Download CF Paramedic Program Lab Skills Book

CF Paramedic Program
Lab Skills Book
Third Semester
Name: _______________________________
© 2014, McGinnes, Ramsey, Bledsoe, Gesner, Leinas, Reyes, Graves, Watts
1
If found please call 352-291-4440 or return to
College of Central Florida,
Emergency Medical Services Program
3001 SW College Rd.
Ocala, FL 34474
Thank You
2
Table of Contents:
Skill
Page
Assess & Manage - Spinal Immob: Prone - Adult, Child, Infant
Assess & Manage - Spinal Immob: Semi-Prone - Adult, Child, Infant
Assess & Manage - Spinal Immob: Sitting (KED)
Assess & Manage - Spinal Immob: Standing - Adult, Pediatric
Assess & Manage - Spinal Immob: Supine - Adult, Pediatric
Assess & Manage - Traction Splint - Adult, Pediatric
Assess and Mgmt - Radiation Burns - Adult, Child and Infant
Assess and Mgmt - Thermal Burn - Adult, Child, Infant
Assess and Mgmt - Electrical Burn Injury - Adult, Child, Infant
Assess and Mgmt - Chemical Burn Injury - Adult, Child, Infant
Assess and Mgmt - Inhalation Burn Injury - Adult, Child, Infant
Helmet Removal Techniques
Donning and Properly Adjusting a Personal Flotation Device (PFD)
In-Water Spinal Immobilization Technique - Adult, Child, Infant
Assess and Mgmt - Thoracic Trauma - Adult, Child, Infant
Assess and Mgmt - Spinal Injury - Adult, Child, Infant
Assess and Mgmt - Altered Mental Status
Assess and Mgmt - Anaphylaxis
Assess and Mgmt - Communicable Disease
Assess and Mgmt - Diabetic Emergencies
Assess and Mgmt - GI Bleed
Assess and Mgmt - Abdominal Pain
Assess and Mgmt - Heat Emergencies
Assess and Mgmt - Neurological Status
Assess and Mgmt - Hematologic Disorders (Sickle Cell)
Assess and Mgmt - Seizures
Assess and Mgmt - HHNK
Assess and Mgmt - Snakebite (Envenomation)
Assess and Mgmt - Suspected Stroke
Assess and Mgmt - Syncope / Weakness
Head Injuries - Child, Infant
Chest Injuries - Child, Infant
Abdominal Injuries - Child, Infant
Extremitiy Injuries - Child, Infant
Contrived Experience Lab
Airway Management Log
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10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
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31
32
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Third Semester Lab Objective Completion List
StudentName:____________________________________ Term:_____________________
(PLEASE PRINT)
Please submit your final lab notebook organized in the following order. Include a title page with tab for
each unit.
1. Report Cover, with your name and course number on outside
2. Third Semester objective completion checklist (this sheet)
3. Third Semester Lab Skills Sheets (You MUST demonstrate competence in ALL skills and
scenarios listed to receive a passing grade)
a. Trauma:
i. Radiation Burn Injury
_______ Demonstrated Competence
ii. Thermal Burn Injury
_______ Demonstrated Competence
iii. Electrical Burn Injury
_______ Demonstrated Competence
iv. Inhalation Burn Injury
_______ Demonstrated Competence
v.
Chemical Burn Injury
_______ Demonstrated Competence
vi. Stabalization of Helmet
_______ Demonstrated Competence
vii. Helmet Removal Techinques
_______ Demonstrated Competence
viii. Spinal Immobilization, Supine
_______ Demonstrated Competence
ix. Spinal Immobilization, Sitting
_______ Demonstrated Competence
x.
Spinal Immobilization, Semi-Prone
_______ Demonstrated Competence
xi. Spinal Immobilization, Prone
_______ Demonstrated Competence
xii. Spinal Immobilization, Standing
_______ Demonstrated Competence
xiii. Fixation, Soft and Traction Splints
_______Demonstrated Competence
xiv.
In-Water Spinal Immobilization Techniques
_______ Demonstrated Competence
xv.
Thoracic Trauma
_______ Demonstrated Competence
xvi. Musculoskeletal Trauma
_______ Demonstrated Competence
xvii. Shock
_______ Demonstrated Competence
xviii. Spinal Injuries, Traumatic & Nontraumatic
_______ Demonstrated Competence
xix.
Head Injury, Pediatric
_______ Demonstrated Competence
xx.
Chest Injury, Pediatric
_______ Demonstrated Competence
xxi. Abdominal Injury, Pediatric
_______ Demonstrated Competence
xxii. Extremity injury, Pediatric
_______ Demonstrated Competence
b. Medical:
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
Asst and Mgmt of Altered Menal Status
Asst and Mgmt of Anaphalaxis
Asst and Mgmt of Appendicitis
Asst and Mgmt of Communicable Disease
Asst and Mgmt of Gastrointestinal Bleed
Asst and Mgmt of Heat Emergencies
Asst and Mgmt of Hematologic Disorders
Asst and Mgmt of HHNK
Asst and Mgmt of Insulin Shock
Asst and Mgmt of Seizures
Asst and Mgmt of Snakebite
Asst and Mgmt of Stroke
4
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
c. Pediatrics:
i. FBOA - Child Conscious (PALS)
ii. FBOA- Child Unconscious(PALS)
iii. FBOA - Infant (PALS)
iv. Asst and Mgmt of Peds Resp arrest (PALS)
v.
Asst and Mgmt of Peds Resp failure (PALS)
vi. Intubation of Newborns/complications (PALS)
vii. Measuring Peds Vitals (PALS)
viii. Length Based resuscitation tape (PALS)
ix. Asst and Mgmt of Peds Resp distress (PALS)
x.
Intraosseous line for infants and children (PALS)
xi. Suctioning of infants and children (PALS)
xii. Vascular access for infants and Children (PALS)
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
d. Special Operations:
i. Stokes Basket: (Stokes and Ropes)
ii. Donning a PFD: (Water rescue)
iii. In-Water Immob Techniques: (Water rescue)
iv. ICS and MCI: (MCI training day)
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
e. Behavioral:
i. Behavioral Emergencies: (DTAK)
ii. Contact and Cover: (DTAK)
iii. Evasive Tactics: (DTAK)
_______ Demonstrated Competence
_______ Demonstrated Competence
_______ Demonstrated Competence
All Completed = 100. One or more not completed = 0.
Skills Score: _______
This score is 24% of your grade
f. Contrived Experience Lab:
1. Scenario:
Smith
Score: ___/100%
2. Scenario:
Johnson
Score: ___/100%
3. Scenario:
Williams
Score: ___/100%
4. Scenario:
Jones
Score: ___/100%
5. Scenario:
Brown
Score: ___/100%
6. Scenario:
Davis
Score: ___/100%
7. Scenario:
Miller
Score: ___/100%
8. Scenario:
Wilson
Score: ___/100%
9. Scenario:
Moore
Score: ___/100%
10. Scenario:
Taylor
Score: ___/100%
11. Scenario:
Anderson
Score: ___/100%
12. Scenario:
Martin
Score: ___/100%
13. Scenario:
Thompson
Score: ___/100%
14. Scenario:
Clark
Score: ___/100%
15. Scenario:
Garcia
Score: ___/100%
16. Scenario:
Martinez
Score: ___/100%
17. Scenario:
Robinson
Score: ___/100%
18. Scenario:
Clark
Score: ___/100%
5
____/24%
19. Scenario:
Rodriguez
Score: ___/100%
20. Scenario:
Lewis
Score: ___/100%
21. Scenario:
Walker
Score: ___/100%
22. Scenario:
Hall
Score: ___/100%
23. Scenario:
Allen
Score: ___/100%
Total Contrived Experience Lab Score: Average of above: ___x 0.44 =
____/44%
Final Practicals:
5. Trauma Scenario Score:
Score: _____/ 100 _____
This score is 10% of your grade
____ /12%
6. Medical Scenario Score:
Score: _____/ 100 = _____
This score is 10% of your grade
____ /12%
7. Professional Behavior Evaluation, Lab Coach:
Score: _____/ 22
This score is 4% of your grade
____ /4%
8. Professional Behavior Evaluation, Lead Instructor:
Score: _____/ 22
This score is 4% of your grade
____ /4%
9. Behavioral Counseling’s: _____
Positive Follow up: _____
Score: BC - PF = _____
This score subtracts 1% from your grade per point.
___
10. Unexcused absences: _____
___
Score: _____
This score subtracts 3% per unexcused absence from your grade.
(Note: Absences, excused or unexcused do NOT excuse you from completing the required competencies)
11. Late Arrivals _____ Early Departures _____
Score: LA+ED=___
This score subtracts 1% per occurrence from your grade.
___
*Note: If you miss more than 50% of the lab, the occurrence counts as an absence, not a late arrival
or early departure.
Total Score
___
Final Letter Grade
___
I DO HEREBY ATTEST THAT ALL INFORMATION CONTAINED ON THIS FORM AND IN
THE DOCUMENTATION IN THIS NOTEBOOK IS TRUE AND ACCURATE.
_____________________________
______________________________
PRINTED NAME
SIGNATURE
DATE
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_____/_____/_____
COLLEGE OF CENTRAL FLORIDA
Team Leader Record
STUDENT:
TERM:
Student must demonstrate competence as a team leader in a minimum of 10 scenarios
DATE
COMMENTS (Adjunct)
Competent? SIGNATURE
(Adjunct)
Reviewed by:
Instructor:
Date:
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CF Paramedic Program
Procedure: Assessment and Management of Spinal Immobilization: Prone - Adult, Pediatric
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student directs assistant to place/maintain head in neutral in-line position
Student directs assistant to maintain manual immobilization of the head
Student performs rapid head to toe assessment/assesses motor, sensory, and distal
circulation in extremities
Student applies measures and applies appropriate size c-collar
Student positions the long spine board immobilization device appropriately
Student directs log roll movement of the patient onto device without compromising the
integrity of the spine
Student applies padding to voids between the torso and the board if necessary
Student immobilizes the patient’s torso to the device using two straps
Student secures the patient’s legs to the device using one strap
Student ensures patients arms are secured to the device
Student immobilizes the patient’s head to the device using CID
Student continuously reassesses motor, sensory, and distal circulation in extremities
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
8
CF Paramedic Program
Procedure: Assessment and Management of Spinal Immobilization: Semi-Prone Adult, Pediatric
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student directs assistant to place/maintain head in neutral in-line position
Student directs assistant to maintain manual immobilization of the head
Student performs rapid head to toe assessment/assesses motor, sensory, and distal
circulation in extremities
Student applies measures and applies appropriate size c-collar
Student positions the long spine board immobilization device appropriately
Student directs log roll movement of the patient onto device without compromising the
integrity of the spine
Student applies padding to voids between the torso and the board if necessary
Student immobilizes the patient’s torso to the device using two straps
Student secures the patient’s legs to the device using one strap
Student ensures patients arms are secured to the device
Student immobilizes the patient’s head to the device using CID
Student continuously reassesses motor, sensory, and distal circulation in extremities
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
9
CF Paramedic Program
Procedure: Assessment and Management of Spinal Immobilization: Adult Sitting (KED)
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student directs assistant to place/maintain head in neutral in-line position
Student directs assistant to maintain manual immobilization of the head
Student performs rapid head to toe assessment/assesses motor, sensory, and distal
circulation in extremities
Student applies measures and applies appropriate size c-collar
Student positions the KED immobilization device appropriately behind patient
Student immobilizes the patient’s torso to the device (Middle, Bottom, Legs, Head, Top)
Student pads behind the patient’s head as necessary
Student continuously reassesses motor, sensory, and distal circulation in extremities
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
10
CF Paramedic Program
Procedure: Assessment and Management of Spinal Immobilization: Standing - Adult, Pediatric
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student directs assistant to place/maintain head in neutral in-line position
Student directs assistant to maintain manual immobilization of the head
Student performs rapid head to toe assessment/assesses motor, sensory, and distal
circulation in extremities
Student measures and applies appropriate size c-collar
Student positions the long spine board immobilization device appropriately behind patient
Student and assistant to move to each side of patient while maintaining c-spine
Student and assistant gently/safely lower the patient and the backboard to the ground while
maintaining in line stabilization of c-spine
Student directs assistant to solely regain control of and continue to maintain in line
stabilization of c-spine
Student applies padding to voids between the torso and the board if necessary
Student immobilizes the patient’s torso to the device using two straps
Student secures the patient’s legs to the device using one strap
Student ensures patients arms are secured to the device
Student immobilizes the patient’s head to the device using CID
Student continuously reassesses motor, sensory, and distal circulation in extremities
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
11
CF Paramedic Program
Procedure: Assessment and Management of Spinal Immobilization: Supine
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student directs assistant to place/maintain head in neutral in-line position
Student directs assistant to maintain manual immobilization of the head
Student performs rapid head to toe assessment/assesses motor, sensory, and distal
circulation in extremities
Student applies measures and applies appropriate size c-collar
Student positions the long spine board immobilization device appropriately
Student directs log roll movement of the patient onto device without compromising the
integrity of the spine
Student applies padding to voids between the torso and the board if necessary
Student immobilizes the patient’s torso to the device using two straps
Student secures the patient’s legs to the device using one strap
Student ensures patients arms are secured to the device
Student immobilizes the patient’s head to the device using CID
Student continuously reassesses motor, sensory, and distal circulation in extremities
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
12
CF Paramedic Program
Procedure: Assessment and Management of Traction Splint
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student assesses motor, sensory, and distal circulation
Student applies manual stabilization of the injured extremity
Student prepares/adjusts splint to the proper length
Student safely places injured extremity in the splint
Student applies the proximal securing strap (ischial strap)
Student applies the distal securing strap (ankle hitch)
Student applies mechanical traction
Student positions/secures the support straps
Student re-evaluates the proximal/distal securing straps
Student reassesses motor, sensory, and distal circulation
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
13
CF Paramedic Program
Procedure: Assessment and Management of Radiation Burns: Adult, Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Ensures safety of the crew before approaching the patient, and secures the scene from others.
Wear appropriate protective gear / stays behind a protective barrier.
Evaluates the patient’s level of consciousness.
Assures the airway is patent, if not, takes action to protect the airway.
If airway compromised considers endotracheal intubation.
Administers oxygen via appropriate oxygen delivery device.
Examine body for any injuries.
Approximates area of burn injury using the “Rule of Nines”.
Documents the extent and type of burn.
Removes all contaminated clothing / decontaminates patient.
Covers burn area with sterile dressing.
Places patient the ECG monitor, watching for possible dysrhythmias.
Takes vitals signs every 5 - 15 minutes and prepares for rapid transport.
Initiates one large bore IV’s and initiates fluid resuscitation if necessary (2 IV’s if severe
injury and initiates 20ml/kg bolus).
If patient is conscious and in pain, administers appropriate pain relief medication.
Administers psychological first aid.
Discusses transport considerations related to extent of the injury, time, location, and hospital
capabilities.
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: ________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
14
CF Paramedic Program
Procedure: Assessment and Management of Thermal Burn: Adult, Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Scene size-up with BSI / recognizes scene safety.
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Move patient away from the source if all possible.
Implementation and Assessment:
Forms a general impression of the patient.
Extinguishes any fire or removes and caustic substances.
Rules out any danger of associated trauma or head and spine injury.
Evaluates the patient’s level of consciousness (if altered considers toxic inhalation).
Assures the airway is patent, if not takes action to protect the airway.
Examines for signs of thermal or inhalation injury during airway exam.
Stridor, hoarseness, coughing, and assesses tidal volume.
Examines breath sounds for possible inhalation injury.
If airway compromised considers endotracheal intubation.
Administers oxygen via appropriate oxygen delivery device.
Examine area of burn (s), which will be to the epidermis.
Approximates area of burn injury using the “Rule of Nines”.
Documents the extent and type of burn.
Covers area with sterile dressing.
Takes vitals signs every 5 - 15 minutes and prepares for rapid transport.
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: ________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
15
CF Paramedic Program
Procedure: Assessment and Management of Electrical Burn Injury: Adult, Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Scene size-up with BSI / recognizes scene safety.
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Ensures the power has been shut off before approaching the patient, and secures the scene
from others.
Wear appropriate protective gear.
Implementation and Assessment:
Evaluates the patient’s level of consciousness.
Assures the airway is patent, if not takes action to protect the airway.
If airway compromised considers endotracheal intubation.
Administers oxygen via appropriate oxygen delivery device.
Examine area of burn (s).
Approximates area of burn injury using the “Rule of Nines”.
Documents the extent and type of burn.
Searches for entrance and exit wounds.
Covers burn area with sterile dressing.
Places patient the ECG monitor, watching for possible dysrhythmias.
Takes vitals signs every 5 - 15 minutes and prepares for rapid transport.
Initiates one large bore IV’s and initiates fluid resuscitation if necessary (2 IV’s if severe
injury and initiates 20ml/kg bolus).
If patient is conscious and in pain, administers appropriate pain relief medication.
Request possible use of Sodium Bicarbonate.
Administers psychological first aid.
Discusses transport considerations related to extent of the injury, time, location, and hospital
capabilities.
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: ________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
16
CF Paramedic Program
Procedure: Assessment and Management of Chemical Burn Injury: Adult, Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Scene size-up with BSI / recognizes scene safety.
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Identify the chemical by seeking the MSDS.
Wear appropriate gear possible an impervious (fluid proof) gown or suit to prevent further
contamination from the chemical.
Implementation and Assessment:
Evaluates the patient’s level of consciousness (if altered considers toxic inhalation).
Assures the airway is patent, if not takes action to protect the airway.
Examines for signs of thermal or inhalation injury during airway exam.
Stridor, hoarseness, coughing, and assesses tidal volume.
Examines breath sounds for possible inhalation injury.
If airway compromised considers endotracheal intubation.
Administers oxygen via appropriate oxygen delivery device.
Dry Chemicals, e.g. dry lime, should be brushed off before flushing with water.
Most chemical burns can be flushed with copious amounts of water
Examine area of burn (s).
Approximates area of burn injury using the “Rule of Nines”.
Documents the extent and type of burn.
Covers area with sterile dressing.
Takes vitals signs every 5 - 15 minutes and prepares for rapid transport.
If hypotension ensues, administers 2 large bore IV’s and initiates fluid resuscitation.
If patient is conscious and in pain, administers appropriate pain relief medication.
Administers psychological first aid.
Discusses transport considerations related to extent of the injury, time, location, and hospital
capabilities.
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: ________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
17
CF Paramedic Program
Procedure: Assessment and Management of Inhalation Burn Injury: Adult, Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Move patient away from the source if all possible.
Forms a general impression of the patient.
Extinguishes any fire or removes and caustic substances.
Rules out any danger of associated trauma or head and spine injury.
Evaluates the patient’s level of consciousness (if altered considers toxic inhalation).
Assures the airway is patent, if airway is not patent, takes action to protect the airway.
Examines for signs of thermal or inhalation injury during airway exam.
Stridor, hoarseness, coughing, and assesses tidal volume.
Examines breath sounds for possible inhalation injury.
If airway compromised considers endotracheal intubation.
Administers oxygen via appropriate oxygen delivery device.
Examine area of burn (s), which will be to the epidermis.
Approximates area of burn injury using the “Rule of Nines”.
Documents the extent and type of burn.
Covers area with sterile dressing.
Takes vitals signs every 5 - 15 minutes and prepares for rapid transport.
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: ________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
18
CF Paramedic Program
Procedure: Helmet Removal Techniques
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Rating
Equipment and Preparation:
Students insures scene safety and BSI
Implementation and Assessment:
1st student kneels above the patients head with palms pressed on the sides of the helmet and
fingertips curled over its lower margin, he or she will immobilized the helmet in as close to
a neutral in-line position as the helmet allows.
nd
2 student kneels alongside the patient’s torso and opens or removes the face shield. Assess
the airway and undoes the chinstraps. 2nd student then places one hand on the mandible and
the other hand under the neck on the occipital and takes over in-line immobilization of the
head.
2nd student then releases his hold on the mandible. Then 1st rescuer will pull the sides of the
helmet slightly apart, away from the sides of the head. Then carefully pulls the helmet in a
straight line off the patient’s head.
Once the helmet has been removed a proper size cervical collar is placed on the patient.
Final Grade
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: ________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
19
CF Paramedic Program
Procedure: Donning and Properly Adjusting a Personal Flotation Device (PFD)
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Preparation:
Student selects the proper sized PFD, one that extends within 6 inches of their waist.
Student attaches and adjusts each strap starting from the bottom working their way from
bottom to top.
Student pulls on the waist to assure a snug fit.
Student assures the PFD will not pull over their head.
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: ________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
20
CF Paramedic Program
Procedure: In-Water Spinal Immobilization Technique: Adult, Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Rating
Equipment and Patient Preparation:
Student insures scene safety
Student prepares all equipment
Student enters the water if safe, with a PFD if too deep to stand on bottom.
Implementation and Assessment:
Student sandwiches the patient’s torso with their arms cradling the head and rotates patient to a
supine position.
Student assures that the nose, naval and toes remain in a single plane.
Student moves the patient by pulling on their shoulders while the rescuer cradles the head in a
neutral position with their forearms.
Additional rescuer slides a longboard under the patient.
Moves patient to a secure location and immobizes patient to longboard with a cervical collar
and straps.
Conserves patient’s body heat and begins patient assessment and management.
Initiates immediate transport.
Final Grade
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: ________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
21
CF Paramedic Program
Procedure: Assessment and Management of Thoracic Trauma: Adult, Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure and confirms the patient’s understanding
Implementation and Assessment:
Student performs a scene size up
Student performs an initial assessment
Student peforms a rapid trauma assessment
Student recognizes the signs and symptoms of traumatic chest injury
Student applies oxygen appropriately
Student recognizes the need for an initiates an IV
Student recognizes and addresses the need for IV fluid bolus of LR or NS
Student recognizes the need for airway management and manages the airway appropriately
Student applies cardiac monitor
Student properly manages the patient’s condition
Student calls a trauma alert if indicated
Transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
22
CF Paramedic Program
Procedure: Assessment and Management of Spinal Injury, Traumatic and Non-traumatic: Adult,
Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Student performs a scene size up
Student rapidly identifies the need for and properly applies spinal motion restriction
Student performs an initial assessment
Student peforms a rapid trauma assessment
Student performs a focused history and physical exam
Student recognizes the signs and symptoms of a spinal injury
Student assesses for and identifies spinal shock
Student calls a trauma alert if indicated
Student continually reassesses the patient
Student transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
23
CF Paramedic Program
Procedure: Assessment and Management Altered Mental Status
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient confirms the patient’s understanding
Implementation and Assessment:
Establish and maintain an adequate airway
Provides adequate oxygenation and ventilation (Confirmation with EtCO2 and SpO2)
Obtains IV access; start appropriate fluid
Obtains blood samples and determines blood glucose level (BGL); Treat if necessary
Monitor cardiac rhythm
Gives appropriate dose of Narcan, if suspected narcotic overdose
Considers thiamine if alcoholic, or malnourished
Protects patient during transport
If patient combative, administers appropriate dose of sedative medication
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
24
Date: _________
CF Paramedic Program
Procedure: Assessment and Management of Anaphylaxis
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Determine LOC and signs of airway compromise;
Checks for angioneurotic edema
Checks for swelling of tongue
Checks for ability to speak
Visible hives or redness
Considers IM Epinephrine 1:1000; gives appropriate dose
Considers necessary airway management steps
Provides adequate oxygenation and ventilation
Completes focused history and physical exam
Finds any medic alert tags or medications
Obtains IV access
Obtains blood samples and determines blood glucose level (BGL); Treat if necessary
If BP < 90 Repeat Epi IM; or IV 1:10000, if IV established
Benadryl IM or IV at appropriate dose
Consider Albuterol via nebulizer
Monitors patient for changes
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
25
Date: _________
CF Paramedic Program
Procedure: Assessment and Management of Communicable Disease
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Implementation and Assessment:
Student is familiar with the different types of infectious diseases
Student is familiar with the different routes an infectious disease can be spread or
contracted
Student understands policies and procedures regarding infection control
Student is familiar with and uses proper personal protective equpiment
Student practices body substance isolation procedures
Student covers all open wounds with a watertight dressing
Student washes hands or uses waterless hand sanitizer after every patient contact
Student understands proper handling of work clothes that have been contaminated
Student does not prepare or eat food in patient care areas
Student understands proper disposal of needles and sharps into appropriate container(s)
Student understands proper disposal of linens and supplies contaminated with bodily fluids
Student avoids rubbing his/her face, noses, eyes, or mouth with gloved hands
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
26
CF Paramedic Program
Procedure: Assessment and Management of Diabetic Emergencies
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Establish and maintain an adequate airway
Provides adequate oxygenation and ventilation
Completes focused history and physical exam
Finds any medic alert tags or medications
Obtains IV access
Obtains blood sample and determines blood glucose level (BGL)
If blood glucose < 60 mg/dl gives appropriate dose of glucose
Oral glucose, if able to protect own airway
IV D50, if unable to protect airway
Glucagon IM, if unable to establish IV on altered mental status
If patient alcoholic or malnutrious, consider thiamine
If Diabetic Ketoacidosis, or HHNK
Start large bore IV of NS; administer fluid bolus per protocol
Monitor patient for changes; treat as necessary
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
27
Date: _________
CF Paramedic Program
Procedure: Assessment and Management of Gastrointestinal Bleed
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student obtains focused history and physical exam
Student recognizes the signs and symptoms of a GI Bleed
Student initiates early IV access
Student initiates fluid rescuscitation to counteract hypovolemia
Student applies high flow O2
Student applies cardiac monitor
Student reassesses vital signs every 5 minutes
Monitors patient for changes
Transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
28
CF Paramedic Program
Procedure: Assessment and Management of Abdominal Pain
The assessment of a patient who complains of abdominal discomfort or whom you suspect of having
abdominal pathology is similar to trauma assessment with an expanded history.
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Performs initial assessment:
General appearance - Survey for potential evidence of problem, positioning, level of
discomfort
ABCs
Level of consciousness
Finds and treats immediate threats to life
SAMPLE history
Focused OPQRST-ASPN history
Any abdominal pain greater than 6 hrs duration may be a surgical emergency
Performs Physical Examination
Again note positioning
Vitals, repeat as necessary
Perform visual inspection of abdomen, notes any findings
Perform palpation to all four quadrants, notes any tenderness, rigidity, guarding,
rebound
Collects any necessary specimens; bowel, urine, emesis
Provides oxygenation appropriate to patient status
Starts large bore IV
Initiates fluid replacement for blood/fluid loss
Monitor cardiac rhythms
Position of comfort and transport to hospital
If GI bleed; start 2 large bore IVs NS; considers bolus at 20mL/kg
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
29
Date: _________
CF Paramedic Program
Procedure: Assessment and Management of Heat Emergencies
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Determine LOC and signs of airway compromise;
Recognizes predisposing factors for heat emergencies:
Age, health, medications, acclimatization, length of exposure, activity, environmental
factors
Recognizes signs and symptoms specific heat emergency
If heat cramps;
Removes patient from environment
Administers appropriate oral saline solution, or sports drink
If heat exhaustion;
Remove patient form environment, keep patient supine
Administer oral saline solution, or sports drink. If unable to take fluid, IV NS
Remove excess clothing and fan patient
Treat shock if present
If heat stroke;
Remove patient from environment, removes clothing
Initiates appropriate cooling - wipe down with cool water, fans for evaporation
If patient begins to shiver, cease cooling measures
Administer O2 and initiate appropriate fluid therapy
Monitor EKG
Avoids vasopressors or anticholinergic meds
Monitor core temperature
Monitors patient for changes
Transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
30
Date: ________
CF Paramedic Program
Procedure: Assessment and Management of Neurologic Status
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Performs initial assessment:
General appearance
Speech
Skin
Facial Droop
Posture/Gait
AVPU
If patient conscious:
Mood
Thought
Perception
Judgment
Memory and attention
Performs Focused History
Performs Physical Examination:
Airway status
Respiratory pattern and status
Cardiovascular status
Sensorimotor status
Motor system status
Vital signs
Given an appropriate scenario is able to correctly calculate the Glasgow Coma Scale
If altered mental status, assesses a factors of AEIOU-TIPS
If stroke symptoms present utilizes Cincinnati Prehospital Stroke Scale (CPSS), or Miami
Emergency Neurological Deficit (MEND)
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
31
Date: _________
CF Paramedic Program
Procedure: Assessment and Management of Hematologic Disorders (Sickle Cell)
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student obtains focused history and physical exam
Student administers High Flow O2
Student initiates an IV
Student initiates fluid rescuscitation as needed to counteract dehydration
Student applies cardiac monitor
Student considers pain control measures
Monitors patient for changes
Transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________ Date: _________
32
CF Paramedic Program
Procedure: Assessment and Management of Seizures
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Establish and maintain an adequate airway
Provides adequate oxygenation and ventilation
Completes focused history and differential diagnosis:
History of seizure, recent head trauma, alcohol/drug abuse, fever/headache/stiffneck,diabetes, heart disease, stroke, medications
Completes physical assessment
Begins appropriate treatment for underling cause
Obtains IV access; start IV NS TKO
Obtains blood sample and determines glucose level; gives D50 if appropriate
Protects patient from harm during a seizure
Monitor cardiac rhythm
Demonstrates ability to administer diazepam and lorazepam as indicated for seizures
Monitor patient for changes; treat as necessary
Recognizes and treats status epilepticus if present
If eclampsia; recognizes signs and symptoms
(Hyperreflexia, headache, confusion, seizure, coma)
Administers Magnesium Sulfate 2 to 4 grams over 10 to 20 minuntes
Transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
33
Date: _________
CF Paramedic Program
Procedure: Assessment and Management of HHNK
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Assesses general appearance of patient as approaching patient
Student establishes and maintains adequate airway, breathing, circulation
Student obtains focused history and physical exam
Student recognizes the signs and symptoms of HHNK
Student assesses blood glucose level
Student initiates an IV
Student initiates fluid rescuscitation to counteract dehydration
Student considers the administration of Thiamine 100mg if patient is an alcoholic or
malnourished
Student applies cardiac monitor
Monitors patient for changes
Transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
34
Date: _________
CF Paramedic Program
Procedure: Assessment and Management of Snakebite (Envenomation)
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Do not become a victim - do not handle the snake
Completes general survey
Insures adequacy of ABCs
Recognizes signs and symptoms of pit viper envenomation:
Fang marks, pain, swelling (progressive), ecchymosis, fasciculation, nausea, vomiting,
unusual taste, tachycardia, signs of shock, vesication, numbness, tingling,
cardiovascular collapse
Recognizes signs and symptoms of elapidae envenomation
(Signs and symptoms may be delayed 10 to 12 hours)
Local paresthesias, minimal swelling, decreased mental status,generalized weakness,
diplopia, ptosis, difficulty swallowing, impending respiratory failure,
hypersalivation, pharyngeal spasm, trismus, fasciculation, hypotension
Identifies snake, if possible
Keeps patient calm
Place in supine, or semi-Fowler’s position
Immobilize extremity at level of heart
Remove all rings, watches, constriction devices
Apply high flow O2
Initiate large bore IV NS
Contact medical control with of patient severity, size, and type of snake
Mark area of bite
Mark limits of swelling, date and time
DO NOT cut, apply ice, or apply tourniquets
For elapidae bites (Coral snake), support respiratory and cardiovascular impairment
Transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
35
Date: _________
CF Paramedic Program
Procedure: Assessment and Management of Suspected Stroke
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure and confirms the patient’s understanding
Implementation and Assessment:
Establish and maintain an adequate airway
Maintains patient in a position that protects airway
If CHF is present, semi-supine position
Provides adequate oxygenation and ventilation
Obtains IV access; start appropriate fluid
Obtains blood sample and determines blood glucose level (BGL); treat if necessary
Considers other causes of symptoms
If stroke symptoms present, utilizes Cincinnati Prehospital Stroke Scale (CPSS), or Miami
Emergency Neurological Deficit (MEND)
Calls stroke alert, if appropriate
Protects patient during transport
Transports to appropriate medical facility
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
36
Date:_________
CF Paramedic Program
Procedure: Assessment and Management of Syncope / Weakness
Syncope is a neurological condition characterized by a sudden, temporary loss of consciousness
characterized by insufficient blood flow to the brain, with recovery almost immediately upon
becoming supine.
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student insures scene safety and BSI
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the patient and confirms the patient’s understanding
Implementation and Assessment:
Establish and maintain an adequate airway
Provides adequate oxygenation and ventilation
Completes focused history and differential diagnosis:
Cardiovascular conditions; dysrhythmia, mechanical problem
Non-cardiovascular: i.e. metabolic, neurological, psychiatric
Idiopathic or unknown cause
Begins appropriate treatment for underling cause
Obtains IV access and sets appropriate flow rate
Obtains blood sample and determines blood glucose level (BGL)
Monitor cardiac rhythm
Monitor patient for changes; treat as necessary
Final Grade
Rating
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
37
Date:________
CF Paramedic Program
Procedure: Head Injuries - Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student washes hands
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the caregiver and confirms their understanding
Implementation and Assessment:
Student assures the scene is safe, applies the appropriate BSI (infection control precautions)
Pediatric head injuries are classified as:
Mild
GCS of 13 to 15
Moderate GCS of 9 to 12
Severe
GCS of less than 8
Administer high-flow, high-concentration oxygen for mild to moderate head injuries
With severe head injury - intubate and ventilate at a normal rate with 100% oxygen
Consider placing patient in a position to protect airway
Maintain C-Spine immobilization until patient is secured to LBB
Be prepared to turn patient and LBB as unit to facilitate airway drainage
Patient with serious oral, nasal (epistaxis), or facial bleeding and no serious spinal injury is
suspected, have patient lean forward to promote drainage
Patient with open neck injury with danger of air embolism, place patient on LBB in
Trendelenburg position
Patient with potential brain injury, elevate head of LBB to 30o to reduce both external
hemorrhage and intracranial pressure
Consider Lidocaine prior to intubation to blunt rise in intracranial pressure
Consider RSI with GCS < 8 who have too much muscle tone for endotracheal intubation
Consider hyperventilation if brain stem herniation is suspected
Scalp Avulsion: Cover open wound and undersurface of scalp with large bulky dressing.
If contaminated, rinse area with normal saline before applying dressing
Pinna Injury: Place torn pinna in as close anatomical position as possible, place dressing
between head and injured ear, cover exposed ear with sterile dressing, bandage the
dressed injury firmly to the head
Eye Injury: Apply soft dressing to injured eye, also cover other uninjured eye to prevent
sympathetic eye movement
Dislodged Teeth: Rinse teeth in normal saline, wrap teeth in saline soaked gauze
Impaled Objects: Leave in place, dress, and bandage to prevent movement. If object
severely impairs airway, remove object.
Treat for shock with positioning, fluids, and maintenance of body temperature
Rapid transport to pediatric trauma facility
Cont. on Page 2
38
Rating
CF Paramedic Program
Procedure: Head Injuries - Child, Infant: Page 2
Follow-up:
Continually monitors patient for improvement
Disposes of contaminated items properly
Documents the procedure appropriately
Final Grade
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
39
Date: _________
CF Paramedic Program
Procedure: Chest Injuries - Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Equipment and Patient Preparation:
Student washes hands
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the caregiver and confirms their understanding
Implementation and Assessment:
Student assures the scene is safe, applies the appropriate BSI (infection control precautions)
Ensure patient is receiving adequate oxygenation, respiratory volume, and rate
Suspect intrathoracic injuries due to elastic nature of ribs
Open Pneumothorax: Cover wound on three sides. “Burp” dressing as needed to prevent
open pneumothorax converting into tension pneumothorax
Tension Pneumothorax: Pleural decompression (pneumocentesis)
1. Position child supine
2. Raise arm above head on affected side
3. Select site: 2nd intercostal at midclavicular line or 4th intercostal at anterior axillary
line
4. Prepare site with povidone iodine solution
5. Attach needle with stylet in place to syringe
6. Insert needle at 90o angle and advance until tip hits a rib
7. Advance needle over the top of the rib margin
8. Push needle tip into pleural space. Slight “pop” usually felt when needle pierces
pleural membrane or parietal pleural
9. Pull back on plunger to aspirate air
10. Remove syringe and stylet, leave catheter in pleural space, anchored in chest wall
11. Monitor patient, vital signs, consider contralateral needle thoracostomy if patient
does not improve.
Treat for shock with positioning, fluids, and maintenance of body temperature
Rapid transport to pediatric trauma facility
Rating
Follow-up:
Continually monitors patient for improvement
Disposes of contaminated items properly
Documents the procedure appropriately
Final Grade
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
40
Date: _________
CF Paramedic Program
Procedure: Abdominal Injuries - Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Rating
Equipment and Patient Preparation:
Student washes hands
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the caregiver and confirms their understanding
Implementation and Assessment:
Student assures the scene is safe, applies the appropriate BSI (infection control precautions)
Ensure patient is receiving adequate oxygenation, respiratory volume, and rate
Significant blunt trauma can result in splenic or hepatic injuries
Spleen is the most commonly injured organ in children
Palpate all four quadrants, one at a time, for DCAP-BTLS-IC
Left upper quadrant pain suggestive of splenic injury
Right upper quadrant and/or right lower thoracic pain suggestive of hepatic injury
Control external hemorrhage with direct pressure
Evisceration: Exposed abdominal organs
1. Remove clothing from around wound
2. Cover wound with sterile dressing soaked with sterile normal saline
3. Cover moistened dressing with sterile occlusive dressing to prevent evaporative drying
Impaled Object: Do not remove from patient
1. Prevent from moving by padding around object with bulky trauma dressings
2. Apply direct pressure if moderate to severe hemorrhage is present
Treat for shock with positioning, fluids, and maintenance of body temperature
Rapid transport to pediatric trauma facility
Follow-up:
Continually monitors patient for improvement
Disposes of contaminated items properly
Documents the procedure appropriately
Final Grade
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
41
Date: _________
CF Paramedic Program
Procedure: Extremity Injuries - Child, Infant
Rating Scale: √: Step performed appropriately and following accepted technique
X: This step was omitted or not performed correctly
Steps in the Procedure or Task:
Rating
Equipment and Patient Preparation:
Student washes hands
Student gathers appropriate equipment
Student identifies the patient, his or her self, and his or her student status
Student explains the procedure to the caregiver and confirms their understanding
Implementation and Assessment:
Student assures the scene is safe, applies the appropriate BSI (infection control precautions)
Ensure patient is receiving adequate oxygenation, respiratory volume, and rate
Injuries usually limited to fractures and laceration
General Principles: Reduce possibility of further injury and reduce discomfort
1. Protect open wounds
2. Position extremity properly
3. Immobilize the injured extremity
4. Monitor neurovascular function in distal limb (PMS = Pulse, Motor, Sensation) before
and after application of all splinting procedures
Femur fracture: Apply traction splint
Tibia/Fibula: Pad and splint as needed using long rigid boards positioned on either side of
limb
Clavicle: Most frequently broken bone in body. Immobilize by using sling and swath or by
wrapping figure eight bandage around shoulders, drawing shoulders back
Humerus: Apply sling and swath to immobilize limb against chest
Radius/Ulna: Secure hand in position of function, splint with short, padded rigid splint
affixed to forearm and hand
Knee: Immobilize in position found unless distal circulation, sensation, or motor function
are impaired
Ankle/Foot: splint sprains or nondisplaced fractures with air splint, pillow splint, or with
long rigid boards positioned on either side of limb
Shoulder - Immobilize in position found using sling and swath
Elbow: Splint using single padded rigid board, providing cross-strapping as necessary, or use
ladder splint conformed to contour/angle of elbow, keep wrist slightly elevated above
elbow, secure to chest using sling and swath
Wrist/Hand: Secure hand in position of function, secure to padded rigid board or inflate air
splint, keep wrist slightly elevated above elbow, secure to chest using sling and swath
Finger: Splint using tongue blades, small, malleable splints, or taped to adjoining fingers to
limit additional movement. Place hand in position of function and further immobilize
Treat for shock with positioning, fluids, and maintenance of body temperature
Rapid transport to pediatric trauma facility
Cont. on Page 2
42
CF Paramedic Program
Procedure: Extremity Injuries - Child, Infant: Page 2
Follow-up:
Continually monitors patient for improvement
Disposes of contaminated items properly
Documents the procedure appropriately
Final Grade
First
Second Third
Evaluator Initials
Attempt Attempt Attempt
Student demonstrates competency.
Student does not demonstrate competency
Student: _________________________________________________________________
Evaluator Signature: _______________________________________
43
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Smith
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
44
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
45
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Johnson
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
46
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
47
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Williams
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
48
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
49
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Jones
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
50
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
51
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Brown
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
52
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
53
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Davis
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
54
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
55
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Miller
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
56
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
57
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Wilson
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
58
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
59
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Moore
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
60
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
61
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Taylor
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
62
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc?)
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
63
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Anderson
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
64
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
65
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Martin
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
66
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
67
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Thompson
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
68
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
69
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Clark
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
70
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
71
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Garcia
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
72
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
73
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Martinez
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
74
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
75
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Robinson
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
76
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
77
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Rodriguez
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
78
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
79
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Lewis
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
80
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
81
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Walker
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
82
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
83
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Hall
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
84
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
85
Date: _________
CF Paramedic Program Contrived Experience Lab
Scenario Evaluation Sheet: Allen
Possible
points
Implementation and assessment:
Did the student approach the patient safely and in proper PPE?
No:
Critical Failure
Yes:
1 Point
Did the student treat the patient, bystanders and co-workers with dignity and respect?
No:
0 Points
Yes:
1 Point
Did the student address immediate life threats in a timely manner?
Not Applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student obtain an accurate and complete history on the patient?
Not obtainable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct
physical assessment, etc)?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student develop a complete and accurate field diagnosis of the patient’s
condition?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student treat the patient’s condition in accordance with the current standard of
care?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
86
Points
earned
Possible
points
Contrived Experience Lab: Page 2
Points
earned
Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely,
correctly and in a timely manner?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student identify and promptly call any alerts specific to the patient’s condition
(Cardiac alert, trauma alert, etc)?
No:
0 Points
Yes:
5 Points
Did the student properly address the patient’s comfort (Position, pain management, etc)?
No:
0 Points
Yes:
5 Points
Did the student choose an appropriate transportation destination?
No:
0 Points
Yes:
5 Points
Did the student begin transport in a timely manner?
No:
Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student adequately reevaluate the patient after treatment?
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Did the student address changes in patient’s condition in accordance with the current
standard of care?
Not applicable:
No possible points, and no points earned
No:
Critical Failure
Yes, with errors that would likely have endangered the patient’s life: Critical Failure
Yes, but with errors that could adversely affect the patient’s outcome:
1 Point
Yes, but with errors that would not adversely affect patient’s outcome:
6 Points
Yes, with no errors:
10 Points
Was the student’s documentation of the incident complete and accurate?
No:
0 Points
Yes:
5 Point
Comments:
Final Grade
First
Attempt
Second
Attempt
Third
Attempt
Evaluator Initials
Score: Points earned / Possible points x 100 =
Student: _________________________________________________________________
Evaluator Printed Name________________ Evaluator Signature: ________________
87
Date: _________
Airway Management Log
Student Name:
Date:
Instructor:
Place: (Circle)
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Lead Instructor:
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Supraglotic Surgical Needle Yes
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Instructor:
Date:
Place: (Circle)
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Supraglotic Surgical Needle Yes
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Comments: 88
Supraglotic Surgical Needle Yes
Child
Infant
No
Airway Management Log
Student Name:
Date:
Instructor:
Place: (Circle)
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Lead Instructor:
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Supraglotic Surgical Needle Yes
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Instructor:
Date:
Place: (Circle)
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Supraglotic Surgical Needle Yes
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Comments: 89
Supraglotic Surgical Needle Yes
Child
Infant
No
Airway Management Log
Student Name:
Date:
Instructor:
Place: (Circle)
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Lead Instructor:
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Supraglotic Surgical Needle Yes
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Instructor:
Date:
Place: (Circle)
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Supraglotic Surgical Needle Yes
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Comments: 90
Supraglotic Surgical Needle Yes
Child
Infant
No
Airway Management Log
Student Name:
Date:
Instructor:
Place: (Circle)
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Lead Instructor:
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Supraglotic Surgical Needle Yes
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Supraglotic Surgical Needle Yes
Position
Obstruction
Age (Circle one) Adult
Child
Infant
No
Comments: Instructor:
Date:
Place: (Circle)
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Supraglotic Surgical Needle Yes
Child
Infant
No
Comments: Date:
Place: (Circle)
Instructor:
Airway Type (Circle one) OPA
NPA
OR ED LAB AMBU Distractions (Circle one) Noise Lighting
Scenario Name?:
Successful?
Oral ET
Nasal ET
Digital ET
Position
Obstruction
Age (Circle one) Adult
Comments: 91
Supraglotic Surgical Needle Yes
Child
Infant
No