Nremt-Skill Sheets

Front 1

Patient Assessment - Trauma

Back 1

1. Practiced body substance isolation precautions throughout procedure
2. Scene size-up
a. Determines the scene is safe
b. Determines the mechanism of injury
c. Determines the number of patients
3. If trauma suspected, competitor verbalizes/simulates, "Spinal
Immobilization performed at this time"
4. Initial Assessment
a. Verbalizes general impression of patient
b. Determines responsiveness/level of consciousness
c. Determines chief complaint/apparent life threats
5. Assesses airway and breathing
a. Assessment
b. Initiates appropriate oxygen therapy
c. Assures adequate ventilation
d. Injury management
6. Assesses circulation
a. Assesses for and controls major bleeding
b. Assesses pulse
c. Assesses skin (color, temperature and condition)
7. Identifies priority patients/makes transport decision
8. Focused Physical Exam and History/Rapid Trauma Assessment
a. Selects appropriate assessment (focused or rapid assessment)
b. Obtains baseline vital signs
c. Obtains S.A.M.P.L.E. history
DETAILED PHYSICAL EXAM
9. Assesses the head
a. Inspects and palpates the scalp and ears
b. Assesses the eyes
c. Assesses the facial area including oral and nasal area
10. Assesses the neck
a. Inspects and palpates the neck
b. Assesses for JVD
c. Assesses for tracheal deviation
11. Assesses the chest
a. Inspects
b. Palpates
c. Auscultates the chest
12. Assesses the abdomen/pelvis
a. Assesses the abdomen
b. Assesses the pelvis
c. Verbalizes assessment of genitalia/perineum as needed
13. Assesses the extremities
One (1) point for each extremity includes inspection, palpation, and
assessment of motor, sensory and circulatory function
14. Assesses the posterior
a. Assesses thorax
b. Assesses lumbar
15. Manages secondary injuries and wounds appropriately. One (1) point
for appropriate management of each injury/wound up to a maximum of
two (2) points.
16. Verbalizes reassessment of the vital signs.

Front 2

Patient Assessment - Medical

Back 2

1. Practiced body substance isolation precautions throughout procedure
2. Scene Safety
a. Determines the scene is safe
b. Determines the mechanism of injury/nature of illness
c. Determines the number of patients
3. If trauma suspected, competitor verbalizes/simulates, "Spinal
immobilization performed at this time"
4. Initial Assessment
a. Verbalizes general impression of patient
b. Determines responsiveness/level of consciousness
c. Determines chief complaint/apparent life threats
5. Assesses airway of breathing
a. Assessment
b. Initiates appropriate oxygen therapy
c. Assures adequate ventilation
6. Assesses Circulation
a. Assesses for and controls major bleeding
b. Assesses pulse
7. Identifies priority patients/makes transport decision
Focused History and Physical Exam//Rapid Assessment
Signs and symptoms. (Assess history of present illness)
OPQRST, and SAMPLE
21. Performs focused physical examination. Assesses affected body
part/system or, if indicated, completes rapid assessment
22. Vitals (obtains baseline vital signs)
23. Intervention (Obtains medical direction or verbalizes standing order for
medication interventions and verbalizes proper additional
intervention/treatment.)
24. Transport (Re-evaluates transport decision)
25. Verbalizes the consideration for completing a detailed physical exam
26. Ongoing assessment (verbalized)
a. Repeats initial assessment
b. Repeats vital signs
c. Repeats focused assessment regarding patient complaint or
injuries

Front 3

Oxygen Administration

Back 3

1. Practiced body substance isolation precautions throughout procedure
2. Assembles regulator to tank
3. Opens tank
4. Checks for leaks
5. Checks tank pressure
6. Attaches non-rebreather mask to oxygen
7. Prefills reservoir
8. Adjusts liter flow to 12 liters/min or greater
9. Applies and adjusts mask to the patient’s face
Note: The judge must advise the competitor to apply a nasal cannula to the pt.
10. Attaches nasal cannula to oxygen
11. Adjusts liter flow up to 6 L/min
12. Applies nasal cannula to the patient
Note: The judge must advise the competitor to discontinue oxygen therapy.
13. Removes the nasal cannula
14. Shuts off the regulator
15. Relieves the pressure within the regulator

Front 4

Bag-Valve-Mask: Apneic Patient

Back 4

1. Practiced body substance isolation precautions throughout procedure
2. Verbalizes opening the airway
3. Verbalizes Inserting an airway adjunct
4. Selects appropriately sized mask
5. Creates a proper mask-to-face seal
6. Ventilates patient at proper rate and adequate volume for at least
30 seconds.
7. Connects reservoir and oxygen
8. Adjusts liter flow to 15 liters/min or greater.
Upon arrival of the second EMT, the second EMT is instructed by the judge to ventilate the
patient while the first EMT controls the mask and the airway.
9. Voices re-opening the airway
10. Creates a proper mask-to-face seal
11. Instructs assistant to resume ventilation at proper rate and
adequate volume for at least 30 seconds.

Front 5

Upper Airway Adjuncts and Suction

Back 5

OROPHARYNGEAL AIRWAY
1. Practiced body substance isolation precautions throughout procedure
2. Selects appropriately sized airway
3. Measures airway
4. Inserts airway without pushing the tongue posteriorly
Judge advises the competitor that the patient is gagging and becoming
conscious.
5. Removes the oropharyngeal airway
SUCTION
Judge advises the competitor to suction the patient’s airway.
6. Turns on/prepares suction device.
7. Assures presence of mechanical suction
8. Inserts the suction tip without suction
9. Applies suction to the oropharynx/nasopharynx
NASOPHARYNGEAL AIRWAY
Judge advises the competitor to insert a nasopharyngeal airway.
10. Selects appropriately sized airway
11. Measures airway
12. Verbalizes lubrication of nasal airway
13. Full inserts the airway with the bevel facing toward the septum

Front 6

Spinal Immobilization: Seated Patient

Back 6

1. Practiced body substance isolation precautions throughout procedure
2. Directs assistant to place/maintain head in neutral in-line position
3. Directs assistant to maintain manual immobilization of the head
4. Reassesses motor, sensory and circulatory function in each extremity
5. Applies appropriately sized extrication collar
6. Positions the immobilization device behind the patient
7. Secures the device to the patient’s torso
8. Evaluates torso fixation and adjusts as necessary
9. Evaluates and pads behind the patient’s head as necessary
10. Secures the patient’s head to the device
11. Verbalizes moving the patient to a long board
12. Reassesses motor, sensory and circulatory function in each extremity

Front 7

Spinal Immobilization: Supine Patient

Back 7

1. Practiced body substance isolation precautions throughout procedure
2. Directs assistant to place/maintain head in neutral in-line position
3. Directs assistant to maintain manual immobilization of the head
4. Assesses motor, sensory and circulatory function in each extremity
5. Applies appropriately sized extrication collar
6. Positions the immobilization device appropriately
7. Directs movement of the patient onto the device without compromising
the integrity of the spine
8. Applies padding to voids between the torso and the board as
necessary
9. Immobilizes the patient’s torso to the device
10. Evaluates and pads behind the patient’s head as necessary
11. Immobilizes the patient’s head to the device
12. Secures the patient’s legs to the device
13. Secures the patient’s arms to the device
14. Reassesses motor, sensory and distal circulation in extremities

Front 8

Traction Splinting

Back 8

1. Practiced body substance isolation precautions throughout procedure
2. Directs application of manual stabilization of the injured leg
3. Directs the application of manual traction
4. Assesses motor, sensory and circulatory function in the injured
extremity
NOTE: The judge acknowledges “motor, sensory and circulatory function are present
5. Prepares/adjusts splint to the proper length
6. Positions the splint at the injured leg
7. Applies the proximal securing device (e.g. ischial strap)
8. Applies the distal securing device (e.g. ankle hitch)
9. Applies mechanical traction
10. Positions/secures the support straps
11. Re-evaluates the proximal/distal securing devices
12. Reassesses motor, sensory and circulatory function in the injured extremity
NOTE: The judge acknowledges “motor, sensory and circulatory function are present and normal.”
NOTE: The judge must ask the competitor how he/she would prepare the patient for transportation.
13. Verbalizes securing the torso to the long board to immobilize the hip
14. Verbalizes securing the splint to the long board to prevent movement of the splint

Front 9

Joint Injury

Back 9

1. Practiced body substance isolation precautions throughout procedure
2. Directs application of manual stabilization of the shoulder injury
3. Assesses motor, sensory and circulatory function to the injured extremity
NOTE: The judge acknowledges “motor, sensory and circulatory function are present and
normal.”
4. Selects proper splinting material
5. Immobilizes the site of the injury
6. Immobilizes the bone above the injured joint
7. Immobilizes the bone below the injured joint
8. Reassesses motor, sensory and circulatory function to the injured extremity
NOTE: The judge acknowledges “motor, sensory and circulatory function are present and normal.”

Front 10

Long Bone Injury

Back 10

1. Practiced body substance isolation precautions throughout procedure
2. Directs application of manual stabilization of the injury
3. Assesses motor, sensory and circulatory function to the injured extremity
NOTE: The judge acknowledges “motor, sensory and circulatory function are present and normal.”
4. Measures the splint
5. Applies the splint
6. Immobilizes the joint above the injury site
7. Immobilizes the joint below the injury site
8. Secures the entire injured extremity
9. Immobilizes hand/foot in the position of function.
10. Reassesses motor, sensory and circulatory function to the injured extremity
NOTE: The judge acknowledges “motor, sensory and circulatory function are present and normal.”

Front 11

Bleeding Control/Shock Management

Back 11

1. Practiced body substance isolation precautions throughout procedure
2. Applies direct pressure to the wound
3. Elevates the extremity
Note: The judge must now inform the competitor that the wound continues to bleed.
4. Applies an additional dressing to the wound
Note: The judge must now inform the competitor that the wound is still continuing to bleed.
The second dressing does not control the bleeding.
5. Locates and applies pressure to appropriate arterial pressure point
Note: The judge must now inform the competitor that the bleeding is controlled.
6. Bandages the wound
Note: The judge must now inform the competitor that the patient is now showing signs and symptoms indicative of hypoperfusion
7. Properly positions the patient
8. Applies high concentration oxygen
9. Initiates steps to prevent heat loss from the patient
10. Indicates need for immediate transportation

Front 12

Cardiac Arrest Management/AED

Back 12

ASSESSMENT
1. Practiced body substance isolation precautions throughout procedure
2. Briefly questions rescuer (judge) about arrest events
NOTE: Acting as the rescuer, judge must now inform competitors about arrest event.
NOTE: Assumption is made that the rescuer is performing CPR.
3. Turns on AED power
4. Attaches AED to patient
5. Directors rescuer to stop CPR and ensures all individuals are clear of
the patient
6. Initiates analysis of the rhythm
7. Delivers shock
8. Directs resumption of CPR
TRANSITION
9. Gathers additional information about arrest event
10. Confirms effectiveness of CPR (ventilation and compressions)
INTEGRATION
11. Verbalizes insertion of a simple airway adjunct (oral/nasal airway)
12. Ventilates, or directs ventilation of the patient
13. Assures high concentration of oxygen is delivered to the patient
14. Assures adequate CPR continues without unnecessary/prolonged
interruption
15. Continues CPR for two minutes (verbalized)
16. Directs rescuer to stop CPR and ensures all individuals are clear of the
patient.
17. Initiates analysis of the rhythm
18, Delivers shock
19. Directs resumption of CPR
20. Verbalizes transportation of patient