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Emergency Medical Technician | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
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| Rating Stars (Click) | Skills | 1 | 2 | 3 | 4 | ||
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Vital Sign - PULSE | ||||||
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Vital Sign - RESPIRATION | ||||||
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Vital Sign - LUNG SOUNDS | ||||||
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Vital Sign - BLOOD PRESSURE | ||||||
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Vital Sign - PULSE OXIMETRY | ||||||
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Basic Airway - OROPHARYNGEAL AIRWAY (OPA) | ||||||
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Basic Airway - NASOPHARYNGEAL AIRWAY (NPA) | ||||||
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Basic Airway - ORAL SUCTIONING | ||||||
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Basic Airway - BAG VALVE MASK | ||||||
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Basic Airway - OXYGEN ADMINISTRATION | ||||||
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Advanced Airway - MULTI-LUMEN AIRWAY (COMBI-TUBE) | ||||||
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Patient Assessment - TRAUMA | ||||||
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Patient Assessment - MEDICAL | ||||||
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Bleeding Control/Shock Management | ||||||
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PNEUMATIC ANTI SHOCK GARMENT (MAST) | ||||||
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Spinal Immobilization - B/B (SUPINE PT.) | ||||||
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Spinal Immobilization - KED (SEATED PT.) | ||||||
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Helmet Removal - FOOTBALL | ||||||
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Helmet Removal - MOTORCYCLE | ||||||
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Splinting - LONG BONE | ||||||
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Splinting - BIPOLAR TRACTION (HARE) | ||||||
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Splinting - UNIPOLAR TRACTION (SAGER) | ||||||
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Scoop Stretcher | ||||||
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BLS/ALS - Cardiac Arrest Management (AED) | ||||||
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BLS/ALS - Nitroglycerin Administration (NTG) | ||||||
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BLS/ALS - Epinephrine Administration (EPI) | ||||||
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CPR - ADULT / CHILD / INFANT | ||||||
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FBAO - ADULT / CHILD / INFANT | ||||||