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General Tips
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To pass each practical skill, the student
must obtain at least 80% of the skill's points and must
not violate any of the critical failure criteria.
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The student must physically and fully
go through all of the steps on each practical skill in order to
sufficiently learn it. Simply repeating what is printed on
the practical skill sheet is not sufficient, and the
student will fail the examination if he or she does that.
The student must demonstrate that he or she is capable of
physically performing the practical skill, not simply repeating
printed lines.
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Each skill must be practiced several times in
order to sufficiently learn it. Simply watching an
instructor demonstrate the skill or watching other students
practice the skill is not sufficient. The student must
physically practice the skill themselves several times in order
to sufficiently learn it.
-
BSI (body substance isolation) is the first
step on each practical skill, and failure to take appropriate
BSI precautions is a critical failure on many practical skills.
Therefore, the student should form the habit of always taking BSI
precautions before every practical skill.
-
Many steps must be performed in a specific
manner in order to obtain the corresponding point or to avoid
violating critical failure criteria. Alternatively, many
steps can be successfully completed in a variety of manners, and
instructors practice different styles of demonstrating these
steps. Students are responsible for understanding what
constitutes critical failure criteria and which procedures are
open to personal variation in style.
-
Some steps must be performed at specific
points during the practical skills, while others can be
performed at points other than the ones printed on the practical
skill sheets. Students are responsible for knowing which
procedures must be performed at specific points in the practical
skills.
-
The most common reason that the student fails
a practical skill is because he or she panics. Stay calm
and go through the practical skill at a comfortable pace.
If the student forgets what to do next, he or she should remain
calm and mentally repeat the steps that he or she has already
completed. If the student wishes, he or she is also
allowed to physically repeat any steps that he or she has
already completed.
-
A capillary refill time of less than two
seconds is acceptable for the circulation portion of a CSM
(circulation, sensation, and motor function) assessment.
Upper Airway Adjuncts and
Suction
#
9 in IU EMT-Basic Course Student Handbook
-
Oropharyngeal airways must be measured from
the earlobe to the corner of the mouth, while nasopharyngeal
airways must be measured from the earlobe to the tip of the
nose.
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The bevel, or the "V" shape, of the
nasopharyngeal airway must face inwards towards the septum, or
the center of the nose.
-
The student must turn on the suction device
before testing for the presence of mechanical suction in order
to obtain the corresponding point.
-
The following constitute violations of
critical failure criteria:
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Forcefully inserting any airway adjunct.
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Inserting the suction catheter into the
airway with suction being applied.
-
Applying suction to the airway for longer
than 15 seconds.
Mouth-to-Mask Resuscitation with
Supplemental Oxygen
#
7 in IU EMT-Basic Course Student Handbook
Oxygen Administration
#
8 in IU EMT-Basic Course Student Handbook
There are currently no tips
for this practical skill.
Cardiac Arrest Management and AED
Administration
#
3 in IU EMT-Basic Course Student Handbook
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While confirming the effectiveness of CPR,
the student should verbalize that he or she is checking for
chest rise and fall during artificial ventilations and for a
pulse during chest compressions.
-
The following constitutes a violation of
critical failure criteria:
Non-Visualized Airway Device (Combitube)
#
6 in IU EMT-Basic Course Student Handbook
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The patient must never go without
oxygen for more than 30 seconds at one time. This includes
the time between the practical skill's start and the first
artificial ventilation, as well as the time required to insert
the Combitube.
-
The student must inflate and deflate both
cuffs while checking the Combitube in order to obtain the
corresponding point.
-
The student should hold the Combitube while
inflating both cuffs after insertion so that the patient's teeth
remain between the two black lines.
-
If the student is unable to successfully
insert the Combitube, he or she should completely remove it,
resume ventilation with the BVM (bag-valve mask) in order to
restart his or her 30-second time limit for insertion, then
reattempt to insert the Combitube. The student can attempt
to insert the Combitube three times, as long as the patient is
not without oxygen for more than 30 seconds.
-
The following constitutes a violation of
critical failure criteria:
Medical Patient Assessment
#
2 in IU EMT-Basic Course Student Handbook
-
The medical and trauma patient assessment
skills are much longer and more detailed than the other
practical skills, and require much more practice to become
competent. The student must practice all possible patient
scenarios multiple times each in order to be properly prepared
for the examinations.
-
The student can receive any type of patient
scenario on examinations, not just the standard chest pain and
respiratory difficulty patient scenarios. The student must
be prepared to assess and treat any of the possible patient
scenarios. Previous examination patient scenarios have
included:
-
The student can receive a scenario with a
patient whose condition decreases as the scenario progresses.
This does not always indicate that the student is not treating
the patient correctly.
-
The student can receive a patient scenario in
which the patient is in respiratory and/or cardiac arrest, and
the student must render the appropriate treatment (CPR, AED
administration, Combitube insertion) in addition to completing
the rest of the practical skill.
-
The student can never lose points for
performing the following actions:
-
Requesting additional help.
-
Taking spinal stabilization precautions
(usually not required for medical patient assessment).
-
Performing spinal immobilization (usually
not required for medical patient assessment).
-
Performing an immediate transport.
-
Most patients in examination scenarios will
be critical patients that require immediate transport.
-
Several steps require the student to make a
decision to perform an action or not. The student cannot simply repeat what is printed on the practical skills
sheet. These steps include:
-
Requesting additional help.
-
Taking spinal stabilization precautions.
-
Performing an immediate transport.
-
Administering interventions.
-
Performing a detailed physical
examination.
-
The student must clearly assess the patient's
level of responsiveness on the AVPU scale, and determine the
patient's level of orientation (the three orientation questions
of person, place, and time) if the patient is awake, in order to
obtain the corresponding point.
-
If the patient is unable to state his or her
chief complaint, the student must dictate the implied chief
complaint and any other apparent life threats to the examiner.
-
The student must fully assess the
patient's breathing rate and quality before applying
oxygen. The student must choose between administering a
non-rebreather mask, a BVM, and a Combitube, based on his or her
assessment of the patient's breathing.
-
The most common conditions of critical
patients requiring immediate transport are:
-
Cardiac or respiratory arrest.
-
Unresponsiveness or altered mental
status.
-
Cardiac chest pain.
-
Difficulty breathing.
-
Poor perfusion.
-
Poor vital signs.
-
Shock.
-
Loss of sensation or motor function.
-
The questions printed on the practical skills
sheets underneath each illness type are only suggested
questions. Asking any questions pertinent to the present
illness will allow the student to obtain the corresponding
point.
-
The entry "Interventions" at the end of the
questions printed on the practical skills sheets underneath each
illness type refers to asking the patient if he or she has
self-administered any interventions prior to the student's arrival.
The student should not consider giving any interventions of his
or her own until the
appropriate location towards the end of the scenario, after
obtaining baseline vital signs.
-
A focused physical examination is performed
on the body parts affected by the present illness. For
example, a patient complaining of chest pain requires inspection
and palpation of his or her chest as well as auscultation to his
or her lung sounds.
-
The student must perform a complete set of
baseline vital signs before considering the administration of
any intervention. Not all patient types will require an
intervention, but the student must still verbalize the
intervention step in order to obtain the corresponding point.
-
The following constitute violations of
critical failure criteria:
-
Failure to identify and treat for shock
when indicated. The examiner will never explicitly
tell the student that the patient is in shock. The
student must be able to recognize shock based on the
following information:
-
The nature of the patient's illness.
-
The patient's level of responsiveness
and orientation.
-
The patient's chief complaint.
-
The patient's vital signs.
-
The patient's signs and symptoms.
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The events leading to the patient's
illness.
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Administering the wrong oxygen delivery
device based on the patient's breathing rate and quality.
Bleeding Control and Shock
Management
#
10 in IU EMT-Basic Course Student Handbook
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After the examiner states that the patient is
showing signs and symptoms indicative of hypoperfusion, the
student should position the patient in the modified
Trendelenburg's position, lying supine with the feet
elevated 6-12 inches.
Long Bone Injury Immobilization
#
12 in IU EMT-Basic Course Student Handbook
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Possible long bone injuries include the
humerus, radius, ulna, tibia, and fibia. The student must
know how to properly splint all of these injuries.
-
Fingers or toes must remain accessible for
CSM assessment.
Joint Injury Immobilization
#
13 in IU EMT-Basic Course Student Handbook
-
Possible joint injuries include the shoulder,
elbow, wrist, knee, and ankle. The student must know how
to properly splint all of these injuries.
-
Fingers or toes must remain accessible for
CSM assessment.
Traction Splint
#
11 in IU EMT-Basic Course Student Handbook
Seated Spinal Immobilization
(KED)
#
4 in IU EMT-Basic Course Student Handbook
-
The neck should be measured for a cervical
collar by counting how many fingers lie between the patient's
collarbone and a parallel line extending from the bottom of the
chin, not the angle of the jaw.
-
The same person that measures the neck must
measure the cervical collar, since two different people's
fingers have different widths.
-
The cervical collar should be measured from
the bottom of the blue plastic, not from the bottom of the white
foam.
-
The torso straps can be secured in any order.
-
Students are encouraged to form the habit of
performing the detailed physical examination of the neck and
back before applying the cervical collar and KED, respectively.
This is a step that must be verbalized on the trauma patient
assessment in order to receive the corresponding points.
-
The following constitute violations of
critical failure criteria:
-
Failure to instruct the assistant to
maintain manual immobilization followed by the assistant
releasing manual immobilization prior to the appropriate
time.
-
Failure to assess all three
components of CSM in all four extremities at the
appropriate times.
-
Bending the patient's spine forward while
moving them to create room to slide the KED behind them.
The proper movement is a slight "straightening up" movement,
not a bending movement.
-
The examiner cannot insert three fingers
underneath any of the three torso straps.
-
Any of the straps are too loose,
according to the examiner's discretion.
Supine Spinal Immobilization (Longboard)
#
5 in IU EMT-Basic Course Student Handbook
-
The neck should be measured for a cervical
collar by counting how many fingers lie between the patient's
collarbone and a parallel line extending from the bottom of the
chin, not the angle of the jaw.
-
The same person that measures the neck must
measure the cervical collar, since two different people's
fingers have different widths.
-
The cervical collar should be measured from
the bottom of the blue plastic, not from the bottom of the white
foam.
-
The chest and hip straps can be secured in
either order.
-
Students are encouraged to form the habit of
performing the detailed physical examination of the
neck and back before applying the cervical collar and while
performing the log roll, respectively. This
is a step that
must be verbalized on the trauma patient assessment in order to
receive the corresponding points.
-
If the patient is not fully alert and
oriented, the student must place the patient's arms underneath
the torso straps in order to obtain the corresponding point.
-
The following constitute violations of
critical failure criteria:
-
Failure to instruct the assistant to
maintain manual immobilization followed by the assistant
releasing manual immobilization prior to the appropriate
time.
-
Failure to assess all three
components of CSM in all four extremities at the
appropriate times.
-
Failure to instruct the assistant to life
the patient's head off of the ground while performing the
log roll in order to maintain a neutral in-line position
followed by the assistant rolling the patient's neck on the
ground while performing the log roll.
-
Excessively bending or rotating the
patient's spine while performing the log roll, according to
the examiner's discretion.
-
Applying either of the blue head blocks
backwards. The "flat" sides must face the
patient's head, with the "slanted" sides facing outwards.
-
Any of the straps are too loose,
according to the examiner's discretion.
Trauma Patient Assessment
#
1 in IU EMT-Basic Course Student Handbook
-
The medical and trauma patient assessment
skills are much longer and more detailed than the other
practical skills, and require much more practice to become
competent. The student must practice all possible patient
scenarios multiple times each in order to be properly prepared
for the examinations.
-
The student can receive any type of patient
scenario on examinations, not just the standard vehicle accident
and fall patient scenarios. The student must be prepared
to assess and treat any of the possible patient scenarios.
Previous examination patient scenarios have included:
-
Object Penetration
-
Gunshot
-
Animal Attack
-
Burn
-
Electrocution
-
Machinery Injury
-
Athletic Injury
-
Bicycle Collision
-
Diving Collision
-
The student can receive a scenario with a
patient whose condition decreases as the scenario progresses.
This does not always indicate that the student is not treating
the patient correctly.
-
The student can receive a patient scenario in
which the patient is in respiratory and/or cardiac arrest, and
the student must render the appropriate treatment (CPR, AED
administration, Combitube insertion) in addition to completing
the rest of the practical skill.
-
The student can never lose points for
performing the following actions:
-
Requesting additional help.
-
Taking spinal stabilization precautions.
-
Performing spinal immobilization.
-
Performing an immediate transport.
-
Most patients in examination scenarios will
be critical patients that require spinal immobilization and
immediate transport.
-
Several steps require the student to make a
decision to perform an action or not. The student cannot simply repeat what is printed on the practical skills
sheet. These steps include:
-
Requesting additional help.
-
Taking spinal stabilization precautions.
-
Performing an immediate transport.
-
Performing a detailed physical
examination.
-
On the state practical skills examination,
the student must perform the detailed physical
examination of the neck and back before applying the
cervical collar and longboard, respectively, in order to obtain
the corresponding points.
-
The student must clearly assess the patient's
level of responsiveness on the AVPU scale and determine the
patient's level of orientation (the three orientation questions
of person, place, and time) if the patient is awake in order to
obtain the corresponding point.
-
If the patient is unable to state his or her
chief complaint, the student must dictate the implied chief
complaint and any other apparent life threats to the examiner.
-
The student must fully assess the
patient's breathing rate and quality before applying
oxygen. The student must choose between administering a
non-rebreather mask, a BVM, and a Combitube, based on his or her
assessment of the patient's breathing.
-
Airway injury management consists of
assessing for possible airway obstructions such as teeth, bones,
blood, vomit, and foreign objects, and removing them as
necessary.
-
The most common conditions of critical
patients requiring immediate transport are:
-
Cardiac or respiratory arrest.
-
Unresponsiveness or altered mental
status.
-
Difficulty breathing.
-
Poor perfusion.
-
Poor vital signs.
-
Shock.
-
Major bleeding.
-
Loss of sensation or motor function.
-
If the student decides to perform an
immediate transport, he or she must perform a rapid
trauma assessment and perform any indicated spinal
immobilization before transporting the patient.
-
A rapid trauma assessment is a "miniature"
physical examination in which the student takes 10 to 30 seconds
to briefly search the patient for any life-threatening injuries.
-
The student must assess all three
components of CSM in each extremity to obtain the corresponding
point for that extremity.
-
The following constitute violations of
critical failure criteria:
-
Failure to identify and treat for shock
when indicated. The examiner will never explicitly
tell the student that the patient is in shock. The
student must be able to recognize shock based on the the
following information:
-
The mechanism of the patient's
injury.
-
The patient's level of
responsiveness.
-
The patient's chief complaint.
-
The amount of the patient's blood
loss.
-
The patient's vital signs.
-
The patient's signs and symptoms.
-
The events leading to the patient's
injury.
-
Administering the wrong oxygen delivery
device based on the patient's breathing rate and quality.
-
For a more detailed explanation of the
different types of physical examination and the procedure to
follow in transporting critical and noncritical patients,
download the following document:
(Opens New Window)
EMT-Basic Lab Fall 2005
©2008 - IU Emergency Medical
Service - Bloomington, IN -
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