Formative Trauma Patient Assessment

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Student name *

Evaluator name *

There is an ".s" or ".i" at the end of every name to differentiate students from instructors on the back end

Scene Size-Up *

Determines the scene/situation is safe

Determines the mechanism of injury/nature of illness

Determines the number of patients

Requests additional help if necessary

Considers stabilization of spine

Required

Primary Survey and Resuscitation, History Taking, and Secondary Assessment *

Verbalizes general impression of the patient

Determines responsiveness/level of consciousness

Determines chief complaint/apparent life-threats

Opens and assesses airway

Inserts adjunct as indicated

Assesses breathing

Assures adequate ventilation

Initiates appropriate oxygen therapy

Manages any injury which may compromise breathing or ventilation

Checks pulse

Assesses skin color, temperature, or condition

Assesses for and controls major bleeding if present

Initiates shock management

Identifies priority patients and makes transport decision based upon calculated GCS

Obtains, or directs assistant to obtain, baseline vital signs

Attempts to obtain SAMPLE history

Inspects mouth, nose and assesses facial area

Inspects and palpates scalp and ears

Assesses eyes for PERRL

Checks position of trachea

Checks jugular veins

Palpates cervical spine

Inspects chest

Palpates chest

Auscultates chest

Inspects and palpates abdomen

Assesses pelvis

Verbalizes assessment of genitalia and perineum as needed

Inspects, palpates, and assesses motor, sensory, and distal circulatory functions in both legs

Inspects, palpates, and assesses motor, sensory, and distal circulatory functions in both arms

Inspects and palpates posterior thorax

Inspects and palpates lumbar and buttocks area

Manages secondary injuries and wounds appropriately

Reassesses patient

Required

Affective *

Accepts evaluation and criticism professionally

Shows willingness to learn

Interacts with simulated patient and other personnel in professional manner

Required

Critical Criteria

Fails to initiate or call for transport of the patient within 10 minute time limit

Fails to take or verbalize appropriate PPE precautions

Fails to determine scene safety

Fails to assess for and provide spinal protection when indicated

Fails to voice and ultimately provide high concentration of oxygen

Fails to assess/provide adequate ventilation

Fails to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock

Fails to differentiate patient’s need for immediate transportation versus continued assessment/treatment at the scene

Obtains other detailed history or performs physical exam before assessing/treating threats to airway, breathing, and circulation

Fails to manage the patient as a competent EMT

Exhibits unacceptable affect with patient or other personnel

Uses or orders a dangerous or inappropriate intervention

Evaluator Comments

Was the student able to successfully perform this skill? *

Yes

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