Monday, December 7, 2009

national registry review

Cardiac Arrest/AED

• Take BSI
• Scene Safe
• Question rescuers about arrest
• Turn on AED
• Attach AED to patient
• Direct everyone to “CLEAR!”
• Analyze
• Deliver shock (if indicated)
• Resume CPR

• Gather additional information about arrest event
• Confirm effectiveness of CPR (ventilation and compressions)

• Verbalizes or directs insertion of a simple airway adjunct (oral/nasal airway)
• Ventilates or directs ventilation of patient
• Assures high conc oxygen is delivered to the patient
• Assures adequate CPR continues without unnecessary/prolonged interruption
• Continues CPR for 2 minutes
• Direct rescuer to stop CPR, ensure “CLEAR!”
• Analyze
• Shock (if indicated)
• Resume CPR

• Verbalizes transport

Oxygen Administration

• Scene Safe
• Attach regulator to tank
• Open tank – blow out dust
• Check for leaks
• Check tank pressure (at least 200psi)
• Attach non-rebreather
• Prefill reservoir
• Adjust flow to 12L or higher
• Applies and adjusts mask to patient’s face

Examiner will say patient is not tolerating the mask, apply nasal cannula instead
• Attach nasal cannula to oxygen
• Adjusts liter flow to 6 liters per minute or less
• Applies nasal cannula to patient

Examiner must advise candidate to discontinue oxygen therapy
• Removes the nasal cannula from the patient
• Shuts off the regulator
• Relieves the pressure within the regulator

Bag Valve Mask – Apneic Patient

• Takes or verbalizes BSI
• Scene Safe
• Voice inserting an airway adjunct
• Select appropriately sized mask
• Creates a proper mask-to-face seal
• Ventilates patient at no less then 700-1000mL volume (at least 30 seconds)
• Connects reservoir and oxygen
• Adjust liter flow to 15L/minute or greater

Examiner indicates arrival of a second EMT. The second EMT is instructed to ventilate while candidate controls the mask and airway.

• Voices re-opening the airway
• Creates a proper mask-to-face seal
• Instructs assistant to resume ventilation at proper volume per breath

Immobilization skills – traction splinting

• Take BSI
• Scene safe
• Directs application of manual stabilization of the injured leg
• Directs the application of manual traction
• Assess CMS

Examiner will state CMS is normal

• Prepares/adjusts splint to the proper length
• Positions the splint next to the injured leg
• Applies the proximal securing device (ischial strap)
• Applies distal securing device (ankle hitch)
• Applies mechanical traction
• Positions/secures support straps
• Re-evaluates the proximal/distal securing devices
• Reassess CMS

Examiner will state CMS is normal
Examiner will ask the candidate how he/she would prepare patient for transportation

• Verbalizes securing the torso to the long board to immobilize the hip
• Verbalizes securing the splint to the long board to prevent movement of the splint

Spinal Immobilization – Supine Patient

• Takes BSI
• Scene Safe
• Directs assistant to place/maintain head in the neutral in-line position
• Directs assistant to maintain immobilization of the head
• Reassess CMS
• Applies appropriately sized extrication collar
• Positions immobilization device appropriately
• Directs movement of the patient onto the device without compromising integrity of the spine
• Applies padding to voids between torso and board as necessary
• Immobilizes the patient’s torso to the device
• Secures the patient’s legs to the device
• Secures arms to the device
• Immobilizes the patient’s head to the device
• Evaluate and pad the head
• Reassess CMS

Bleeding Control / Shock Management

• Take BSI
• Scene Safe
• Apply direct pressure to the wound
• Elevates the extremity

Examiner will say “it keeps bleeding”

• Applies an additional dressing to the wound

Examiner says it keeps bleeding

• Apply tourniquet
• Properly position patient
• Applies high concentration oxygen
• Provide warmth for patient (blanket during transport)
• Indicate need for immediate transport

Immobilization skills – Long Bone Injury

• Take BSI
• Scene Safe
• Direct application of manual stabilization of the injury
• Assess CMS

Examiner says CMS is fine

• Measures splint
• Applies the splint
• Immobilizes joint above the injury
• Immobilizes joint below the injury
• Secures the entire injured extremity
• Immobilizes the hand/foot in the position of function
• Reassesses CMS

Examiner says CMS is fine

Spinal Immobilization – Seated Patient

• Take BSI
• Scene safe
• Direct assistant to place/maintain head in neutral in-line position
• Direct assistant to maintain manual immobilization of the head
• Reassess CMS
• Applies appropriately sized extrication collar
• Positions the immobilization device behind the patient
• Secures the device to the patient’s torso
• Evaluates torso fixation and adjusts as necessary
• Evaluates and pads behind the patient’s head as necessary
• Secures the patient’s head to the device
• Verbalizes moving the patient to a long board
• Reassess CMS