hard” at a depth of 1/3 to 1/2 the depth of the chest wall, and should allow chest to return to normal position.



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19. INFANT TWO-RESCUER CPR Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Check for scene safety. 3. Student one check unresponsiveness.


4. Student one open airway – Neck in neutral position.


5. Student one check breathing.


6. Student one gives 2 ventilations.


7. Student two check brachial pulse.

• With the palm facing up, position the arm out and slightly bent at the elbow. Take 2 or 3 fingers and place them midsection of the arm between the bicep muscle and humerus bone.



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19. INFANT TWO-RESCUER CPR 8. Student two performs 15 compressions.

• Place two thumbs at center of breast bone just below the mid-nipple line and squeeze the infants posterior chest with the encircled fingers.


rate of at least 100 compressions per minute, should be pushed “hard” at a depth of 1/3 to 1/2 the depth of the chest wall, and should allow chest to return to normal position.



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20. RECOVERY POSITION Equipment:

None Procedure: 1. Determine patient has no spinal injury. 2. Student kneels beside the victim and straightens the victim’s legs. 3. Student grabs the patient’s leg and shoulder to roll towards himself / herself. 4. Adjust top leg so that both hip and knee are bent at a right angle. 5. Adjust bottom arm to support patient’s head and prevent the mouth from

touching the ground. 6. Evaluates respiratory function for compromise. Critical Criteria: 1. Prevents further aggravation / injury to the patient.



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21. ADULT CONSCIOUS / UNCONSCIOUS FOREIGN BODY AIRWAY OBSTRUCTION

Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Check for scene safety. 3. Determine patient is choking.

• Can not speak, breath, and cough. 4. Confirm patient is choking; ask patient “Are you choking”.

• Nods head yes.

• Holds hands around neck in the “universal” sign. 5. Perform sub-abdominal thrusts:

• Stand behind patient. • Position one foot forward and one foot back.

• Position one arm around the patient’s abdominal area and make the hand

into a fist. Place the fist midway between the naval and xiphoid process bone. Position the other arm around the patient’s abdominal area and wrap it around the fist.

• Pull hands inward and upward motion.

6. Continue sub-abdominal thrusts till:

• Object comes out. Or

• Patient goes unconscious.


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21. ADULT CONSCIOUS / UNCONSCIOUS FOREIGN BODY AIRWAY OBSTRUCTION

7. Determine patient is unconscious and gently lower to the ground. 8. Visualize mouth for foreign body.

a. If object is seen, use a finger sweep to remove.

b. If no object seen, then proceed to next step. 9. Attempt to ventilate.

a. If blocked, reposition and ventilate again. Still blocked; then proceed to next step.

b. If chest rises, determine if patient is breathing and circulation.

10. Provide 30 chest compressions.


• Kneeling alongside victim, the compressions should be pushed “hard” at a

depth of 1 ½ to 2 inches, and should allow chest to return to normal position.

11. Repeat steps 8 to 10 till object is removed. Critical Criteria:

1. Improperly positioned hands for sub-abdominal thrusts. 2. When lowering unconscious patient to the ground, do not allow head to fall to

the ground. 3. Did not check for object prior to ventilation every time the cycle is repeated. 4. Did not provide compressions at the correct depth. 5. Did not allow for full chest recoil. 6. Evaluates breathing and circulation after object is removed.


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22. CHILD CONSCIOUS / UNCONSCIOUS FOREIGN BODY AIRWAY OBSTRUCTION

Equipment:


• Can not speak, breath, and cough. 4. Confirm patient is choking; ask patient “Are you choking”.

• Nods head yes.

• Holds hands around neck in the “universal” sign. 5. Perform sub-abdominal thrusts:

• Stand or kneel behind patient. • If standing, position one foot forward and one foot back.

• Position one arm around the patient’s abdominal area and make the hand

into a fist. Place the fist midway between the naval and xiphoid process bone. Position the other arm around the patient’s abdominal area and wrap it around the fist.

• Pull hands inward and upward motion.

6. Continue sub-abdominal thrusts till:




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a. If object is seen, use a finger sweep to remove.

b. If no object seen, then proceed to next step. 9. Attempt to ventilate.

c. If blocked, reposition and ventilate again. Still blocked; then proceed to next step.

d. If chest rises, determine if patient is breathing and circulation.

10. Provide 30 chest compressions.

• Place heel of one hand on the center of the chest between the mid-nipple line.

Or

• Use heel of one hand on the center of the chest between the mid-nipple line and second hand on top of the first hand extended or interlace fingers.

• Kneeling alongside victim, the compressions should be pushed “hard” at a

depth of 1/3 to 1/2 the depth of the chest wall, and should allow chest to return to normal position.

11. Repeat steps 8 to 10 till object is removed.


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Critical Criteria: 1. Improperly positioned hands for sub-abdominal thrusts. 2. When lowering unconscious patient to the ground, do not allow head to fall to

the ground. 3. Did not check for object prior to ventilation every time the cycle is repeated. 4. Did not provide compressions at the correct depth. 5. Did not allow for full chest recoil. 6. Evaluates breathing and circulation after object is removed.


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23. INFANT CONSCIOUS / UNCONSCIOUS FOREIGN BODY AIRWAY OBSTRUCTION

Equipment:


• Can not speak, breath, and cough. 4. Confirm patient is choking.

• Holds hands around neck in the “universal” sign. • Skin color turning blue.

5. Perform 5 back slaps:

• Cradle patient in one hand with the head in the palm. Position fingers in a “V” formation to allow for head support and object removal.

• Position patient in a downward direction and utilize the other hand to slap

between the shoulder blades. 6. Perform 5 chest thrusts:

• Position patient into a supine position and place 2 fingers on the center of the chest just below the mid-nipple line.

• Compressions should be pushed “hard” at a depth of 1/3 to 1/2 the depth

of the chest wall, and should allow chest to return to normal position.


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23. INFANT CONSCIOUS / UNCONSCIOU FOREIGN BODY AIRWAY OBSTRUCTION

7. Continue back slaps and chest thrust till:




e. If object is seen, use a finger sweep to remove.

f. If no object seen, then proceed to next step. 10. Attempt to ventilate.

g. If blocked, reposition and ventilate again. Still blocked; then proceed to next step.

h. If chest rises, determine if patient is breathing and circulation.

11. Provide 5 back slaps and 5 chest thrusts. 12. Repeat steps 9 to 11 till object is removed Critical Criteria: 1. Improperly positioned patient for back slaps and chest thrusts. 2. Did not check for object prior to ventilation every time the cycle is repeated. 3. Did not provide compressions at the correct depth. 4. Did not allow for full chest recoil. 5. Evaluates breathing and circulation after object is removed.


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24. PROPER GLOVE REMOVAL TECHNIQUE Equipment: Gloves Procedure: 1. Partially remove the first glove by pinching the glove at wrist and folding it

down part way (careful to only touch the outside of the glove). 2. Apply the same technique to the second glove, but completely remove the glove

inside-out and off the hand.

3. Grab the inside part of the glove on the first hand and completely removing the glove inside-out.

4. Dispose gloves in bio-hazard bag. 5. Student washes hands by appropriate method.

Critical Criteria: 1. Correctly removes gloves.


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25. DIAGNOSTIC VITAL SIGNS

Pulse (Radial) Equipment:

None Procedure: 1. Locates the radial artery (anterior thumb side of wrist). 2. Palpate pulse using two fingers. 3. Counts number of beats

• 15 seconds multiplied by 4 • 30 seconds multiplied by 2

4. Determines quality • Strong • Weak • Regular • Irregular

Respirations Equipment:

None Procedure: 1. Observe rise and fall of patient’s chest

• 30 seconds multiply by 2 • 15 seconds multiply by 4

2. Determine quality • Normal • Shallow • Labored • Noisy


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Skin Perfusion

Equipment:

None Procedure: 1. Feel patient’s skin to determine extreme temperatures

• Hot • Warm • Cool • Cold

2. Feel patient’s skin to determine condition • Dry • Moist

3. Depress patient’s finger nail for blood return • Normal < 2 seconds • Abnormal > 2 seconds

Pupils Equipment:

Pen light Procedure: 1. Maneuver pen light from the lateral side of the eye and shine over the pupil. 2. Perform the same maneuver on the other eye. 3. Determine reactivity.

• Fixed • Reactive • Sluggish


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4. Determine equality • Equal • Unequal

5. Determine pupil size • Dilated • Constricted • Normal

Auscultation of the Blood Pressure

Equipment: Blood pressure cuff and stethoscope Procedure: 1. Expose arm. 2. Apply the cuff around the arm (most cuffs have an indicator arrow that should

line up with the area of the brachial artery). 3. Palpate the brachial artery. 4. Place the stethoscope over the brachial artery. 5. Grasp the ball-pump, close the pressure control valve, and begin squeezing the

ball-pump. 6. Continue squeezing the ball-pump till at the desired pressure. 7. Slowly open the pressure control valve on the ball-pump and release air. 8. As the air releases from the blood pressure cuff, monitor the pressure gauge.

• Systolic number - first sound of heart beat.

• Diastolic number – no longer hearing the heart beat.


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9. Open the pressure control valve on the ball-pump all the way to release the rest of the air out of the cuff

Palpation of the Blood Pressure Equipment: Blood pressure cuff Procedure: 1. Expose arm. 2. Apply the cuff around the arm (most cuffs have an indicator arrow that should

line up with the area of the brachial artery). 3. Palpate the radial artery. 4. Grasp the ball-pump, close the pressure control valve, and begin squeezing the

ball-pump. 5. Continue squeezing the ball-pump till at the desired pressure. 6. Slowly open the pressure control valve on the ball-pump and release air. 7. As the air releases from the blood pressure cuff, monitor the pressure gauge.

• Systolic number - first feel of a heartbeat. • Diastolic number – not able to obtain with palpation.

8. Open the pressure control valve on the ball-pump all the way to release the rest of the air out of the cuff.

Oxygen Saturation Equipment: Pulse Oximetry device


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Procedure: 1. Choose the appropriate sensor probe for the patient’s age or size and connect to

device. 2. Prepare finger.

• Clean area of contaminates • Use nail polish remover for painted nail • Remove acrylic nail

3. Turn on device. 4. Compare displayed pulse rate with palpated radial rate.

Critical Criteria:

1. Assess all vital signs. 2. Uses all devices appropriately.


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26. SCENE SIZE-UP ASSESSMENT Equipment:

None Procedure: 1. Take body substance isolation precautions.

• Gloves.

• Eye protection.

• Mask.

• Gowns.

• Trauma sleeves. 2. Inspect the scene for safety (personal protection). 3. Determines the mechanism of injury or nature of illness. 4. Determines the number of patients. 5. Determines the need for additional resources. 6. Determines the need for spinal immobilization. Critical Criteria: 1. Identifies the appropriate protection for the incident provided. 2. Identifies situations on the incident that would cause personal injury. 3. Determines the cause of the incident.


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27. INITIAL ASSESSMENT Equipment:

None Procedure: 1. Scene Size-up.

• Take body substance isolation precautions. • Check for scene safety.

2. Student will perform an initial assessment. 3. Inspect general impression of the patient (visual assessment).

• Overall appearance.

• Level of distress.

• Patient characteristics. 4. Student one introduces himself / herself to the patient and obtains consent

for patient care. 5. Determine chief complaint. 6. Determine mental status.

• AVPU scale – Alert, Verbal, Pain, and Unresponsive.

• Orientation - Alert to person, place, time, and event. 7. Assess airway.

• Suspecting spinal injury - Student two kneels behind the head of the patient and applies manual immobilization of head in a neutral in-line position for trauma.


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27. INITIAL ASSESSMENT 8. Assess breathing. 9. Assess circulation. 10. Assess and control major external bleeding. 11. Assess perfusion.

• Color.

• Temperature.

• Condition.

• Capillary refill. 12. Identify priority and transport decisions. Critical Criteria: 1. Identifies life threatening situations.


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28. FOCUSED HISTORY EXAM Equipment:

Pen light, blood pressure cuff, stethoscope, and pulse oximeter. Procedure: 1. Scene Size-up.


2. Initial Assessment. 3. Student will perform a focused history exam. 4. Baseline vital signs.

• Pulse. • Respirations. • Blood Pressure. • Oxygen saturation. • Skin perfusion. • Pupils.

5. SAMPLE History.

• Signs and symptoms – includes OPQRST for certain incidents.

• Allergies. • Medications. • Pertinent past history.


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28. FOCUSED HISTORY EXAM

• Last oral intake. • Events leading to the injury or illness.

6. Complete Rapid physical exam. 7. Reevaluate transport decision. Critical Criteria: 1. Assess all vital signs. 2. Uses all devices appropriately. 3. Identifies all of the pertinent information from the patient.


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29. RAPID / PRIMARY PHYSICAL EXAM Equipment:

Stethoscope Procedure: 1. Scene Size-up.


2. Initial Assessment.

• Suspecting spinal injury - Student two kneels behind the head of the patient and applies manual immobilization of head in a neutral in-line position.

3. Student one will be performing a rapid exam and should inspect for DCAP

BTLS:

• Deformities • Contusions

• Abrasions • Punctures/penetrations • Burns • Tenderness • Lacerations • Swelling


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29. RAPID / PRIMARY PHYSICAL EXAM 4. Palpate the head and neck.

• Inspect for jugular vein distention. • Inspect for tracheal deviation. • Palpate for crepitus.

5. Suspected spinal injury - size and apply the appropriate cervical collar 6. Palpate the chest.

• Auscultate breath sounds on both sides of the chest. • Inspect for symmetrical chest rise and fall.

• Inspect for paradoxical motion. • Palpate for crepitus.

7. Palpate the abdomen in four quadrants.

• Palpate for rigidity. • Inspect for distension.

8. Palpate the pelvis.

• Compress downward and inward to identify any instability. 9. Palpate all four extremities.

• Palpate distal pulses at the dorsalis pedis or posterior tibial, and radial. • Inspect for motor function with wiggling toes and fingers.

• Inspect for sensory function with squeezing or pinching extremities.


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29. RAPID / PRIMARY PHYSICAL EXAM 10. With the assistance of other students, log roll patient.

• Suspected spinal injury will incorporate the use of the backboard.

11. Assess the back. 12. Complete focused history exam. 13. Reevaluate transport decision. Critical Criteria: 1. Moves the patient in a safe and effective manner. 2. Immediately takes manual immobilization of the head and neck for trauma

patient. 3. Completes a quick and through assessment.


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30. DETAILED / SECONDARY PHYSICAL EXAM

Equipment:

Pen light, stethoscope, and 4 x 4 gauze. Procedure: 1. Scene Size-up.


2. Initial Assessment. 3. Perform focused history and rapid physical exam. 4. Student will be performing a detailed physical exam and should evaluate for

DCAP BTLS:

• Deformities • Contusions

• Abrasions • Punctures/penetrations • Burns • Tenderness • Lacerations • Swelling

5. Assess the head.

• Inspect around the eyes and eyelids for redness. • Inspect the eyes for contacts.


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• Inspect the eyes for pupil function. Take pen light from the corner of the

eye and shine on to the pupil. Determine if the pupils are equal and reactive.

• Inspect behind the ears for Battle’s Signs (bruising).

• Inspect the ear canal for drainage of blood or spinal fluid. Use 4x4 gauze

folded in fours to identify spinal fluid inside blood by a halo.

• Palpate scalp for depressions of the skull.

• Palpate areas of the face like zygomas, maxillae, and mandible for instability.

• Inspect the mouth for cyanosis around the lips, foreign body (includes

dentures or loose teeth), and unusual odors.

• Inspect the nose. 6. Palpate the front and back of the neck.

• Inspect for jugular vein distention. • Inspect for tracheal deviation. • Inspect skin for crepitus (crackling) under the skin.

7. Palpate the chest over the ribs.

• Inspect for symmetrical chest rise and fall.

• Inspect for paradoxical motion.

• Auscultate anterior breath sounds at midaxillary and midclavicular area.

• Auscultate posterior breath sounds at the bases and apices area. • Palpate for crepitus.


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• Compress downward and inward on the iliac crest to identify any instability.

10. Palpate all four extremities.

• Inspect for medical alert bracelets. • Palpate dorsalis pedis or posterior tibial pulse, and radial pulse. • Inspect for motor function with wiggling toes and fingers.


11. With the assistance of other students, log roll patient. 12. Palpate the back. Critical Criteria: 1. Moves the patient in a safe and effective manner. 2. Did not neglect to assess any area of the patient. 3. Assessed appropriate areas for the type of mechanism of injury and chief

complaint.


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31. ONGOING ASSESSMENT

Equipment:

None Procedure: 1. Scene Size-up.


2. Initial Assessment. 3. Perform focused history and rapid physical exam. 4. Perform a detailed physical exam. 5. Student will perform an ongoing assessment. 6. Repeat initial assessment. 7. Reassess vital signs. 8. Repeat focused assessment. 9. Check interventions. Critical Criteria: 1. Evaluates the effectiveness of treatment measures.


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32. GLUCOMETER Equipment:

Glucometer, test strip, alcohol prep, 4 x 4 gauze, sharps box and lancet. Procedure: 1. Take body substance isolation precautions. 2. Open foil packet of the test strip and remove. 3. Insert test strip into meter. 4. Determine appropriate finger to obtain blood sample and use lancet to

puncture the skin. 5. Dispose lancet in sharps box. 6. Touch and hold the test strip tip in the drop of blood until meter beeps and

begins timer. 7. Remove test strip and dispose in red biohazard bag. 8. Place bandage on lanced site. 9. Read results on display. Critical Criteria: 1. Fails to dispose of lancet in sharps box. 2. Fails to dispose of test strip in red biohazard bag.


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33. SPIKING INTRAVENOUS (IV) BAG

Equipment:

IV Solution bag and Drop set or tubing Procedure: 1. Remove protective cover from the solution bag. 2. Remove the protective cover from the spike end of the tubing. 3. Slide the spike end of the tubing into the port on the solution bag. 4. Squeeze the drip chamber and fill solution to the fill line on the drip chamber. 5. Open the roller clamp wheel to allow the solution to flow through the tubing

and remove the air out of the tubing.

• May need to take the protective cover at the end of the tubing to allow the fluid to push out the air.

• Re-attach the cover when done.

6. Shut the roller clamp wheel when all of the air is out of the tubing. Critical Criteria: 1. Air bubbles left in the tubing. 2. Overfill drip chamber with fluid.


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34. LIMB LEAD PLACEMENT FOR ECHOCARDIOGRAM (ECG / EKG)

Equipment: Monitor, limb leads, electrode connecting wire, razor, and 4x4 gauze Procedure: 1. Take body substance isolation precautions. 2. Turn monitor "On" 3. Prepare patient's skin for electrode application.

• Remove excessive hair from the electrode sites (shaving). • Clean skin and dry it briskly with a towel or gauze.

4. Attach limb leads to electrode connecting cable. 5. Place Limb electrodes in the following location:

• RA - Right arm, upper arm or upper chest near the shoulder. • LA - Left arm, upper arm, or upper chest near the shoulder. • RL - Right leg or lower abdominal quadrant near the hip. • LL - Upper leg or lower abdominal quadrant near the hip.

6. Press print to record ECG. Critical Criteria: 1. Placed leads in wrong location.


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35. HOSPITAL TELEMETRY REPORT Equipment:

Radio Procedure: 1. Communicate to dispatch the patient priority level. 2. Connected to hospital. 3. Unit number. 4. Patient’s age and gender. 5. Patient chief complaint. 6. Brief history of the patient’s problem. 7. Brief description of physical findings and vital signs. 8. Care provided. 9. Requesting or not requesting any orders. 10. ETA to facility. Critical Criteria: 1. Clearly speaks on the radio. 2. Provides a concise picture of the situation.


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36. MANUAL IN-LINE STABILIZATION

Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Student one needs to evaluation the environment to determine the best

position to begin providing cervical immobilization.

• Behind the patient in a vertical position. • Front of patient in a vertical position.

• Behind the patient’s head in a horizontal position.

3. Place hands firmly around the base of the skull on either side. 4. Support lower jaw with index and long fingers and gently lift into neutral

position. 5. Student two applies cervical collar. 6. Secures to spinal device. Critical Criteria: 1. Adjusted the head in a neutral position forcefully or rapidly. 2. Failure to maintain neutral position as patient moves.


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37. APPLYING A CERVICAL COLLAR (C-COLLAR)

Equipment:

Cervical collar Procedure: 1. Take body substance isolation precautions. 2. Apply manual in-line stabilization. 3. Measure for proper collar size by placing one hand along the side of the

patient’s neck and determine length of neck. 4. Place the chin support onto the patient’s chin (When a patient is supine on the

ground, the collar should be slid under the neck prior to applying the chin support).

5. Wrap the collar around the neck and secure. 6. Inspect for proper fit. 7. Maintain manual in-line stabilization till secured to spinal device. Critical Criteria:

1. Release manual in-line stabilization prior to securing to spinal device.


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38. BACKBOARD IMMOBILIZATION – SUPINE

Equipment: Long spine board, 4 sets of straps, commercial head immobilizer or towel roll, 2” tape, and straps Procedure: 1. Takes body substance isolation precautions. 2. Student one kneels behind the head of the patient and applies manual

immobilization of head in a neutral in-line position. 3. Student two will assess the head and neck. 4. Student two sizes and applies the appropriate cervical collar. 5. Student two continues with a rapid physical exam. 6. Position backboard next to patient with the straps positions to prevent being

stuck under patient or board. 7. Student two and/or three kneels to the opposite side of the backboard. 8. Student at the head of the patient will coordinate movement and will advise

when to begin the log roll. 9. On command, the student or students will roll patient toward them and keep

patient in a straight line. 10. Students will grab the backboard and pull tight against the patient’s back. 11. Students should expose the back area for abnormalities. 12. Patient is lowered in a straight line on command to the supine position. 13. Reposition patient by sliding patient in an upward motion (axial) on the

board. 14. Positions patient in line with cervical immobilization device. 15. Secure patient's body with straps in the following order:


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38. BACKBOARD IMMOBILIZATION - SUPINE

• Crossing straps on the upper torso area. • Secure head according to commercial head immobilization device.

Or

• Towel roll on each side of head and secure with 2” tape across chin of

cervical collar and folded 2” tape across forehead. • Crossing straps on the abdominal area.

Critical Criteria: 1. Moves the patient in a safe and effective manner. 2. Prevents injury to self by using correct technique. 3. Immediately takes manual immobilization of the head and neck. 4. Does not release manual immobilization till maintained mechanically. 5. Does not allow excessive movement of patient after secured with straps.


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39. BACKBOARD IMMOBILIZATION - STANDING Equipment: Long spine board, 4 sets of straps, commercial head immobilizer or towel roll, 2” tape, and straps Procedure: 1. Takes body substance isolation precautions. 2. Student one stands behind the patient and applies manual immobilization of

the head in a neutral in-line position. 3. Student two sizes and applies the appropriate cervical collar. 4. After applying cervical collar, the student two takes over manual

immobilization of the head from the front of the patient. 5. Student three prepares the backboard, exposes the back area for

abnormalities, and positions the backboard behind the patient. 6. Student one resumes manual immobilization of the head in a neural in-line

position from behind the patient. 7. Student two and Student three:

• Each takes a side of the patient. • Presses the backboard against the back of the patient.

• Each takes one hand and from the front of the patient, grabs under the

patient’s armpit.

• Each takes other hand and grabs the handle of the backboard.

8. Patient is advised to cross arms and to relax as the backboard is lowered. 9. Student one gives command to begin slowly lowering the backboard.


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39. BACKBOARD IMMOBILIZATION - STANDING

10. Reposition patient by sliding patient in an upward motion (axial) on the

board. 11. Positions patient in line with cervical immobilization device. 12. Secure patient's body with straps in the following order:

• Crossing straps on the upper torso area.

• Secure head according to commercial head immobilization device.

Or

• Towel roll on each side of head and secure with 2” tape across chin of cervical collar and folded 2” tape across forehead.

• Crossing straps on the abdominal area



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40. BACKBOARD IMMOBILIZATION – SEATED IN VEHICLE

Equipment: Long spine board, 4 sets of straps, commercial head immobilizer or towel roll, 2” tape, and straps Procedure: 1. Takes body substance isolation precautions. 2. First student tries to position himself/herself in the backseat behind the

patient and applies manual immobilization of head in a neutral in-line position (may require manually applying from the front or side of the patient).

3. Second student sizes and applies the appropriate cervical collar. 4. Third student prepares the backboard and positions the backboard on the

vehicle’s seat slightly under the patient’s buttocks.

• Utilize the stretcher as support under the backboard.

Or

• Student will support the head portion of the backboard 5. Second student upon command of the first student, will rotate the patient’s

torso so that the patient’s buttock is on the backboard and the patient’s back is aligned with the backboard.

6. Expose the back area for abnormalities. 7. Second student will take over manual immobilization of the head till the first

student can reposition outside the vehicle and resume. 8. First student gives command to begin slowly lowering the backboard. 9. Reposition patient by sliding patient in an upward motion (axial) on the

board.


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40. BACKBOARD IMMOBILIZATION – SEATED IN VEHICLE

10. Positions patient in line with cervical immobilization device. 11. Secure patient's body with straps in the following order:

• Crossing straps on the upper torso area.

• Secure head according to commercial head immobilization device.

Or

• Towel roll on each side of head and secure with 2” tape across chin of cervical collar and folded 2” tape across forehead.

• Crossing straps on the abdominal area.



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41. BACKBOARD DIAMOND CARRY Equipment: Backboard, manikin, and straps Procedure:

1. The 4 students will form a diamond shape around the backboard. One student at

the head, one at the feet, and one at each side. 2. All students will face inward to the patient. 3. Student at the patient’s head will give the command to perform a power lift to

raise the backboard. 4. When the backboard is completely lifted, the student at the foot will reposition to

face outward and hold the backboard from behind. 5. After the student at the feet is completed with repositioning, the students on the

side will face the patient’s feet and release the outer hand. The side students will now hold the backboard with one hand.

6. Student at the patients head will give the command to move when everyone is

done repositioning.

Critical Criteria:

1. Able to drag for 10’.

2. Prevents further aggravation / injury to the patient.



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42. BACKBOARD 4 POINT CARRY Equipment: Backboard, manikin, and straps Procedure: 1. The four students will each take a corner of the backboard (two students on one

side of the patient and two students on the other side of the patient). 2. All students will face inward to the patient. 3. One of the students at the patient’s head will give the command to perform a

power lift to raise the backboard. 4. When the backboard is completely lifted, all four students will face the direction

of the patient’s feet and release the outer hand. The side students will now hold the backboard with one hand.

5. Student at the patients head will give the command to move when everyone is

done repositioning. Critical Criteria: 1. Able to drag for 10’. 2. Prevents further aggravation / injury to the patient. 3. Prevents injury to self by using correct technique.


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43. STRETCHER LOADING INTO AMBULANCE

Equipment: Stretcher, manikin, and ambulance Procedure: 1. One student should be guiding the feet of the stretcher and one student should be

guiding the head of the stretcher. 2. Students will maneuver the stretcher to behind the ambulance and open the

doors (head of the stretcher should be going into the compartment first). 3. Student one at the feet will position the stretcher’s wheels at the head against the

compartment door opening.

• Some ambulances have dump valves that lower the compartment to the height of the stretcher’s wheels at the head.

• Some ambulances require the second student to lift the stretcher’s wheels at

the head onto the floor of the ambulance.

4. Once the top head area wheels are on the compartment floor, student one will release the wheel leg lock and push the stretcher into ambulance.

5. Student two will assist lifting the wheel undercarriage. 6. Student one will push the stretcher all the way into the compartment and secure

the stretcher to the mounting brackets.

Critical Criteria: 1. Stretcher does not drop to the ground. 2. Prevents further aggravation / injury to the patient.



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44. STRETCHER UNLOADING FROM THE AMBULANCE

Equipment: Stretcher, manikin, and ambulance Procedure: 1. Student one will open the doors of the ambulance. 2. If dump valve present, activate the dump valve to lower the compartment closer

to the ground. 3. Student two should secure the stretcher for moving.

• Secure equipment needed for the patient; for example, portable oxygen bottle needs to be placed on the stretcher, disconnected from wall mount, and secured to portable bottle.

• Observe for any straps, hoses, or wires that can get caught and place on top of

the stretcher. • Observe patient’s extremities and make sure that they are centered on the

stretcher.

4. Student one should release the stretcher from the mounting bracket and prepare for pulling out the stretcher.

5. Student two will exit the compartment and stand on the side of the stretcher to

assist with the removal from the ambulance.

• Makes sure the stretcher’s wheel carriage is lowered down gently. • Makes sure the stretcher’s wheel legs are locked straight.

6. Student one will pull the stretcher out of the compartment enough to allow the stretcher wheel carriage to drop and lock.

7. Student two will grab the head section of the stretcher and assist with a smooth

lowering to the ground.


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44. STRETCHER UNLOADING FROM THE AMBULANCE

8. Once the stretcher is out of the compartment, student one will pull the stretcher at the foot area and student two will push at the head area.

Critical Criteria: 1. Stretcher does not drop to the ground. 2. Equipment does not entangle or gets caught while removing the stretcher.

3. Prevents further aggravation / injury to the patient. 4. Prevents injury to self by using correct technique.


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45. STAIR CHAIR Equipment: Stair chair and stretcher Procedure: 1. Assemble stair chair into the chair formation. 2. Assist patient to the stair chair. 3. Secure patient with chair straps. 4. Advise patient to keep arms crossed or hold on to side of chair. 5. One student grabs handles at the back of the chair, second student grabs the

handles at the feet of the chair, and third student “backs-up” the second student down the stairs.

6. Third student places one hand on the back of student at the feet to brace as the

student descends the stairs. 7. Patient is carried down the stairs feet first. 8. Patient is transferred to stretcher.

Critical Criteria:

1. Moves the patient in a safe and effective manner.


3. Uses a student to backup the student going down the stairs first.


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46. FLEXIBLE STRETCHER Equipment:

Reeves Sleeve or Ferno 131 Procedure: 1. Utilize the appropriate lift technique to assist the patient onto the flexible

stretcher. 2. Student will secure patient with the device straps and make sure that they are

tight enough to not allow the patient to move. 3. Students will prepare to lift and carry:

• Two students – one at the head and one at the feet. • Four students – two students on each side. • Six students – three students on each side.

4. Students will perform a power lift on the command of the student positioned at the patient’s head.

5. Students will carry at arms length. 6. Stretcher is lowered upon command. Critical Criteria: 1. Able to carry 10 feet. 2. Moves patient in a safe and effective manner. 3. Prevents injury to self by using correct technique.


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47. PORTABLE OXYGEN CYLINDER SETUP

Equipment:

Portable oxygen bottle and oxygen regulator Procedure: 1. Student identifies the appropriate cylinder by checking label / tag and not just

the color of the tank. 2. Removes the protective seal. 3. Check regulator and cylinder valve assembles to make sure it is free of foreign

materials like dirt, oil, grease, etc. 4. Check washer/gasket is in good condition (Should replace with every new

bottle). 5. Align the regulator so that the pins fit snugly into the correct holes on the

valve stem and hand tighten the regulator. 6. Open the cylinder valve (counter-clockwise rotation). 7. Check for leaks. 8. Verify full bottle from the regulator gauge. 9. Attach oxygen connective tubing to the regulator. 10. Turns the flow valve to the appropriate volume rate. Critical Criteria: 1. Adjust flow rate to the appropriate amount for the attached device.


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48. BAG - VALVE – MASK (BVM)

Two-Person - BVM Equipment:

Bag valve device (BVD), portable oxygen cylinder, and oxygen regulator. Procedure: 1. Take body substance isolation precautions. 2. Open patient’s airway or confirms patient’s airway is open.

• Head tilt / chin lift with no spinal injury suspected. • Jaw thrust for suspected spinal injury.

3. Student determines a need to manually ventilate by patient’s condition and/or

oxygen saturation reading. 4. Assembles the BVD with correct mask size. 5. Sets up the oxygen delivery system. 6. Attaches the BVD to the oxygen regulator. 7. Adjusts flow 15 liters per minute. 8. Student will verify oxygen is flowing through the BVD by listening and feeling

oxygen movement. 9. Student one:

• Positions directly above the victim’s head. • Place the mask on the victim’s face, using the bridge of the nose as a guide

for correct position. • Use the E-C clamp technique to hold the mask place with both hands.


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48. BAG – VALVE – MASK (BVM)

• Use the thumb and index finger of one hand to make a “C”, pressing the edges of the mask to the face.

• Use the remaining 3 fingers form an “E” to lift the angles of the jaw.

10. Student two:

• Squeeze the bag over one second long, while watching for chest rise (may need to squeeze bag against leg for increased volume).

• Applies continuous cricoid pressure.

11. Ventilation rate:

• Adult – 10 to 12 breaths per minute. • Child – 12 to 20 breaths per minute. • Infant – 12 to 20 breaths per minute.

12. Insert oral or nasal airway. One-Person - BVM Equipment:

Bag valve device (BVD) Procedure: 1. Take body substance isolation precautions. 2. Open patient’s airway or confirms patient’s airway is open.



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48. BAG – VALVE - MASK 3. Student determines a need to manually ventilate by patient’s condition and/or

oxygen saturation reading. 4. Assembles the BVD with correct mask size. 5. Sets up the oxygen delivery system. 6. Attaches the BVD to the oxygen regulator. 7. Adjusts flow 15 liters per minute. 8. Student will verify oxygen is flowing through the BVD by listening and feeling

oxygen movement. 9. Place the mask on the victim’s face, using the bridge of the nose as a guide for

correct position. 10. Use the E-C clamp technique to hold the mask place.

• Use the thumb and index finger of one hand to make a “C”, pressing the

edges of the mask to the face. • Use the remaining 3 fingers form an “E” to lift the angles of the jaw.

• Squeeze the bag over one second long, while watching for chest rise (may

need to squeeze bag against leg for increased volume).



12. Insert oral or nasal airway.


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48. BAG – VALVE – MASK (BVM) Critical Criteria: 1. Maintains proper face to mask seal. 2. Oxygen flow rate set correctly. 3. Two-person maneuver, one student maintains continuous cricoid pressure

during ventilation. 4. Monitors effect of treatment.


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49. MOUTH TO MASK VENTILATION WITH SUPPLEMENTAL OXYGEN

Equipment:

Face mask, one-way valve, portable oxygen cylinder, and oxygen regulator. Procedure: 1. Take body substance isolation precautions. 2. Open patient’s airway or confirms patient’s airway is open.


3. Student determines a need to manually ventilate by patient’s condition and/or

oxygen saturation reading. 4. Assembles the appropriate mask size with one-way valve. 5. Sets up the oxygen delivery system. 6. Attaches the mask to the oxygen regulator. 7. Adjusts flow 15 liters per minute. 8. Student will verify oxygen is flowing through the mask by listening and feeling

oxygen movement. 9. Place the mask on the victim’s face, using the bridge of the nose as a guide for

correct position. 10. Use the E-C clamp technique to hold the mask place.

• Use the thumb and index finger of one hand to make a “C”, pressing the edges of the mask to the face.

• Use the remaining 3 fingers form an “E” to lift the angles of the jaw.


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49. MOTH TO MASK VENTILATION WITH SUPPLEMENTAL OXYGEN

• Ventilate through the one-way valve, while watching for chest rise.



12. Insert an oral or nasal airway.

Critical Criteria: 1. Maintains proper face to mask seal. 2. Oxygen flow rate set correctly. 3. Monitors effect of treatment.


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50. NON-REBREATHING FACE MASK

Equipment:

Portable oxygen cylinder, oxygen regulator, and non-rebreathing face mask Procedure: 1. Takes body substance isolation precautions. 2. Student determines a need for oxygen therapy by patient’s condition and

oxygen saturation reading. 3. Sets up the oxygen delivery system. 4. Attaches the non-rebreathing face mask to the oxygen regulator. 5. Adjusts flow of 10 to 15 liters per minute. 6. Student will verify oxygen is flowing through the non-rebreathing face mask

by listening and feeling oxygen movement.

• Reservoir bag should be expanded and it may require the student to inflate by holding a finger over the rubber valve gasket.

7. Student will begin applying the non-rebreathing face mask to the patient.

• Pulls the elastic head band around the patient’s head. • Maintain a seal may require the need to pull the elastic straps to secure the

mask against the face. • Gently adjusts the metal nosepiece to conform to the patient’s nose.

8. Re-evaluates patient condition and oxygen saturation reading. Critical Criteria:

1. Correctly applies the non-rebreathing face mask. 2. Oxygen flow rate set correctly. 3. Monitors effect of treatment.


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51. NASAL CANNULA Equipment:

Portable oxygen cylinder, oxygen regulator, and nasal cannula Procedure: 1. Takes body substance isolation precautions. 2. Student determines a need for oxygen therapy by patient’s condition and

oxygen saturation reading. 3. Sets up the oxygen delivery system. 4. Attaches the nasal cannula to the oxygen regulator. 5. Adjusts flow 1 to 6 liters per minute. 6. Student will verify oxygen is flowing through the nasal prongs by listening and

feeling oxygen movement. 7. Student will begin applying the nasal cannula to the patient.

• Nasal prongs into patient’s nostrils with bevel facing inward and downward.

• Tubing wrapped around each ear. • Tighten or loosen the loop by adjusting the tubing ring.

8. Re-evaluates patient condition and oxygen saturation reading. Critical Criteria:

1. Correctly applies the nasal cannula. 2. Oxygen flow rate set correctly. 3. Monitors effect of treatment.


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52. OROPHARYNGEAL (OPA) INSERTION

Equipment: Oropharyngeal, Bag-valve-mask device, and oxygen source with oxygen supply tubing. Procedure: 1. Takes body substance isolation precautions.

2. Determine the patient is unable to maintain an open airway.

3. Determine proper size (corner of mouth to earlobe)

4. Student will hyperextend the neck and open the patient's mouth by using

crossed finger technique.

5. Insert Oropharyngeal: • Method 1 – insert with the tip facing the side of the mouth. Rotate 90

degrees when the tip approaches the posterior wall of the pharynx (back of the tongue).

Or

• Method 2 – insert with the tip facing the roof of the patient’s mouth. Rotate 180 degrees when the tip approaches the posterior wall of pharynx (back of the tongue).

6. Remove if patient begins to gag and consider nasopharyngeal.

7. Ventilation with BVM. Critical Criteria:

1. Determines the patient is unable to maintain an open airway. 2. Selects appropriate size OPA.

3. Inserts in a manner that is not create injury to the patient.


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53. NASOPHARYNGEAL (NPA) INSERTION Equipment: Nasopharyngeal, Bag-valve-mask device, oxygen source with oxygen supply tubing, and water-soluble lubricant (Optional Lidocaine gel and Neo-Synephrine). Procedure: 1. Takes body substance isolation precautions. 2. Determine the patient is unable to maintain an open airway. 3. Determine proper size by measuring the nostril to the earlobe. 4. Lubricate with a water-soluble lubricant.

• (Optional Lidocaine gel) 5. Position patient's head in a neutral position, inspects nose, and selects larger

nostril.

• (Optional spray Neo-Synephrine into nasopharynx)

6. Insert Nasopharyngeal with bevel facing nasal septum. 7. Student should stop insertion if resistance is met and consider insertion into

the other nostril. 8. Insert till flange rests against the nostril. 9. Ventilation with BVM.


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53. NASOPHARYNGEAL (NPA) INSERTION Critical Criteria: 1. Determine the patient is unable to maintain an open airway. 2. Selects the appropriate size NPA. 3. Uses appropriate lubricant. 4. Inserts with bevel facing the septum. 5. Inserts in a manner that is not create injury to the patient.


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54. SELLICK MANUEVER

Equipment:

None. Procedure: 1. Visualize the cricoid cartilage. 2. Palpate to confirm location. 3. Apply firm downward pressure to the cricoid ring with your thumb and index

finger on either side. 4. Continue pressure till airway is secured with commercial device. Critical Criteria: 1. Release pressure prior to securing airway.


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55. COMBITUBE Equipment:

Combitube, 140 cc syringe, 15 cc syringe, water-soluble gel, ITD, BVM, oxygen source with oxygen supply tubing, securing device, and stethoscope. Procedure: 1. Takes body substance isolation precaution. 2. Assure a patent airway and ventilate with 100% O2 before attempting

placement of the Combitube. 3. Assess for contraindications:

• Patients under 16 years of age and/or under five feet tall. • Patients who are conscious or who have an intact gag reflex. • Patients with known esophageal disease (esophageal varices, alcoholics,

etc.). • Patients who have ingested caustic substances.

4. Prepare Combitube for insertion by lubricating distal end with water-soluble gel.

5. Maintain neck in a neutral, semi-flexed position (only if there is no chance of

cervical injury). 6. Lift the tongue and mandible anteriorly with one hand.

• CAUTION: When facial trauma has resulted in sharp, broken teeth or dentures, remove dentures and exercise extreme caution when passing the Combitube into the mouth to prevent the cuff from tearing.

7. With the other hand, hold the Combitube so that it curves in the same

direction as the natural curvature of the pharynx. Insert the tip into the mouth and advance gently until the printed ring is aligned with the teeth.

• CAUTION: DO NOT FORCE THE COMBITUBE. If the tube does not

advance easily, redirect it or withdraw and reinsert.


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55. COMBITUBE 8. Inflate line 1, the blue pilot balloon leading to the pharyngeal balloon with

100cc of air using the 140cc syringe.

• This may cause the Combitube to move slightly from the patient's mouth. 9. Inflate line 2, the white pilot balloon leading to the distal cuff with

approximately 15cc of air using the 20cc syringe. 10. Confirms placement:

• Begin ventilation through the longer blue connecting tube. If auscultation of breath sounds is positive and auscultation of gastric insufflation is negative, continue ventilation.

• If auscultation of breath sounds is negative and gastric insufflation is

positive, immediately begin ventilation through the shorter clear connecting tube. Confirm tracheal ventilation by auscultation of breath sounds and absence of gastric insufflation.

• Attach end-tidal CO2 monitoring device.

11. Secure Combitube with commercial device. 12. Monitor SpO2 with pulse oximeter. 13. Provide 100% O2 with positive pressure oxygen or bag-valve-device. 14. Attach Impedance Threshold Device (ITD) or Resq-pod. 15. Monitor for changes in breathing or airway status. Critical Criteria:

1. Did not insert Combitube to proper depth. 2. Did not inflate both cuffs with proper amounts.

3. Did not confirm successful placement.

4. Inserted the device in a manner that was dangerous to the patient.


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56. KING TUBE Equipment: King LTS-D tube, water soluble gel, ITD, 80cc syringe, BVD, oxygen source with oxygen supply tubing, securing device, and stethoscope. Procedure: 1. Takes body substance isolation precaution. 2. Assure a patent airway and ventilate with 100% O2 before attempting

placement of the King device. 3. Assembles and checks equipment. 4. Lubricates tip of tube with a water-soluble gel. 5. Places patient's head in neutral position. 6. Apply Tongue jaw-lift maneuver with one hand while passing the tube with

the other hand. Insert device at 45-90 degree angle and rotate to midline as it passes the tongue.

7. Advance till gastric access lumen is aligned with teeth or gums. 8. Inflate pharyngeal cuff with recommended volume for the tube size. 9. Confirms placement:

• Negative epigastric sounds. • Positive bilateral breath sounds.


10. Secure King device with commercial device.


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56. KING TUBE 11. Monitor SpO2 with pulse oximeter.

12. Provide 100% O2 with positive pressure oxygen or bag-valve-device. 13. Attach Impedance Threshold Device (ITD) or Resq-pod.

14. Monitor for changes in breathing or airway status. Critical Criteria:

1. Did not inflate cuff with proper amounts. 2. Did not confirm successful placement. 3. Inserted the device in a manner that was dangerous to the patient.


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57. LARYNGEAL MASK AIRWAY (LMA) Equipment:

Laryngeal mask, appropriate syringe for cuff inflation, water-soluble gel, ITD, securing device, stethoscope, BVD, and oxygen source with oxygen supply tubing. Procedure: 1. Takes body substance isolation precaution. 2. Assure a patent airway and ventilate with 100% O2 before attempting

placement of the laryngeal mask. 3. Tightly deflate the cuff so that it forms a smooth "spoon-shape." Lubricate the

posterior surface of the mask with water-soluble lubricant. 4. With the head extended and the neck flexed, carefully flatten the laryngeal

mask tip against the hard palate. 5. Advance the mask until definite resistance is felt at the base of the

hypopharynx. 6. Without holding the tube, inflate the cuff to manufacturer recommended

volume. 7. Confirms placement:

• Negative epigastric sounds. • Positive bilateral breath sounds.


8. Secure laryngeal mask with commercial device. 9. Monitor SpO2 with pulse oximeter.

10. Provide 100% O2 with positive pressure oxygen or bag-valve-device.


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57. LARYNGEAL MASK AIRWAY (LMA)

11. Attach Impedance Threshold Device (ITD) or Resq-pod.

12. Monitor for changes in breathing or airway status. Critical Criteria:

1. Did not inflate cuff with proper amounts. 2. Did not confirm successful placement. 3. Inserted the device in a manner that was dangerous to the patient.


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58. AIRWAY SUCTIONING Equipment:

Portable suction unit, tonsil-tip catheter, and whistle-tip catheter Procedure: 1. Takes body substance isolation precautions. 2. Determines the need to suction patient’s airway. 3. Chooses the appropriate catheter and places it on the suction hose.

• Tonsil-tip catheter is better suited for gastric content and thick secretions due to larger diameter.

• Whistle-tip catheter is better suited for low to medium suction or nasal

suctioning.

4. Make sure the suctioning unit is properly assembled, turns the unit “on”, and tests the suction by occluding the catheter.

5. Open patient's mouth with cross-finger maneuver.

• Tonsil-tip catheter measure corner of the mouth to the earlobe to determine depth of insertion.

6. Insert catheter and suction no longer than 15 seconds.

• Suction while withdrawing. • Patient that continues to vomit or obstructed airway may require longer

suction time.

7. Student should place suction tip in the water bottle to clear the tubing (if necessary).


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58. AIRWAY SUCTIONING Critical Criteria: 1. Determine patient is unable to maintain open airway. 2. Suction unit is properly assembled. 3. Assures presence of suction. 4. Inserting the suction to the measured depth. 5. Suctions while withdrawing.


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59. EPI-PEN AUTOINJECTOR ADMINISTRATION

Equipment:

Epi-pen autoinjector Procedure: 1. Take body substance isolation precautions. 2. Check for right medication. 3. Check for right patient. 4. Check expiration date. 5. If possible, check cloudiness and discoloration. 6. Grasp device with the tip pointing downward (hold like a pen). 7. Remove auto-injector activation cap. 8. Identify the injection site on the lateral portion of thigh, midway between

waist and knee. 9. Push auto-injector at a perpendicular angle to the thigh and hold firmly

against site until injector activates. 10. Hold in place until medication is fully injected for a minimum of 10 seconds. 11. Dispose of injector in biohazard container. Critical Criteria: 1. Injects in wrong location. 2. Bounces after injection or removes too quickly.


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60. NITROGLYCERIN ADMINISTRATION

Equipment:

Nitroglycerin tablet or metered spray Procedure: 1. Take body substance isolation precautions. 2. Verify patient has blood pressure greater than 100 mmHg systolic. 3. Check for right medication. 4. Check for right patient. 5. Check expiration date. 6. Verify number of doses previously taken by the patient. 7. Position patient in semi-fowler position. 8. Ask patient to lift tongue. 9. Place tablet or spray metered dose under the tongue. 10. Recheck blood pressure after 5 minutes. Critical Criteria: 1. Do not let patient chew or swallow nitroglycerin tablets. 2. Failure to assess blood pressure before and after administration.


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61. METERED DOSE INHALER ADMINISTRATION

Equipment:

Metered dosed inhaler Procedure: 1. Take body substance isolation precautions. 2. Check for right medication. 3. Check for right patient. 4. Check expiration date. 5. Verify number of doses previously taken by the patient. 6. Make sure the inhaler is at room temperature. 7. Shake inhaler. 8. If administering oxygen therapy with face mask, then stop and remove from

patient’s face. 9. Ask patient to exhale deeply before placing lips around opening of the inhaler. 10. Have the patient inhale deeply and depress the inhaler. 11. Instruct patient to hold breath for as long as comfortable. 12. Reapply oxygen therapy. Critical Criteria: 1. Assisted with metered dosed inhaler for the wrong situation.


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62. ORAL GLUCOSE ADMINISTRATION Equipment:

Oral glucose Procedure: 1. Take body substance isolation precautions. 2. Utilize glucometer to determine blood glucose levels. 3. Determine patient can swallow and is able to protect his/her airway. 4. Check expiration date. 5. Squeeze glucose gel on tongue depressor. 6. Direct patient to open mouth and insert tongue depressor between cheek and

gum. 7. After glucose gel is dissolved, repeat with another dose till the tube is emptied. 8. Repeat blood glucose level check after 5 minutes.

Critical Criteria: 1. Determines to administer glucose with blood glucose less than 60. 2. Administered to patient that is unable to follow direction and swallow.


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63. INTRAMUSCULAR (IM) INJECTION Equipment:

Desired medication, appropriate size syringe, 21 gauge needle, alcohol prep, and bio-hazard sharp box. Procedure: 1. Take body substance isolation precautions. 2. Check expiration date. 3. Check cloudiness. 4. Check discoloration. 5. Check for allergies. 6. Expose injection site of deltoid region. 7. Clean site with alcohol prep. 8. Spread skin taut between thumb and index finger.

• If patient has minimal fat mass, than squeeze the site. • If pediatric patient, than preferred to use anterior thigh at middle 1/3 and

squeeze the site. 9. Insert 21 gauge or smaller with 1-1 1/2 inch needle at 90 degree angle. 10. Aspirate for blood and if seen, then stop procedure. 11. Inject medication slowly. 12. Remove needle and dispose in bio-hazard sharps box. 13. Apply pressure to site with gentle massage and cover site with Band-Aid. Critical Criteria: 1. Did not aspirate prior to injection.


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64. SUBCUTANAEOUS (SUB-Q) INJECTION Equipment:

Desired medication, appropriate size syringe, 25 gauge needle, alcohol prep, and bio-hazard sharp box. Procedure: 1. Take body substance isolation precautions. 2. Check expiration date. 3. Check cloudiness. 4. Check discoloration. 5. Check for allergies. 6. Expose injection site of deltoid region. 7. Clean site with alcohol prep. 8. Pinch site between thumb and index finger. 9. Insert 25 gauge or smaller with 5/8 inch needle at a 45 or 90 degree angle and

bevel up. 10. Aspirate for blood and if seen, then stop procedure. 11. Inject medication slowly. 12. Remove needle and dispose in bio-hazard sharps box. 13. Apply pressure to site with gentle massage and cover site with Band-Aid. Critical Criteria: 1. Did not aspirate prior to injection.


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65. PREHOSPITAL STROKE EXAM – CINCINNATI STROKE SCALE

Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Facial droop – Student will have the patient smile or show his or her teeth.

• Determine normal - Both sides of face move equally.

• Determine abnormal - One side or both sides of face does not move. 3. Arm drift – Student will have the patient close his/her eyes and hold his/her

arms straight out in front for about 10 seconds.

• Determine normal - Both arms move equally or not at all.

• Determine abnormal - One arm drifts down compared with the other side. 4. Speech – Student will have the patient say, "You can't teach an old dog new

tricks”.

• Determine normal - Patient uses correct words with no slurring.

• Determine abnormal - Slurred words, inappropriate words, or mute. Critical Criteria: 1. Able to determine abnormal responses.


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66. EXPANDED STROKE EXAM – MIAMI EMERGENCY NEUROLOGICAL DEFICIT SCALE Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Level of Consciousness.

• Alert. • Verbal. • Pain. • Unresponsive.

3. Speech – Student will have the patient say, "You can't teach an old dog new

tricks”.

• Determine normal - Patient uses correct words with no slurring.

• Determine abnormal - Slurred words, inappropriate words, or mute. 4. Question – Age.

• Determine long term memory. 5. Question – Month.

• Determine short term memory. 6. Commands – Open and close eyes.

• Determine normal – opens and closes eyes.


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66. EXPANDED STROKE EXAM - MIAMI EMERGENCY NEUROLOGICAL DEFICIT

SCALE

• Determine abnormal – does not open and close eyes. 7. Facial droop – Student will have the patient smile or show his/her teeth.

• Determine normal - Both sides of face move equally.

• Determine abnormal - One side or both sides of face does not move. 8. Visual fields – Student takes both hands and places them in the

upper quadrant of the patient’s visual fields. The student will wiggle fingers of one hand and ask patient to point or state which side he/she saw movement. Student will test a both upper and lower quadrant fields.

• Determine normal – views movement in all four quadrants.

• Determine abnormal – does not view movement in any

quadrant. 9. Horizontal gaze – Student will have the patient face forward and

track his/her index finger with the patient’s eyes only. Student will move finger horizontally from one side of the patient to the other side of the patient slowly. It may be required to hold the patient’s chin to prevent the patient’s head from moving.

• Determine normal – follows the finger to both sides.

• Determine abnormal – unable to follow the finger completely in

one direction or has unequal eye movement. 10. Arm drift – Student will have the patient close his/her eyes and hold his/her

arms straight out in front for about 10 seconds.

• Determine normal - Both arms move equally or not at all.


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SCALE

• Determine abnormal - One arm drifts down compared with the other side. 11. Leg drift – Student will have the patient keep his/her eyes open

and lift one leg at a time.

• Determine normal – lift with ease.

• Determine abnormal – unable to lift or show weakness with the lift.

12. Sensory – Student will have the patient close his/her eyes. The

student will instruct the patient to determine which arm or leg that is being touched and if the sensation feels the same.

• Determine normal – equally senses touch on both arms and

legs.

• Determine abnormal – does not sense the touch in an area or the touch feels different when comparing the arms or legs.

13. Coordination of the arms – Student will hold out his/her index

finger and ask the patient to do the same. The patient will be instructed to touch his/her nose and to then touch the student’s finger. The patient should then repeat with the other hand.

• Determine normal – able to touch both locations.

• Determine abnormal – difficulty to move smoothly and touch

the intended target. 14. Coordination of the legs – Student will position with legs side by

side. The student will instruct the patient to lift a leg and bend it to have the heel to the knee. The patient will then slide the heel down the shin, and repeat with the other leg.


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SCALE

• Determine normal – able to move legs to intended areas.

• Determine abnormal – difficulty to move leg smoothly. Critical Criteria: 1. Able to determine abnormal responses.


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67. CHILDBIRTH Equipment:

OB kit with absorbent pads, sterile gloves, 2 clamps, scalpel, and blue bulb syringe. Procedure: 1. Take body substance isolation precautions which include sterile gloves. 2. Assemble equipment and maintain a sterile field. 3. Place towels and/or absorbent pads on the floor around the delivery area to

soak up fluids released from delivery. 4. Drape sterile sheets on patient’s abdomen, under buttocks, and over each

thigh. 5. Allow the mother to push the head out with the contractions. Student should

place hand on the baby’s head as it presents to prevent explosive birth. 6. Support baby’s head as it delivers.

• If amniotic sac has not broken, use dull instrument to puncture it. 7. Student should check to see for cord wrapped around the baby’s neck.

• If cord is present, gently lift over the baby’s head without pulling hard on the cord. When unable to remove, than clamp and cut the cord.

8. Utilize blue bulb syringe to suction the mouth of fluid. 9. Utilize blue bulb syringe to suction the nose of fluid. 10. Continue to support the head as the shoulders deliver. 11. Once the delivered, hold the baby firmly and place the neck in neutral

position. 12. Dry off the baby and wrap in a blanket or towel. Make sure to cover the top of

the baby’s head.


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67. CHILDBIRTH 13. Place first clamps for the umbilical cord about 4 fingers width from the body

and place the second clamp 2 to 4 inches from the first clamp. 14. Cut the cord between the clamps. 15. Determine the baby’s APGAR score at 1 minute and 5 minutes after birth. 16. If excessive bleeding occurs, massage the abdomen at the fundus of the uterus

to assist with controlling bleeding. 17. Allow placenta to deliver itself and secure in bag. Critical Criteria: 1. Did not suction mouth before nose. 2. Unable to determine APGAR score. 3. Able to recognize complications and respond with correct actions.


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68. CHILDBIRTH COMPLICATIONS Equipment:

OB kit with absorbent pads, sterile gloves, 2 clamps, scalpel, and blue bulb syringe. Prolapsed Cord: Procedure: 1. Take body substance isolation precautions which include sterile gloves. 2. Place the patient in a position that removes pressure from the cord.

• Head down. Or

• Pelvis elevated. 3. Administer high flow oxygen to patient. 4. Instruct patient to not push during contractions. 5. Student will utilize a sterile glove to insert several fingers into the vagina to

gently push the baby off the cord and maintain cord pulsation. 6. Maintain visible port of cord with moist sterile dressing. 7. Transport immediately. Limb Presentation: Procedure: 1. Take body substance isolation precautions which include sterile gloves. 2. Place the patient in a position that removes pressure from the cord.


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68. CHILDBIRTH COMPLICATIONS

• Head down.

Or

• Pelvis elevated. 3. Administer high flow oxygen to patient. 4. Transport immediately. Breech Birth: Procedure: 1. Take body substance isolation precautions which include sterile gloves. 2. Place the patient in a position that removes pressure from the cord.

• Head down.

Or

• Pelvis elevated. 3. Administer high flow oxygen to patient. 4. Transport immediately. 5. If the buttock passed through the vagina, than position the patient for

delivery. 6. Assemble equipment and maintain a sterile field. 7. Place towels and/or absorbent pads on the floor around the delivery area to

soak up fluids released from delivery. 8. Drape sterile sheets on patient’s abdomen, under buttocks, and over each

thigh. 9. Student should place hand on the baby’s buttock as it presents to prevent

explosive birth.


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68. CHILDBIRTH COMPLICATIONS

10. After legs and buttocks deliver, student should support the trunk by letting

the legs dangle over his/her arm. 11. During head delivery, place a gloved hand into the patient’s vagina with your

palm facing the baby’s face. Make a “V” with your index and middle fingers on either side of the baby’s nose. Push the vaginal wall away from the baby’s face until the head delivers.

Critical Criteria: 1. Able to recognize complications and respond with correct actions.


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69. PATIENT ASSESSMENT / MANAGEMENT - MEDICAL

Equipment:

Blood pressure cuff, stethoscope, pulse oximeter, and pen light. Procedure: Scene Size-up: 1. Take body substance isolation precautions. 2. Inspect the scene for safety (personal protection). 3. Determines the nature of the illness. 4. Determines the number of patients. 5. Determines the need for additional resources. 6. Determines the need for spinal immobilization. Initial Assessment: 7. Inspect general impression of the patient (visual assessment). 8. Student one introduces himself / herself to the patient and obtains consent

for patient care. 9. Determine chief complaint. 10. Determine mental status. 11. Assess airway. 12. Assess breathing – provides oxygen therapy and assures adequate ventilation. 13. Assess circulation – Assess pulse. 14. Assess and control major external bleeding.


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15. Assess perfusion. 16. Identify priority and transport decisions. Focused History and Rapid Assessment: 17. SAMPLE History – signs and symptoms.

• Respiratory – onset, provokes, quality, radiates, severity, time, interventions.

• Cardiac – onset, provokes, quality, radiates, severity, time, interventions.

• Altered Mental Status – description of the episode, onset, duration,

associated symptoms, evidence of trauma, interventions, seizures, fever.

• Allergic reaction – history of allergies, what were you exposed to, how were you exposed, effects, progression, interventions.

• Poisoning/overdose – substance, when did you ingest/become exposed,

how much did you ingest, over what time period, interventions, estimated weight.

• Environmental Emergency – source, environment, duration, loss of

consciousness, effects general or local.

• Obstetrics – are you pregnant, how long have you been pregnant, pain or contractions, bleeding or discharge, do you feel the need to push, last menstrual period.

• Behavioral – how do you feel, determine suicidal tendencies, is the patient

a threat to self or others, is there a medical problem, interventions. 18. Allergies. 19. Medications. 20. Past pertinent history. 21. Last oral intake. 22. Events leading to present.


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23. Inspect for DCAP BTLS:

• Palpate the head and neck. • Suspected spinal injury - size and apply the appropriate cervical collar

• Palpate the chest. • Palpate the abdomen in four quadrants.

• Palpate the pelvis.

• Palpate all four extremities.

• With the assistance of other students, log roll patient.

• Assess the back.

24. Baseline vital signs. 25. Interventions obtain medical direction or verbalize standing orders for

medication interventions. 26. Transport (re-evaluate transport decisions). 27. Verbalize the consideration for completing detailed exam. Performs on-going assessment: 28. Repeat initial assessment. 29. Reassess vital signs. 30. Repeat focused assessment. 31. Check interventions.


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Critical Criteria: 1. Did not take or verbalize body substance isolation precaution. 2. Did not determine scene safety. 3. Did not obtain medical direction or verbalize standing orders for medical

interventions. 4. Did not provide high concentration of oxygen. 5. Did not find, or manage problems associated with airway, breathing,

hemorrhage, or shock. 6. Did not differentiate patient’s need for transportation versus continued

assessment at the scene. 7. Did other detailed physical examination before assessing airway, breathing,

and circulation. 8. Did not ask questions about the present illness. 9. Administered a dangerous or inappropriate intervention.


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70. SCOOP STRETCHER Equipment: Scoop Stretcher Procedure: 1. Takes body substance isolation precautions. 2. Separate the frame of the scoop stretcher at the top by depressing the catch

device and applying outward pressure. 3. Repeat depressing the bottom catch device to complete separation. 4. Place one half next to the patient to evaluate the appropriate length. 5. Adjust the length by sliding the lower end out of the upper end and locking it

into position with the locking peg. 6. Place one half of the scoop stretcher on each side of the patient. 7. Place half of the scoop stretcher under the patient by having the second

student gently roll the patient away (careful not to pinch the patient). 8. Place the second half under the patient. 9. Take the foot end and connect the device together. 10. Take the head end and connect the device together. 11. Make sure the device ends locked together. 12. Secure with straps. 13. Use proper lifting technique. Critical Criteria: 1. Moves the patient in a safe and effective manner. 2. Prevents injury to self by using correct technique.


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71. PNEUMATIC ANTI-SHOCK GARMENT FOR SPLINTING

Equipment:

Pneumatic anti-shock garment, and backboard Procedure: 1. Take body substance isolation precautions. 2. Expose injured area. 3. Evaluate distal pulse, motor function, and sensory function. 4. Put patient on PASG while in supine position. Top of the PASG should be just

below the lowest rib. 5. Aligns the extremity. Do not align joint injury, if resistance is met. 6. Lay PASG on backboard and logroll patient onto backboard.

• PASG folded method: Required PASG to be folded so that the velcro does not stick. After patient is on backboard, the leg sections are pulled down and the abdominal section remains in position. The abdominal section is unfolded and wrapped first.

Or • PASG unfolded method: Requires PASG to be open on the backboard.

Patient is rolled onto the backboard and PASG. The abdominal section is wrapped first.

7. Wrap left and right leg with velcro straps. 8. Attach foot pump assembly and make sure the valves are shut off. 9. Inflate appropriate section for splinting till firm. DO NOT INFLATE TILL

VELCRO MAKES A TEARING SOUND. 10. Re-evaluate distal pulse, motor function, and sensory function. Critical Criteria: 1. Inflate in the incorrect order.


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72. CONTROLLING EPISTAXIS – NOSE BLEED

Equipment:

Gauze and ice pack Procedure: 1. Take body substance isolation precautions. 2. Instruct the patient to sit while leaning forward and head tilted forward. 3. Instruct the patient to pinch patient’s nostrils together. 4. Still bleeding, apply ice at the bridge of the nose. 5. Still bleeding, transport. Critical Criteria: 1. Failure to position patient correctly and allowing blood to drip in the back of

the throat.


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73. CONTROLLING EXTERNAL BLEEDING TO AN EXTREMITY

Equipment:

4 x 4 gauze and roller bandage. Procedure: 1. Take body substance isolation precautions. 2. Take gauze and apply direct pressure to bleeding site. 3. Still bleeding, elevate extremity by 6 inches. 4. Still bleeding, apply pressure dressing. Utilize roller bandage to stretch tight

over the dressing site. 5. Still bleeding, add more gauze and apply a tighter second roller bandage. 6. Still bleeding, apply arterial pressure point. Critical Criteria: 1. Failure to apply correctly.


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74. HARE TRACTION SPLINT

Equipment:

Hare traction splint Procedure: 1. Take body substance isolation precautions. 2. Expose injured area. 3. Student one stabilizes the affected leg. 4. Student two:

• Checks distal pulse, motor function, and sensory function. • Place the splint next to the uninjured leg and adjust to the proper length

from the top of the patient’s pelvis to 6-8 inches past the ankle. • Attach the ankle hitch about the foot and ankle. • Manually applies gentle in-line traction to the ankle hitch.

i. Open fracture with PMS keep sterile.

ii. Open fracture with (-) PMS pull traction. 5. Student one:

• Slide the splint into position under the injured leg. • Place the ischial pad against the iliac crest.

• Fasten the ischial strap. • Connect the loops of the ankle hitch to the end of the splint.

6. Tighten the ratchet and release manual traction. Continue to pull till:

• Patient has relief of pain and muscle spasms. 7. Secure with straps.


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74. HARE TRACTION SPLINT

8. Re-evaluate distal pulse, motor function, and sensory function. 9. Secure patient to long spinal board. Critical Criteria: 1. No loss of traction at any point. 2. Did not reassess distal pulse, motor function, and sensory function.


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75. SAGER TRACTION SPLINT

Equipment:

Sager traction splint Procedure: 1. Take body substance isolation precautions. 2. Expose injured area. 3. Student one applies manual traction of the affected leg. 4. Student two checks distal pulse, motor function, and sensory function. 5. Position Sager traction splint between the patient's legs. 6. Adjust the splint to the distance slightly past the patient’s ankle. 7. Apply the abductor bridle (thigh strap) around the upper thigh of the

fractured limb.

• Push the ischial perineal cushion gently down while pulling the thigh strap snugly.

8. Apply the Malleolar Harness (ankle harness) and attach to traction handle. 9. Place one hand on padded shaft and other hand on traction handle while

gently extending. 10. Pull traction handle and release manual traction. Continue to pull till:

• Maximum of 7kg (15lbs) for one femur fracture. • Maximum of 14kg for bilateral femur fractures. • Patient has relief of pain and muscle spasms.

11. Secure with large elastic leg cravats.


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75. SAGER TRACTION SPLINT 12. Re-evaluate distal pulse, motor function, and sensory function. 13. Secure patient to long spinal board. Critical Criteria: 1. No loss of traction at any point. 2. Did not reassess distal pulse, motor function, and sensory function.


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76. APPLYING AN AIR SPLINT Equipment:

Air splint. Procedure: 1. Take body substance isolation precautions. 2. Expose injured area. 3. Evaluate distal pulse, motor function, and sensory function. 4. Student one aligns extremity, stabilizes, and supports the extremity.

• Do not align joint injury, if resistance is met. Utilize another device. 5. Student two:

• Place arm through the splint and grasp the patient’s hand or foot. • Apply gentle traction while sliding the splint into position.

• Inflate splint by mouth to a point that a slight dent can be made into the

plastic when pressed with a finger. 6. Re-evaluate distal pulse, motor function, and sensory function. Critical Criteria: 1. Securely attaches the device and prevents movement. 2. Did not reassess distal pulse, motor function, and sensory function.


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77. APPLYING A RIGID SPLINT Equipment:

Long or small wood planks, tape, wrap, and padding material. Procedure: 1. Take body substance isolation precautions. 2. Expose injured area. 3. Evaluate distal pulse, motor function, and sensory function. 4. Student one aligns extremity, stabilizes, and supports the extremity.

• Do not align joint injury, if resistance is met. 5. Student two acquires the appropriate length wood planks and provides

padding to ensure even contact with splint.

• Place wood on each side of the injury. • Place wood under the injury.

6. Secure extremity to rigid splint.

• Long bone injury – immobilize the joint above and joint below the injury. • Joint injury – immobilize the bone above and bone below the injury.

7. Re-evaluate distal pulse, motor function, and sensory function. Critical Criteria: 1. Securely attaches the device and prevents movement. 2. Did not reassess distal pulse, motor function, and sensory function.


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78. APPLYING A VACUUM SPLINT Equipment:

Vacuum splint. Procedure: 1. Take body substance isolation precautions. 2. Expose injured area. 3. Evaluate distal pulse, motor function, and sensory function. 4. Student one aligns extremity, stabilizes, and supports the extremity.

• Do not align joint injury, if resistance is met. 5. Student two:

• Wraps and secures the vacuum splint around the extremity. • Draws the air out of the splint with the pump.



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79. SPLINTING THE HAND AND WRIST

Equipment:

Small board, tape, roller bandage, and padding material. Procedure: 1. Take body substance isolation precautions. 2. Expose injured area. 3. Evaluate distal pulse, motor function, and sensory function. 4. Student one aligns extremity, stabilizes, and supports the extremity. 5. Student two:

• Places soft roller bandage in the palm. • Applies small board on the palmar side. • Secure hand to board with the fingers exposed.



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80. SLING AND SWATHE

Equipment:

Triangle bandage and ace wrap. Procedure: 1. Take body substance isolation precautions. 2. Expose injured area. 3. Determine patient has a fractured clavicle, fractured scapula, or

acromioclavicular joint separation. 4. Evaluate distal pulse, motor function, and sensory function. 5. Instruct patient to stabilize and supports the extremity by having the arm

slightly bent and held against his/her chest. 6. Open triangle bandage and place a knot in one corner of the triangle. 7. Place the knotted portion on the injured arm’s elbow. 8. Take the two other ends and tie together around the patient’s neck. 9. Utilize triangle bandage or ace wrap to bind the swathe against the chest by

wrapping around the arm and chest wall. 10. Re-evaluate distal pulse, motor function, and sensory function. Critical Criteria: 1. Securely attaches the device and prevents movement. 2. Did not reassess distal pulse, motor function, and sensory function.


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81. REMOVING A FOREIGN OBJECT FROM THE EYE Equipment:

Irrigation equipment and cotton tip applicator Procedure: 1. Take body substance isolation precautions. 2. Perform irrigation of the affected eye with normal saline and flushing from

nose outward.

• Flush using a faucet spray from a sink or shower. • Flush using bottle of normal saline or sterile water. • Flush using a basin filled with water. • Flush using nasal cannula tubing.

3. Patient still has foreign object under eyelid.

• Instruct patient to look down and grasp upper lashes to pull away from the eye.

• Place cotton tip applicator on the outer surface in the middle of the upper

lid. • Fold the eye lid back by pulling forward and up over the applicator. • Gently remove object from eye lid with moistened sterile applicator.

Critical Criteria: 1. Flushed foreign object toward other eye.


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82. MORGAN LENS Equipment:

Morgan lens, Normal Saline bag,10 drop administration set, and towel. Procedure: 1. Remove contact lenses. 2. Have the patient look down, insert edge of the lens under the upper lid. Have

the patient look up, retract the lower lid. 3. Release lower lid over the lens. 4. Connect Morgan lens to a bag of normal saline and a 10 drop

administration set. Open administration set to desired flow rate. 5. Tape tube and adaptor to patient's forehead to prevent accidental lens

removal. 6. Absorb outflow with towels. 7. Removal: Have patient look up. Retract lower lid behind interior border

of the lens. Hold position. Have patient look down, retract upper lid and slide lens out.

Critical Criteria: 1. Incorrectly insert device.


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83. EVISCERATION Equipment:

Sterile gauze, sterile water, aluminum foil, and tape Procedure: 1. Take body substance isolation precautions. 2. Do not touch or move exposed organs. 3. Cover organs with sterile gauze moistened with sterile water. 4. Cover moistened sterile gauze with sterile bulky dressing or occlusive dressing

like aluminum foil. 5. Secure dressing with tape. Critical Criteria: 1. Inability to stabilize and protect exposed organs.


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84. STABLIZING AN IMPALED OBJECT Equipment:

Gauze, tape, and items to provide rigid support. Procedure: 1. Take body substance isolation precautions. 2. Control hemorrhaging.. 3. Apply bulky dressing around the object. 4. Secure dressing in place with tape or wraps. 5. Evaluate effectiveness of stabilizing. Critical Criteria: 1. Inability to stabilize object.


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85. SUCKING CHEST WOUND Equipment:

Vaseline gauze, aluminum foil, Ashman chest seal, and tape. Procedure: 1. Take body substance isolation precautions. 2. Determine patient has a sucking chest wound. • Make a one way valve by applying a square section of Vaseline gauze foil or

aluminum foil over the hole in the patient’s chest. Tape to 3 sides to make flutter valve.

Or • Apply Ashman Chest Seal device 3. Re-evaluate lung sounds. Critical Criteria: 1. Inability to create flutter valve.


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86. TREATING SHOCK Equipment:

Gauze, bandages, and splinting equipment. Procedure: 1. Perform scene size-up.


2. Position patient supine. 3. Perform initial assessment. 4. Control all external bleeding sites with gauze and bandages. 5. Perform focused history and rapid physical exam. 6. Splint bone and joint injuries. 7. Maintain normal body temperature with blankets. 8. Elevate legs into trendelenburg position about 6 to 12 inches. 9. Perform detailed physical exam. 10. Perform ongoing assessment. Critical Criteria: 1. Did not perform blood pressure, after treatment.


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87. SHORT BOARD SPINAL IMMOBILIZATION Equipment:

Short backboard, long back board, cervical collar, straps Procedure: 1. Takes body substance isolation precaution.

2. Manual immobilization of head in a neutral in-line position.

3. Size and apply appropriate cervical collar.

4. Insert short backboard at a 45 degree angle behind the patient while limiting

patient movement (Device should be centered in the back). 5. Connect and adjust torso straps. 6. Secure head to short backboard. 7. Move and secure patient to long spine board.

• Crossing straps on the upper torso area. • Crossing straps on the abdominal area.



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88. KENDRICK EXTRICATION DEVICE (KED) Equipment:

KED, Cervical Collar, long spine board, and 4 backboard straps. Procedure:

Tonight - Top strap My - Middle strap Baby - Bottom strap Looks - Leg straps Hot - Head straps

1. Takes body substance isolation precaution. 2. Manual immobilization of head in a neutral in-line position. 3. Size and apply appropriate cervical collar. 4. Insert device at a 45 degree angle behind the patient while limiting patient

movement (Device should be centered in the back).

5. Connect and adjust torso straps (Top Green strap, Middle Yellow strap, and bottom Red strap).

6. Connect and adjust groin straps (Attach to same side or cross strap).

7. Place pad behind patient's head to fill any void spaces. 8. Position head flaps, and fasten the forehead and chin straps. 9. After removal from confined space, place patient on long backboard. 10. Loosen top torso green strap and leg straps. 11. Secure patient's body by:

• Crossing straps on the upper torso area. • Crossing straps on the abdominal area.


136


88. KENDRICK EXTRICATION DEVICE (KED) Critical Criteria: 1. Moves the patient in a safe and effective manner. 2. Prevents injury to self by using correct technique. 3. Immediately takes manual immobilization of the head and neck. 4. Does not release manual immobilization till maintained mechanically. 5. Does not allow excessive movement of patient after secured with straps.


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89. BASKET STRETCHER Equipment:

Basket stretcher Procedure: 1. Move patient into the basket:

• If patient has suspected spinal injury, patient should be appropriately placed on backboard.

Or

• If no suspected spinal injury, patient will lifted into the basket with the appropriate lift technique.

2. Student will secure patient with the device straps and make sure that they are

tight enough to not allow the patient to move. 3. Students will prepare to lift and carry:

• Two students – one at the head and one at the feet. • Four students – two students on each side. • Six students – three students on each side.

4. Students will perform a power lift on the command of the student positioned at the patient’s head.

5. Students will carry at arms length. 6. Stretcher is lowered upon command. Critical Criteria: 1. Able to carry 10’. 2. Moves patient in a safe and effective manner. 3. Prevents injury to self by using correct technique.


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90. INFANT IMMOBILIZATION – IN A CAR SEAT Equipment:

Tape, towels, pads, cervical collar. Procedure: 1. Take body substance isolation precautions. 2. Apply manual in-line stabilization. 3. Apply cervical collar. 4. Roll towels or pads to support alongside the infant’s head. 5. Secure rolls and head with tape. 6. Secure car seat to stretcher. Critical Criteria: 1. Immediately takes manual immobilization of the head and neck. 2. Does not release manual immobilization till maintained mechanically.


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91. REMOVING A FOOTBALL HELMET Equipment:

Tool to remove face mask. Procedure: 1. Take body substance isolation precautions. 2. Apply manual in-line stabilization. 3. Determine the need to remove the helmet face mask.

• Respirator management • Initiate care to facial injuries

4. Student one places one hand on the mandible (thumb on one side and the

fingers on the other side) and the other hand under the patient’s head at the occipital area.

5. Student two removing face mask.

• Cutting tool to remove tabs

Or

• Remove facemask screws 6. Evaluate the ability to perform respirator management. Remove entire

helmet when not able to gain access to the airway or unable to remove in a timely manner.

• Cut or loosen chin strap. • Student one places one hand on the mandible (thumb on one side and the

fingers on the other side) and the other hand under the patient’s head at the occipital area.


140


91. REMOVING A FOOTBALL HELMET • Student two moves the helmet laterally to the ears and may need to tilt

forward to finish removal.

• Student two applies manual in-line stabilization.

7. Apply cervical collar. 8. Secure to spinal device.

Critical Criteria: 1. Remove helmet with no respirator management compromise. 2. Failure to stabilize the head and neck.


141


92. REMOVING A FULL FACE HELMET Equipment:

None Procedure: 1. Take body substance isolation precautions. 2. Student one applies manual in-line stabilization by placing hands on each side

of the helmet with the fingers on the victim’s mandible. 3. Student two cuts or loosens the straps. 4. Student two transfers manual in-line stabilization by placing one hand on the

mandible (thumb on one side and the fingers on the other side) and the other hand under the patient’s head at the occipital area.

5. Student one:

• Should inspect for glasses and remove. • Laterally move helmet to clear the ears. • Tilt helmet backwards to raise over the nose and remove.

• Applies manual in-line stabilization.

6. Apply cervical collar. 7. Secure to spinal device. Critical Criteria: 1. Failure to stabilize the head and neck.


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93. PATIENT ASSESSMENT / MANAGEMENT - TRAUMA

Equipment:

Blood pressure cuff, stethoscope, pulse oximeter, and pen light. Procedure: Scene Size-up: 1. Take body substance isolation precautions. 2. Inspect the scene for safety (personal protection). 3. Determines the mechanism of injury. 4. Determines the number of patients. 5. Determines the need for additional resources. 6. Determines the need for spinal immobilization. Initial Assessment: 7. Inspect general impression of the patient (visual assessment). 8. Student one introduces himself / herself to the patient and obtains consent

for patient care. 9. Determine chief complaint. 10. Determine mental status. 11. Assess airway and student two performs manual in-line cervical

immobilization. 12. Assess breathing – provides oxygen therapy and assures adequate ventilation. 13. Assess circulation – Assess pulse. 14. Assess and control major external bleeding.


143



15. Assess perfusion. 16. Identify priority and transport decisions. Focused History and Rapid Assessment: 17. Inspect for DCAP BTLS:

• Palpate the head and neck. • Suspected spinal injury - size and apply the appropriate cervical collar

• Palpate the chest. • Palpate the abdomen in four quadrants.

• Palpate the pelvis.

• Palpate all four extremities.

• With the assistance of other students, log roll patient.

• Assess the back.

18. Baseline vital signs. 19. SAMPLE History. Performs detailed physical exam: 20. Assess the head.

• Inspect around the eyes and eyelids for redness. • Inspect the eyes for contacts.

• Inspect the eyes for pupil function. Take pen light from the corner of the

eye and shine on to the pupil. Determine if the pupils are equal and reactive.

• Inspect behind the ears for Battle’s Signs (bruising).


144



• Inspect the ear canal for drainage of blood or spinal fluid. Use 4x4 gauze folded in fours to identify spinal fluid inside blood by a halo.

• Palpate scalp for depressions of the skull.

• Palpate areas of the face like zygomas, maxillae, and mandible for instability.

• Inspect the mouth for cyanosis around the lips, foreign body (includes dentures

or loose teeth), and unusual odors.

• Inspect the nose. 21. Palpate the front and back of the neck.

• Inspect for jugular vein distention. • Inspect for tracheal deviation. • Inspect skin for crepitus (crackling) under the skin.

22. Palpate the chest over the ribs.

• Inspect for symmetrical chest rise and fall.

• Inspect for paradoxical motion.

• Auscultate anterior breath sounds at midaxillary and midclavicular area.

• Auscultate posterior breath sounds at the bases and apices area. • Palpate for crepitus.





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• Compress downward and inward on the iliac crest to identify any instability.

24. Palpate all four extremities.

• Inspect for medical alert bracelets. • Palpate dorsalis pedis or posterior tibial pulse, and radial pulse. • Inspect for motor function with wiggling toes and fingers.


25. With the assistance of other students, log roll patient. 26. Palpate the back. 27. Manages secondary injuries and wounds appropriately. Performs on-going assessment: 28. Repeat initial assessment. 29. Reassess vital signs. 30. Repeat focused assessment. 31. Check interventions.


146



Critical Criteria: 1. Did not take or verbalize body substance isolation precaution. 2. Did not determine scene safety. 3. Did not asses for spinal protection. 4. Did not provide for spinal protection when indicated. 5. Did not provide high concentration of oxygen. 6. Did not find, or manage problems associated with airway, breathing,

hemorrhage, or shock. 7. Did not differentiate patient’s need for transportation versus continued

assessment at the scene. 8. Did other detailed physical examination before assessing airway, breathing,

and circulation. 9. Did not transport patient within 10 minute time limit.


147



148


*EMS CODE OF ETHICS*

As adopted by the National Association of EMTs

Professional status as an Emergency Medical Technician and Emergency Medical Technician-Paramedic is maintained and enriched by the willingness of the

individual practitioner to accept and fulfill obligations to society, other medical professionals, and the profession of Emergency Medical Technician. As an Emergency Medical Technician-Paramedic, I solemnly pledge myself to the

following code of professional ethics:

A fundamental responsibility of the Emergency Medical Technician is to conserve life, to alleviate suffering, to promote health, to do no harm, and to encourage the

quality and equal availability of emergency medical care.

The Emergency Medical Technician provides services based on human need, with respect for human dignity, unrestricted by consideration of nationality, race

creed, color, or status.

The Emergency Medical Technician does not use professional knowledge and skills in any enterprise detrimental to the public well being.

The Emergency Medical Technician respects and holds in confidence all

information of a confidential nature obtained in the course of professional work unless required by law to divulge such information.

The Emergency Medical Technician, as a citizen, understands and upholds the

law and performs the duties of citizenship; as a professional, the Emergency Medical Technician has the never-ending responsibility to work with concerned

citizens and other health care professionals in promoting a high standard of emergency medical care to all people.

The Emergency Medical Technician shall maintain professional competence and

demonstrate concern for the competence of other members of the Emergency Medical Services health care team.

An Emergency Medical Technician assumes responsibility in defining and

upholding standards of professional practice and education.

The Emergency Medical Technician assumes responsibility for individual professional actions and judgment, both in dependent and independent

emergency functions, and knows and upholds the laws which affect the practice of the Emergency Medical Technician.


149


*EMS CODE OF ETHICS*

An Emergency Medical Technician has the responsibility to be aware of and participate in matters of legislation affecting the Emergency Medical Service

System.

The Emergency Medical Technician, or groups of Emergency Medical Technicians, who advertise professional service, do so in conformity with the dignity of the profession. The Emergency Medical Technician has an obligation to protect the public by not delegating to a person less qualified, any service which requires the professional competence of an Emergency Medical Technician The Emergency Medical Technician will work harmoniously with and sustain confidence in Emergency Medical Technician associates, the nurses, the physicians, and other members of the Emergency Medical Services health care team. The Emergency Medical Technician refuses to participate in unethical procedures, and assumes the responsibility to expose incompetence or unethical conduct of others to the appropriate authority in a proper and professional manner. ________________________________________ Written by: Charles Gillespie M.D. Adopted by: The National Association of Emergency Medical Technicians, 1978.


150


State of Florida DO NOT RESUSCITATE ORDER (DNRO)


151


START Triage

GREEN - Walking Wounded YELLOW - Delayed RED - Immediate BLACK - Deceased


152


Jump START – Pediatric Triangle


153


All Risk Triage Tags


154


Glasgow Coma Score

Eye Opening

Spontaneous 4

To Loud Voice 3

To Pain 2

None 1

Verbal Response

Orientated 5 Confused, Disorientated 4

Inappropriate words 3

Incomprehensible sounds 2

None 1

Best Motor Response Obeys 6

Localizes 5

Withdraws (flexion) 4 Abnormal flexion posturing 3

Extension posturing 2

None 1


155


APGAR Score

Test 0 Points 1 Point 2 Points

Activity (Muscle Tone) Absent Arms & legs extended

Active movement with flexed arms &

legs

Pulse (Heart Rate) Absent Below 100 bpm Above 100 bpm

Grimace (Response Stimulation or Reflex Irritability)

No Response Facial grimace Sneeze, cough, pulls away

Appearance (Skin Color) Blue-gray, pale all over

Pink body and blue extremities

Normal over entire body – Completely

pink

Respiration (Breathing) Absent Slow, irregular Good, crying


156


Rule of Nines


157


CPR and FBAO Chart

Adult Child Infant

Age 9 years and older 1 to 8 years old under 1 year old Lone Rescuer Calling

911 After determining unresponsiveness After 2 minutes of CPR After 2 minutes of CPR

Opening the Airway Hyperextended with head tilt and chin lift

Hyperextended with head tilt and chin lift

Neutral or Sniffing position with head tilt

and chin lift

Rescue Breathing 1 breath / 5-6 seconds 1 breath / 3-5 seconds 1 breath / 3-5 seconds

Pulse Check Carotid Artery Carotid Artery Brachial Artery Compression Landmarks

Center of the chest between the nipples

Center of the chest between the nipples

Just below the nipple line

Compressin Method

2 hands with heel of one hand on top of the

other Heel of 1 hand or 2 hands

on top of the other

1 Rescuer - 2 fingers or

2 Rescuers - 2 thumbs encircling the chest

Compression Depth 1 1/2 to 2 Inches 1/3 to 1/2 depth of the

chest 1/3 to 1/2 depth of the

chest

Compressions/minute 100 100 100

Compressions/respirations 30/2 one person 30/2 two person

30/2 one person 15/2 two person

30/2 one person 15/2 two person

Cycle of CPR

5 times of 30 compressions / 2

ventilations or

2 minutes of CPR


ventilations or

2 minutes of CPR or


ventilations


ventilations or

2 minutes of CPR or


ventilations

FBAO - Conscious Abdominal thrusts Abdominal thrusts 5 back slaps and 5 chest

thrusts

FBAO - Unconscious

Look for object ventilate twice

30 chest thrusts


30 chest thrusts


30 chest thrusts

Applying the AED

Witnessed Arrest - Immediately Defibrillation

or Unwitnessed Arrest - 2

minutes of CPR then Defibrillation

Witnessed Arrest - Immediately Defibrillation

or Unwitnessed Arrest - 2

minutes of CPR then Defibrillation AED not recommended


158


Jump Kit Inventory

Center Pouch #1 Airway

Outer Pouch #3 Trauma

Outer Pouch #4 Diagnosis Equipment

End

Pouch #2

Airway


1. Oxygen cylinder and regulator 2. Hand held V-Vac suction 3. Airway roll 4. Side one (in order):

a. Sharp box b. pediatric NRB c. 3 pairs of safety glasses d. 3 pairs of trauma sleeves e. 3 HEPA Masks f. 3 Universal gowns g. 1 Convience bag h. ResQpod

5. Side two (in order):

a. Nebulizer b. 2 Adult NRB c. 2 Adult NC d. Easy Cap CO2 e. Tube holder

Airway Roll

Back pocket 1 • King tube • 60cc syringe

Back pocket 2 • 140cc syringe • 20cc syringe

Back pocket 3 • Combitube

Back pocket 4 • LMA tube • 30ml syringe

Front Left side holders (in order): • Adult Magil Forceps • Pediatric Magil Forceps • Assorted OPAs • Assorted NPAs • 4 packages of Lubrication jelly • Bite block/stick




End Pouch #2

Airway


159


Jump Kit Inventory




End

Pouch #2

Airway

Outer Pouch #4

Diagnosis Equipment

1. Pulse oximeter 2. Stethoscope w/ safety seal 3. Back straps (in order):

• Tympanic thermometer • glucometer and lancet

device • oral glucose • penlight • Adult BP cuff


1. Burn sheet 2. 2 Multi-Trauma dressing 3. 5 sterile 4x4s 4. 2 Icepacks 5. 1 red bag 6. Back wall (in order):

a. Stack of non-sterile 4x4 b. 2 triangular bandages c. 1 Blood stopper d. 1 Ring cutter e. 1 Trauma shear f. 1 – ace bandage g. 2 – 4” kling h. 2 inch tape

End Pouch #2 Airway

1. Adult BVM with mask and tubing




End Pouch #2

Airway


160


Approved Abbreviations

• AAOx3 – Alert and orientated times person, place, and time/date • abd – abdomen • ac – before meals • AMI – acute myocardial infraction • amt – amount • ant – anterior • ASA – Aspirin • BM – bowel movement • BP – blood pressure • BS – blood sugar • BVM – Bag valve mask • CA – cancer • CC – chief complaint • CHF – congestive heart failure • CNS – central nervous system • c/o – complaining of • COPD – chronic obstructive pulmonary disease • DNR – do not resuscitate • DOA – dead on arrival • ECG – electrocardiogram • EENT – eye, ear, nose, and throat • EKG – electrocardiogram • ETA – estimated time of arrival • Fx – fracture • H/A - headache • HEENT – head, eyes, ears, nose, and throat • HTN – hypertension • HX – history • IM – intramuscular • IV – intravenous • IVP – intravenous push • kg – kilogram • LLQ – left lower quadrant • LOC – level of consciousness • LR – lactated ringers • Lt – left • LUQ – left upper quadrant • mcg - microgram • mg – milligram


161


Approved Abbreviations

• MI – myocardial infarction • ml – milliliter • NC – nasal cannula • NPO – nothing by mouth • NRB – non-rebreather mask • NS – normal saline • NTG – nitroglycerin • OD – overdose • pc – after meals • PERL – pupils equal and reactive to light • po – by mouth • PRN – whenever necessary or as needed • PTA – prior to arrival • RLQ – right lower quadrant • RUQ – right upper quadrant • SOB – short of breath • TKO – to keep open • Y/O – years old • V.S. – vital signs • w/o – without • WNL – within normal limits


162


Trauma Telemetry - CUTT REPORT


163


Trauma Telemetry – CUTT Report


164


Telemetry Report – Med-Com Report

Rescue Unit: ________

Patient Age: ________ Gender: __________

Chief Complaint: ___________________________________________________ Signs and Symptoms/Physical Findings: ______________________________________________________________________________________________________ Medical History: ___________________________________________________ Medications: ______________________________________________________________________________________________________ Allergies: ___________________________________________________

Vital Signs

BP: _______ Pulse: _______ Respirations: _______ SAO2: _______ GCS: _______ Temperature: _______

Treatment Provided: ETA to Facility: __________________________________________________

* Make Copies *


165



166


CLINICAL PERFORMANCE SKILLS CHECK OFF SHEET

SKILL DATE

RESCUE UNIT NUMBER / HOSPITAL

PARAMEDIC / INSTRUCTOR (PRINT)

Patient Movement

Perform cradle carry

Perform extremity carry

Perform firefighter carry

Perform pack strap carry

Perform backboard 4 point carry

Perform backboard diamond carry

Perform walking assist

Perform arm drag

Perform blanket drag

Perform clothes drag

Perform firefighter's drag

Perform shoulder or arm to arm drag

Perform blanket lift

Perform direct ground lift Perform stretcher loading into ambulance Perform stretcher unloading from ambulance

Perform stretcher raise

Perform stretcher lower

Perform stretcher adjust back rest

Apply flexible stretcher

Apply scoop stretcher


167



SKILL DATE



Airway and Breathing Equipment and Procedures

Apply basket stretcher

Apply stair chair

Perform Bag valve mask ventilations

Apply non-rebreather

Apply nasal cannula

Setup nebulizer

Setup C-PAP

Setup portable oxygen cylinder

Perform yankare suctioning Perform whistle tip suctioning of the mouth Perform whistle tip suctioning through device

Setup portable suction unit

Insert oropharyngeal

Insert nasopharyngeal

Perform sellick maneuver

Insert combitube

Insert King tube

Insert Laryngeal mask airway

Perform assisted breathing

Setup pulse oximetry


168



SKILL DATE



Setup capnographer

Determine respirations rate

Auscultate respirations - rhonchi

Auscultate respirations - wheezing

Auscultate respirations - rales

Auscultate respiration - stridor

Auscultate respirations - normal

Observe endotracheal intubation

Observe nasotracheal intubation

Observe pleural decompression

Observe cricothyroidotomy

Observe needle cricothyroidotomy

Observe automatic respirator setup

Observe nasagastric tube insertion

Circulation Equipment and Procedures

Perform CPR on Adult

Perform CPR on Pediatric

Perform CPR on Infant

Setup AED

Setup monitor for 4 lead ECG


169



SKILL DATE



Setup monitor for 12 lead ECG

Setup IV bag

Auscultate blood pressure

Palpate blood pressure

Palpate capillary refill

Observe IV administration

Observe adult IO administration

Observe pediatric IO administration

Observe defibrillation

Observe pacing

Observe synchronized cardioversion

Observe ECG transmission to hospital

Observe mechanical CPR device setup

Trauma Equipment and Procedures

Apply vacuum splint

Apply rigid splint

Apply sager splint

Apply hare splint

Apply PASG

Apply air splint

Apply Sam splint


170



SKILL DATE



Apply short spinal board

Apply kendrick extrication device

Apply cardboard splint

Apply pillow splint

Apply sling and swathe splint

Apply cervical collar on adult

Apply cervical collar on child

Apply backboard standing

Apply backboard seated in vehicle

Apply backboard supine

Apply backboard in the water

Apply manual cervical immobilization Apply immobilization to an impaled object Apply removal technique to a foreign object of the eye Apply flushing to eye from chemical burn Apply direct pressure to soft tissue injury Apply elevation technique to soft tissue injury Apply pressure point technique to soft tissue injury

Apply dressing to an evisceration Apply dressing to a sucking chest wound

Perform full face helmet removal

Perform football helmet stabilization


171



SKILL DATE



Other Equipment and Procedures

Perform glucose test

Observe nitrous oxide administration

Observe physical restraint application

Observe blood draw

Observe morgan lens therapy

Medication Administration

Administer epi-pen autoinjector

Administer nitroglycerin

Administer metered dosed inhaler

Administer oral glucose

Adminster subcutaneous injection

Administer intramuscular injection

Assessment / Exams

Perform initial assessment

Perform focused history exam

Perform rapid physical exam

Perform detailed physical exam


172



SKILL DATE



Perform Cincinnati stroke exam

Perform MEND stroke exam

Perform START triage assessment

Perform JumpSTART triage assessment

Perform Trauma Alert Assessment

Perform High Index Assessment

Perform Cardiac Alert Assessment

Perform pupil assessment

Perform APGAR assessment

Perform burn assessment

Perform Glasgow coma scale score

Medical Incidents

Observe obstructed airway emergency

Oberseve asthma emergency Observe chronic obstructive pulmonary disease emergency

Observe pulmonary edema emergency

Observe pneumonia emergency

Observe cardiac shock emergency Observe cardiac dysrhythmia emergency Observe acute coronary syndrome emergency

Observe hypertensive emergency


173



SKILL DATE



Observe altered mental status emergency

Observe violent behavior emergency

Observe seizure emergency

Observe stroke emergency

Observe syncopal episode emergency

Observe bite emergency

Observe sting emergency

Observe poisoning emergency

Observe drug overdose emergency Observe normal labor delivery emergency Observe complicated labor delivery emergency

Observe allergic reaction emergency

Observe diabetic emergency Observe non-traumatic abdominal emergency Observe non-traumatic chest emergency

Trauma Incidents

Observe dive injury emergency

Observe cold related emergency

Observe heat related emergency

Observe near drowning emergency

Observe electrical emergency


174



SKILL DATE



Observe head injury emergency

Observe spinal injury emergency

Observe eye injury emergency

Observe chest injury emergency

Observe abdominal injury emergency

Observe extremity injury emergency

Observe burn injury emergency

Telemetry

Perform medical incident telemetry

Perform trauma incident telemetry


175



176


McFatter Technical Center / Broward Fire Academy Clinical Report Form

Student Name:_______________ Date:__________ Report Number:___

Department:_______________ Rescue Unit Number:________

Incident Type: Trauma / Medical Age:_____ Gender: Male / Female

SUBJECTIVE What the person tells you • Chief Complaint

• S-A-M-P-L-E

Signs/symptoms Allergies Medications Last Meal Event leading to illness/injury

• O-P-Q-R-S-T Onset Provocation Quality Radiate/Region Severity 1-10 Time

• Pertinent Negatives CP NV LOC SOB


177


OBJECTIVE What you found Scene Size-up Age, kg, position • Physical Exam • NEURO (GCS) • SKIN • HEAD • NECK • BACK • CHEST • ABD • PELVIS • LOW EXTREM • UPR EXTREM • SECONDARY

ASSESSMENT

Possible Diagnosis

PLAN

• Treatment Provided to pt

• Effects/Changes in patient condition – Secondary Assessment

• Destination • Transfer care to

Nurse or Dr

Time Blood Pressure Pulse Respirations SaO2 % Glucose / Temp


178



179


CLINICAL ATTENDANCE ROSTER

NAME:__________________________________________

CLASS:__________________________________________

Date Hospital Time

In Time Out

Total Hours

Instructor (Print)

Instructor (Signature)

Date Department / Unit # Time

In Time Out

Total Hours

Lead Paramedic (Print)

Lead Paramedic (Signature)

Instructor Feedback: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


180


EMS Student Field Evaluation Emergency Medical Technician

Preceptor: We appreciate you allowing our student to ride with your agency to observe the daily operations. This opportunity will provide them with time to practice their skills and assessments during their scheduled field ride times. Please provide any comments and feedback regarding their actions during this time. Each student has been provided with a skills performance sheet to track their performance while in the field setting.

Student Name: __________ Date: __________ Unit Number: _____

Place a X in the corresponding column Satisfactory Unsatisfactory Feedback/ Comments

Arrived/Left on time during the scheduled times

Groomed and wearing the correct uniform during the

scheduled time

Showed respect and professionalism to all

patients and team members

Actively showed enthusiasm and participated in all daily

activities/functions

Demonstrated skills and assessments correctly and had a willingness to learn

Student Strengths:

________________________________________________________________________________________________________________________________________________________________________________________________

Areas of Improvement:

________________________________________________________________________________________________________________________________________________________________________________________________

Additional Comments: ________________________________________________________________________________________________________________________________________________________________________________________________

Preceptor Name: _______________ Preceptor Signature: _______________


181



182


HIPAA Health Insurance Portability and Accountability Act 1996

Acknowledgement of Training

The Federal Government requires that all Healthcare Employees, Healthcare Agencies, Healthcare Volunteers, and Healthcare Students to complete training on HIPAA patient privacy. I acknowledge and understand that patient information is confidential and should not be shared. I acknowledge that I have received HIPAA training, understand patient privacy, and will abide by the rules and regulation regarding to HIPAA. Participant Name (Print): _______________________________________________ Participant Name (Signature): _______________________________________________ Date of Training: _______________________________________________

Class number: ___________


183


72 Hour Report Agreement Letter

Date: ________

I acknowledge that I have 72 hours (3 days) from the start of the ride

time to complete any reports and electronically send to the designated

instructor. Any report that is received beyond the 72 hour timeline will

not be accepted for the required 5 reports for the program. I further

acknowledge that I must request additional rescue ride hours if short

the 5 reports. Failure to complete the 5 reports prior to the completion

of the course could mean a delay in receiving an EMT course

completion certificate on the last day of class. Finally, I understand

that the rescue ride reports count for a grade. Any report graded as

unsatisfactory will be allowed to redo the report once. The student has

72 hours after receiving the failed report electronically by the

instructor to correct and resubmit. The resubmitted report will count

for final grade. Any resubmitted report with a second unsatisfactory

will be considered failing that graded portion of the class and could be

subjected for administrative withdraw.

Student (Print): _____________________________________________________ Student Name (Signature): _____________________________________________________


184


MEDIA RELEASE Date: ____________________________ I hereby give permission to the School Board of Broward County, Florida to make audio and/or visual recordings or photographs of me and to use these finished materials for educational purposes and/or to promote the positive aspects of the Broward County Schools through communication media such as newspaper and television. I further realize that all such uses and distribution by the Broward County School Board shall be within their sole discretion. Name (print) Signature Address City State Zip Code Registered Program: Health Science Core (HSC) Emergency Medical Technician – Basic (EMT-B) Firefighter Minimum Standards Emergency Vehicle Operations


185


http://www.browardhealth.org/?id=1646&sid=1 1. Annual Risk Management Course

2. Broward Health Orientation & Exam

3. Aspirations Precautions Education Packet

4. Code of Conduct

5. Data Security Form

6. Flu Vaccination Course

7. Hand Hygiene

8. HIPAA/Compliance Program & Exam

9. Student Influenza Declination Form

10. SBAR

11. Stroke Awareness

12. Student Responsibility Form

13. Team Collaboration Course

http://www.browardhealth.org/?id=1646&sid=1

http://www.browardhealth.org/upload/docs/deptlearning/code_of_conduct_book_sm.pdf

http://exams.browardhealth.org/compliance_HIPAA_2009/index.htm


186


Town of Davie Fire Rescue Department

Release and Hold Harmless

Request for Permission to Ride as an Observer and Hold Harmless Agreement

The undersigned being over the age of eighteen (18) does hereby request the Town of Davie, Broward County, Florida for permission to ride as an observer only in an authorized Town of Davie motor vehicle unit. IN CONSIDERATION of the permission granted __________________________ by the Town of Davie to ride as an observer with the Town of Davie Fire Rescue Department and any related events and activities, I, the undersigned for myself, my heirs, assigns and administrators, HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE THE TOWN OF DAVIE AND ITS AGENTS, OFFICERS AND EMPLOYEES from all liability to the undersigned, my heirs, assigns and administrators, of and from all claims and demands, actions and causes of action, damages, losses and liabilities, costs, expenses and compensation on account of the death or injury to myself or my property, and any and all know and unknown, foreseen and unforeseen damages and consequence thereof caused by or arising out of my participation in the Leadership Program for the Town of Davie. This observation is for the purpose of my educational benefit. If permission is granted, I hereby agree to obey, at all times, all instructors, orders and commands given to me by unit members in command of any vehicle in which I may be riding. I fully realize and appreciate the basic nature of Emergency Medical work and the possibility that a situation will arise which might result in my being exposed to the danger of physical harm or injury, including but not limited to motor vehicle accidents through negligence of third parties or the Town of Davie, I nevertheless, freely accept these risks. I HAVE CAREFULLY READ THE FOREGOING RELEASE AND WAIVER AND KNOW THE CONTENTS THEREOF AND HAVE SIGNED THIS RELEASE AND WAIVER AS MY OWN FREE ACT. This release and Waiver contains the entire agreement between the undersigned and the Town of Davie and the terms of this Release and Waiver are contractual and not mere recital. I expressly agree that this Release and Waiver is intended to be as broad and as inclusive as permitted by law of the State of Florida, and that if any portion, thereof is held invalid, it is agreed that the balance shall notwithstanding, continue in full force and effect. Name: ___________________________________________________________ Age: ___________ Phone:__________________________________________ Address:_________________________________________________________ _________________________________________________________________ Driver’s License Number: ___________________________________________ Signature: ________________________________________________________ STATE OF FLORIDA COUNTY OF I, an officer authorized to take acknowledgements, hereby certify that this __________ day of ___________________, 20______, personally appeared before me ________________________, to me well known to be the person described in and who executed the foregoing release, and acknowledged to me that he/she executed the same freely and voluntarily for the uses and purpose therein.

_______________________________ Notary Public


187


CITY OF PEMBROKE PINES FIRE DEPARTMENT

LIABILITIY RELEASE AND INDEMNIFICATION

I, ________________________________, on this ____ day of ______________,

20____, request the permission of the City of Pembroke Pines Fire Department

to accompany the Paramedics on the Fire Department Emergency Medical

Rescue Vehicles of this City, during the course of emergency transportation and

emergency medical services, as performed by them, and for other duties which

they perform.

I realize the granting of this request by the City may include my accompanying

the above on vehicle owned and operated by the City. I further realize that the

City is allowing me to accompany the Paramedics at my own request and with

considerable benefit to me. In consideration of the granting of this request, I

hereby agree to:

1. Discharge the City of Pembroke Pines, a municipal corporation, in Broward County, Florida, its successors and assigns, from any and all claims, demands, damages, actions and causes of action, present and future, whatsoever which I may have as a result of any injuries which may occur during my accompanying of the Paramedics, as described above;

2. Indemnify the City of Pembroke Pines, its successors and assigns from

any and all loss, liability or damages which may occur due to my participation in this program and accompanying of the Paramedics as described above;

3. Agree to pay all attorneys fees and cost which may be incurred by

litigation arising from this release and indemnification and the matter described herein.

________________________________ ______________________________ Witness Signature of Rider ________________________________ _______________________________ Witness Date