District of Columbia Department of Health

Health Emergency Preparedness and Response Administration

EMS Educational Institution
Emergency Medical Technician
Practical Examination
Handbook

Based on the
Emergency Medical Technician Psychomotor Examination Users Guides
National Registry of Emergency Medical Technicians November 2011




J uly 2012











EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 2 of 122 ORG: July 2012

EMS Educational Institution Educational Course
Practical Examination Handbook


Release Notes


J uly 2012 Initial Release


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Regulation and Policies

The following table identifies the regulations and policies that influence this manual.

Law Regulation Policy Title Effective Date
17-357 EMS Act of 2008, Section 8 01 J une 2009
29-505 Emergency Medical Technician Course 04 Dec 1998
2010-0011
EMS Educational Institution
Certification Standards
01 Dec 2010
2010-0012 EMS Instructor Standards 01 Dec 2010
2011-0015 EMS Curriculum and Course Standards 01 Aug 2011
2011-0016
EMS National Education Standards
Transition Procedures
01 Aug 2011
2012-0020 EMT Practical Examination Standards 01 Oct 2012













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Preface

With the adoption of the National Registry of Emergency Medical Technicians certification
requirement in the District, we have also adopted the NREMT practical examination standard.
To assist our educational institutions with the practical examination process, we have patterned
this handbook around the NREMT basic life support practical exams. The majority of this
handbook is taken from information contained in the EMT Psychomotor Examination Users
Guide that was developed by the National Registry of Emergency Medical Technicians. This
handbook includes the updates included in the National Education Standards. It is designed to be
used in conjunction with the Practical Skill Station Scenario booklet which is maintained by the
EMS Division at the Health Emergency Preparedness and Response Administration (HEPRA) at
the DC Department of Health (DOH).

The handbook is divided into four sections:
Conducting a Practical Skill Examination
Examination Forms
Individual Examination Stations Instructions and Scripts
Signs for Examination Stations

The Conducting a Practical Skill Examination section contains information to help organize
and track the practical skill examination stations. It includes the duties of the Examination
Coordinator, the Examination Staff, and the Exam Candidates. Information is included on issues
that may arise with the candidates and how such concerns should be addressed. Examination
results and how to address examination failures is also discussed. This section also includes a
listing of the minimum passing scores and times limits for all of the stations, as well as the
number and types of personnel that would be needed to staff all of the stations.

The Examination Forms section includes the DOH required forms as well as several forms for
your convenience. The Examination Stations Staff Chart allows you to fill in the names of the
various individuals that will be assisting with the practical exam and the role they will be taking.
There is a Practical Exam Checklist to assist you in making sure everything is ready to
administer the exam. There are student practical skill cards for the students to use. This will help
them keep track of what stations they have taken.

The required forms include the Candidates Statement, the EMT Practical Examination Candidate
Reporting Form, the Complaint Form, the Complaint Reporting Form and the QA Committee
Review Form.

The Practical Exam Roster is a required form that is used to track all of the students taking the
exam. It includes the minimum passing scores for each station, maximum time period, a column
to record their attendance, a column to record the students score for each station, and a column
to mark their overall results. This must be signed by the Examination Coordinator and the
Districts EMS Official. This document will be kept with the course record at the educational
institution.

EMS Educational Institution EMT Practical Examination Handbook
The third section of the handbook is divided into segments for orientation scripts for examination
staff and candidates, as well as specific testing infonnation for each of the various examination
stations. In each station section you will find a page that list the time limit for the station, the
equipment needed, the number and type of personnel needed and the minimum passing score.
The next page contains the instructions to the Skill Examiner for the station. There is also a page
that gives instructions to the Candidate. Several stations also contain instructions for the
Simulated Patient Lastly, a copy of the NREMT Skill Sheet for that station is included.
The final section is the "Individual Examination Station Signs." We have included signs that you
can printout for all of the Practical Skill Stations as well as the Student Staging Area.
This guide will change over time as new skill procedures are enacted and old skill procedures
discontinued. You should always feel free to contact the EMS Division at the Department of
Health anytime you have questions concerning anything dealing with these skill scenarios or
anything concerning EMS certifications or educational issues.
We hope that you find this Examination Station Handbook useful. If you see mistakes in this
handbook please let us know. We are working hard to improve the services offered by the EMS
Division, and we are working to be responsive to your needs as EMS educators and providers.
Let us know how we can best help you.
Brian W. Amy, MD, MHA, MPH, FACPM
Senior Deputy Director,
Health Emergency Preparedness and Response Administration (HEPRA)
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Table of Contents

Release Notes. .2
Regulations and Policies .3
Preface ...4

Conducting a Practical Skill Examination .9
Notification of the Department of Health ...10
Observation by the Department of Health ....10
Examination Stations ..10
Examination Coordinator 11
Skill Examination Staff ...12
Skill Examiner Qualifications ...12
Patient Assessment/Management Trauma ...13
Patient Assessment/Management Medical ...13
BVM Ventilation of an Apneic Patient and
Oxygen Administration by Non-rebreather Mask ..13
Cardiac Arrest Management/AED ..13
Spinal Immobilization & Random Skill Stations 14
Skill Examiner Responsibilities 14
Exam Candidates 15
Late Arrivals .15
Interruption of the Psychomotor Examination .15
False Identification 16
Use of Prohibited Materials ..16
Candidates Suspected of Dishonest Action ..17
Irregular Behavior .17
Dismissal from the Psychomotor Exam 18
Examination Results 18
Practical Exam Failures 18
Failure of 3 or Less Skill Stations Decision Flow Chart 21
Failure of 4 or More Skill Stations Decision Flow Chart ...22
Completion of the Psychomotor Examination ..23
Reporting the Examination Results ...24
Examination Station Reference Charts 25
Examination Station Master Equipment Listing 26

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Examination Forms 27
Examination Stations Staffing Chart ..28
EMT Practical Examination Checklist 29
Skill Station Rotation Cards 30
Candidates Statement 31
EMT Practical Examination Candidate Reporting Form 32
EMT Practical Examination Complaint Form 33
EMT Practical Examination Complaint Report Form 34
EMT Practical Examination QA Committee Review Form 35
District of Columbia EMT Practical Examination Roster ...36

Individual Examination Stations Instructions and Scripts 38
District EMS Official Skill Examiner Orientation
to the Psychomotor Exam 39
Security and Setup .41
District EMS Official Candidate Orientation to the Psychomotor Exam 42
EMT Psychomotor Exam Report Form 45
Station 1: Patient Assessment Management Trauma ...47
Instructions to the Practical Skills Examiner 48
Instructions to the Simulated Trauma Patient 53
Instructions to the Candidate .54
NREMT Skill Sheet ..55
Station 2: Patient Assessment Management Medical ..57
Instructions to the Practical Skills Examiner 58
Instructions to the Simulated Medical Patient ..63
Instructions to the Candidate .64
NREMT Skill Sheet ..65
Station 3: Bag-Valve-Mask Ventilation of an Apneic Patient 67
Instructions to the Practical Skills Examiner 68
Instructions to the Candidate .71
NREMT Skill Sheet ..72
Station 4: Oxygen Administration by Non-rebreather Mask ..73
Instructions to the Practical Skills Examiner 74
Instructions to the Candidate .76
NREMT Skill Sheet ..77
Station 5: Cardiac Arrest Management AED ...78
Instructions to the Practical Skills Examiner 79
Instructions to the Candidate .82
NREMT Skill Sheet ..83

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Station 6: Spinal Immobilization Station Supine Patient 84
Instructions to the Practical Skills Examiner 85
Instructions to the Candidate .87
NREMT Skill Sheet ..88
Random Skill Stations 7a, 7b, 7c and 7d General Instructions ...89
Station 7a: Spinal Immobilization Station Seated Patient ...90
Instructions to the Practical Skills Examiner 91
Instructions to the Candidate 94
NREMT Skill Sheet ..95
Station 7b: Bleeding Control/Shock Management .96
Instructions to the Practical Skills Examiner 97
Instructions to the Candidate 99
NREMT Skill Sheet .100
Station 7c: Immobilization Skills Long Bone Injury.. 101
Instructions to the Practical Skills Examiner 102
Instructions to the Candidate ...104
NREMT Skill Sheet 105
Station 7d: Immobilization Skills J oint Injury ..106
Instructions to the Practical Skills Examiner ..107
Instructions to the Candidate ..109
NREMT Skill Sheet 110

Individual Examination Station Signs ...111
Station 1: Patient Assessment Management Trauma 112
Station 2: Patient Assessment Management Medical 113
Station 3: Bag-Valve-Mask Ventilation of an Apneic Patient ..114
Station 4: Oxygen Administration by Non-rebreather Mask 115
Station 5: Cardiac Arrest Management AED .116
Station 6: Spinal Immobilization Station Supine Patient ...117
Station 7a: Spinal Immobilization Station Seated Patient .118
Station 7b: Bleeding Control/Shock Management 119
Station 7c: Immobilization Skills Long Bone Injury .120
Station 7d: Immobilization Skills J oint Injury ...121
Candidate Staging Area 122

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Conducting a
Practical Skill Examination
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Conducting a Practical Skill Examination

Practical skill examinations are conducted through the local EMS Educational Institution for all
basic life support certification courses (Emergency Medical Responder and Emergency Medical
Technician). The Department of Health will send a representative to the practical skill
examination to observe and verify that the examination is performed according to the standards
set forth by the National Education Standards, the National Registry of Emergency Medical
Technicians, and the standards adopted by the District of Columbia.


Notification of the Department of Health
The EMS Division of the Department of Health (DOH) must be notified prior to any practical
skill examination being held. This is done as part of the submission of the EMS Course Approval
Application (DC-DOH EMS Form 2011-0015B). Should it become necessary to change the date
of the practical exam, you will need to notify the EMS Division as soon as possible, preferably
no less than 14-days prior to the new date.

Observation of the Practical Examination by the Department of Health
A representative from the EMS Division will report to the testing site on the date indicated. The
DOH EMS Official is there to validate that the examination is being conducted in accordance
with the guidelines and standards as set forth by the District of Columbia and the National
Registry.

Note: Should the DOH EMS Official observe any i rregularity that call s into question the
validity of the exam, he or she has the authority to stop the examination.

As an educational institution conducting the practical exam, you have the responsibility to insure
that all of the equipment utilized is in good working order. Any equipment found to not be
functioning properly must be removed from use.

Note: If no replacement equipment is avail able, testing on that skill station must be
stopped.


EMT Examination Stations
The EMT practical examination consists of seven (7) stations, six (6) mandatory and one (1)
random skill station. The skill stations consist of both skill based and scenario based testing. The
random skill station is to be conducted so that the candidate is totally unaware of the skill to be
tested until he/she arrives at the test site.

The candidate will be tested individually in each station and will be expected to direct the actions
of any assistant EMTs who may be present in the station. The candidate should pass or fail the
examination based solely on his/her actions and decisions.

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Examination Coordinator
The Examination Coordinator is responsible for the overall planning, staffing, implementation,
quality control and validation of the psychomotor examination process in conjunction with the
Districts EMS Official. The Examination Coordinator is responsible for the following upon
approval by the Districts EMS Division at DOH:

Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Examination Coordinator must help
ensure that each Skill Examiner conducts himself/herself in a similar manner throughout
the examination.

Coordinating the examination with an approved agent to oversee administration of the
psychomotor examination.

Maintaining a list of candidates who will be attending the psychomotor examination. The
candidate list must include name, call-back phone number, and portion(s) of the
examination that each candidate needs to complete. This will help the Examination
Coordinator to appropriately plan, staff, and set-up the facilities to help assure a smooth
examination. If the examination is postponed or canceled, the Examination Coordinator is
responsible for the immediate notification of all candidates, Skill Examiners, Simulated
Patients and District EMS Officials.

Assuring that the District EMS Division receives a copy of the final list of candidates
registered for the psychomotor examination seven (7) days prior to the scheduled
examination.

Ensuring that the facilities for the psychomotor examinations meet the National Registry
and District of Columbia acceptable educational standards.

Selection of qualified Skill Examiners. The Skill Examiners must be vetted and approved
by the Medical Director of the educational institution. Each examiner must be certified
or licensed to perform the skill that he/she is to evaluate and approved by the
educational institutions Medical Director.

Selection of Simulated Patients. Appropriate individuals of average adult height and
weight who can serve as Simulated Patients. Simulated Patients must be adults or
adolescents who are greater than sixteen (16) years of age. They should be individuals of
average adult height and weight to serve as Simulated Patients. A high fidelity simulation
manikin capable of responding as a real patient given the scenario(s) may be used as the
Simulated Patient. Candidates who are registered to take the examination may not serve
as patients or assistants for any skill.

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Obtaining clean, functional, and required equipment for each skill station and ensuring
that all equipment is operational.

Overseeing the timely flow of all candidates through the skill stations in conjunction with
the District EMS Official.

Ensuring that excessive hall talk between candidates or discussing specific examination
scenarios or material does not occur throughout the examination.

The Examination Coordinator cannot serve as a Skill Examiner during the examination.
The Examination Coordinator must be present at the site during the examination. If the
Examination Coordinator is not able to be present at the examination due to unforeseen
circumstances, he/she must assign a competent, informed, and capable person to coordinate all
examination activities in his/her absence. In such a case, this person shall serve as and assume all
responsibilities of the Examination Coordinator throughout the examination.


Skill Examination Staff
The examination coordinator is responsible for the overall planning, implementation, quality
control and validation of the examination process. Skill examiners must be selected and
approved by the educational institutions medical director.

Skill Examiner Qualifications
Skill Examiners should be recruited from the local EMS community. You can only consider
people who are currently certified or licensed to perform the skill you wish them to evaluate. In
addition, careful attention should be paid to avoid possible conflicts of interest, local political
disputes, or any additional pre-existing conditions that could potentially bias the Skill Examiner
towards a particular group or the entire group of candidates. In no case should a primary
instructor serve as a Skill Examiner for any of his/her own students. Casual instructor staff
may be utilized if necessary so long as they are not biased and do not evaluate any skill for
which they served as the primary instructor.
For example, the local PHTLS or ITLS instructor who taught the trauma portion of the
candidates class may not serve as the Patient Assessment/Management Trauma Skill
Examiner, but can be utilized to evaluate another skill so long as you feel he/she is not
biased and is qualified to perform the skill to be evaluated.

Every effort should be made to select Skill Examiners who are fair, consistent, objective,
respectful, reliable, and impartial in his/her conduct and evaluation. Skill Examiners should be
selected based upon their expertise and understanding that there is more than one acceptable way
to perform all skills. The Examination Coordinator should work to obtain Skill Examiners who
are not acquainted with the candidates if possible. All Skill Examiners are responsible for the
overall conduct of his/her skill evaluation area, ensuring the integrity and reliability of the
examination and his/her skill, and for maintaining strict security of all examination-related items
throughout the examination.

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The selected examination team should represent a combination of out-of-hospital care providers
and may also include nurses, physicians and other appropriately trained allied health personnel.
All Skill Examiners should have experience in working with EMTs, teaching, or formal
evaluation of psychomotor skills. The Skill Examiner should possess local credibility in the field
of out-of-hospital care. We encourage recruitment of currently Nationally Registered EMTs
to serve as Skill Examiners as they are already familiar with the examination process and
possess a previously demonstrated expertise in the skill. If Nationally Registered EMTs are not
available to staff all skills, you should select suitable personnel as outlined above.

Ultimate approval for assuring that examiners meet these minimum qualifications is at the
discretion of the Districts State EMS Officer or approved agent. The designated District EMS
Official has the authority to dismiss any Skill Examiner for due cause at any point during the
psychomotor examination.

Patient Assessment/Management Trauma
The Patient Assessment/Management Trauma Skill Examiner can be a Nationally Registered
EMT or higher. A nurse, physician, or other appropriately trained allied health provider who is
familiar with current out-of-hospital management of a trauma patient may also serve as an
examiner for this skill. At a minimum, the examiner should have ample experience in providing
patient care at the EMT level. The Skill Examiner should have previously completed a focused
trauma care course, such as PHTLS, ITLS, or ATLS.

Patient Assessment/Management Medical
The Patient Assessment/Management Medical Skill Examiner can be a Nationally Registered
EMT or higher. A nurse, physician, or other appropriately trained allied health provider who is
familiar with current out-of-hospital management of a medical patient may also serve as an
examiner for this skill. At a minimum, the examiner should have ample experience in providing
patient care at the EMT level.

BVM Ventilation of an Apneic Adult Patient and
Oxygen Administration by Non-rebreather Mask
The BVM Ventilation of an Apneic Adult Patient & Oxygen Administration by Non-rebreather
Mask Skill Examiner can be a Nationally Registered EMT or higher. A nurse, physician, or other
appropriately trained allied health provider who is familiar with the various types of common
airway adjuncts, oxygen delivery systems, and out-of-hospital care protocols for immediate
ventilation of an apneic adult patient may also serve as an examiner for this skill. At a minimum,
the examiner should have ample experience in providing patient care at the EMT level and be
licensed to perform bag-valve-mask ventilation and operate various oxygen adjuncts and
equipment to administer supplemental oxygen.

Cardiac Arrest Management/AED
The Cardiac Arrest Management/AED Skills Examiner can be a Nationally Registered EMT or
higher. A nurse, physician, or other appropriately trained allied health provider who is familiar
with the out-of-hospital care protocols for management of an adult patient in cardiac arrest may
also serve as an examiner for this skill. At a minimum, the examiner should have ample
experience in providing patient care at the EMT level and be certified to perform CPR and use an
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AED. The Skills Examiner should hold current credentials equivalent to the American Heart
Associations BLS Instructor for Healthcare Providers.

Spinal Immobilization (Supine Patient) and Random EMT Skills
The Spinal Immobilization (Supine Patient) Skills Examiner and the Random EMT Skills
Examiner must be an EMT (Nationally Registered or state-certified) who is licensed to perform
the following skills in the out-of-hospital setting:
1. Spinal Immobilization (Supine Patient)
2. Spinal Immobilization (Seated Patient)
3. Bleeding Control/Shock Management
4. Long Bone Immobilization
5. J oint Immobilization

A reputable, impartial EMT Instructor who thoroughly understands the principles and various
acceptable practices of completing the above-listed skills is recommended to serve as a Skill
Examiner for the Spinal Immobilization (Supine Patient) Skill and the Random EMT Skill

Skill Examiner Responsibilities
Skill Examiners are responsible for the following:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
Simulated Patient and other staff conduct themselves in a similar manner throughout the
examination.
Objectively observing and recording each candidates performance.
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate.
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Psychomotor Skills Candidate exactly as printed in the material
provided by the Department of Health. Skill Examiners must limit conversation with
candidates to communication of instructions and answering of questions. All Skill
Examiners must avoid social conversation with candidates or making comments on a
candidates performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms.
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins.
Checking all equipment, props, and moulage prior to and during the examination.
Briefing any Simulated Patient and programming any high fidelity simulation manikin
for the assigned skill.
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination.
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the State EMS Official or approved agent.

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Exam Candidates
There are issues that can arise either before or during the testing process that will need to be
addressed. Additionally, while the overwhelming majority of candidates who will be challenging
the Psychomotor Exam will do so in an ethical manner, there is a small minority who will try to
work around or cheat the process. The most common issues observed are addressed below.

Late Arrivals
Situations such as inclement weather conditions or ambulance runs are typical examples in
which the candidate may be granted permission to begin the psychomotor examination late. If
admitted into the examination, candidates arriving late must be afforded the opportunity to
complete all of the psychomotor examination he/she needs. No candidate may be permitted to
complete only a portion of the psychomotor examination he/she needs. If you can ensure the
candidate will be able to complete all portions of the psychomotor examination he/she needs,
you must orient the candidate to the psychomotor examination in the usual manner before
permitting him/her to start the examination. If the facility cannot ensure that the candidate will be
able to complete all portions of the psychomotor examination he/she needs, the candidate must
be dismissed from the examination and instructed to make alternate arrangements to complete
the psychomotor examination at a later date.

Interruption of the Psychomotor Examination
Once the examination has started, if a candidate withdraws from the examination for any reason
prior to completion, collect the candidates skill evaluation materials in the usual manner and
report any results completed up until that point. You should write a note of explanation on the
reverse side of candidates report form as well as on the Practical Examination Roster.

Despite the Examination Coordinators best planning, an interruption outside of anyones control
may disturb a candidate who is taking the psychomotor examination. An excessive interruption
in a room where a candidate is attempting to complete a skill is an example of an interruption
that could affect the candidates concentration. In this circumstance, the District EMS Official
should use his/her best judgment and nullify the result if necessary if you believe the interruption
adversely impacted the candidates performance.

Perhaps the most severe form of interruption during the psychomotor examination can occur
when the fire alarm sounds for a fire drill or the electricity goes off in the building. Should this
occur, the District EMS Official, Skill Examiners, and Examination Coordinator must secure all
examination materials until you are able to re-enter the building or power is restored. If
necessary, you should nullify results for candidates testing in skills when the interruption
occurred and permit him/her to restart and complete that skill on his/her initial attempt after
order is restored in the examination site. These are general guidelines for dealing with the rare
interruptions of psychomotor examinations. Should you ever be confronted with such a situation,
use your best judgment in consultation with the Exam Coordinator. Your decisions should be
based on ensuring that all candidates were able to complete the psychomotor examination in the
same standardized format as all other candidates. Do not make any decision that could
potentially jeopardize the health and safety of anyone involved with the examination!

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False Identification
If at any time it is ascertained that a candidates identification does not match the official
examination roster or information that the candidate has completed on the form, the Districts
EMS Official must be immediately notified and attempt to identify the impersonator. All
examination materials handed-in by the impersonator must be clearly marked to fully indicate
that the candidate identified on the EMT Psychomotor Examination Report Form did not actually
complete the psychomotor examination. The District EMS Official must also dismiss the
impersonator from the examination site. A report must be filed with the Districts EMS Division
to document the irregularity and to identify all individuals involved, including the candidate
scheduled to take the examination as well as the true identity of the impersonator if it can be
determined.

Photocopies of any ID are not official and will not be accepted. If a candidate has no acceptable
form of ID and the Examination Coordinator, Physician Medical Director, or any other person in
an official capacity at the examination site cannot verify his/her true identity, the District EMS
Official must immediately dismiss the candidate from the psychomotor examination.

Use of Prohibited Materials
Candidates are not permitted to use notes of any type that were brought into the examination
and they are not permitted to take any study materials into any skill when testing. Candidates
must not copy any material from the examination or make recordings of the examination at
any time or in any way. The use of calculators, pagers, cellular telephones, personal digital
assistants, or any other mechanical or electronic communication device is strictly prohibited
throughout the psychomotor examination.

If a candidate is discovered attempting to engage or engaging in any kind of inappropriate
behavior during the psychomotor examination, such as giving or receiving help; using prohibited
notes, books, papers, or a mechanical device of any kind; using recording, photographic, or any
other electronic communication device; removing or attempting to remove examination materials
or notes from any room; or taking part in any act of impersonation, the candidate will be
dismissed from the examination process by the District EMS Official.

If you suspect any candidate of committing any of the above actions, the District EMS Official
must prepare a written report, paying particular attention to the following criteria:
Identify each suspected candidate by name, identification number, and level of
examination.
Identify any other candidate(s) who are also suspected of being involved. Place his/her
name(s), identification number(s), and level of examination(s) in the report. Please
explain the degree to which the additional candidate(s) was/were cooperating in the
misconduct.
Identify the names, addresses, and phone numbers of all Skill Examiners, Simulated
Patients, Examination Coordinator, and any other person who also observed the incident.
All completed reports must be submitted to the State EMS Official or approved agent
before leaving the site.
Each person submitting the report must sign the report.
All Reports Must Be Submitted to the Districts State EMS Officer.
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Even though all NREMT psychomotor examination materials are copyrighted, some candidates
may attempt to use or share fraternity notes or other illegal information with each other in
preparation for the psychomotor examination.

If you suspect any candidate of such activity, immediately notify the District EMS Official. You
will be directed to perform the following:
1. Immediately suspend administration of the psychomotor examination to all
candidates at that site.
2. Interview any candidate suspected of this inappropriate behavior. If more than one (1)
candidate is suspected, the interviews must be conducted separately.
3. Attempt to obtain all copies of such notes or recordings for inspection.
4. Enlist the assistance of law enforcement personnel to assist with retrieval of the
copyrighted property of the NREMT.

After all materials have been retrieved, all interviews completed, and the District EMS Official is
reasonably satisfied that all candidates involved have been dismissed, administration of the
psychomotor examination may resume at the discretion of the District EMS Official.

Candidates Suspected of Dishonest Action
A written report must be submitted in all suspected cases of dishonesty in the psychomotor
examination by the District EMS Official in addition to any proctor(s), the Examination
Coordinator, and all other personnel who witnessed the occurrence. The report must include the
following:
Name, address, and phone number of the person who witnessed the occurrence
Purpose/function at the examination site
A summary of all facts concerning the situation

Prior to returning completed examination materials, the District EMS Official must clearly mark
the EMT Psychomotor Examination Report Forms of all candidates involved and attach all
affected forms to the incident report. The Report Must Be Submitted to the Districts State EMS
Officer.

Irregular Behavior
If a candidate's behavior during the psychomotor examination disturbs or prevents others from
doing his/her best work, warn the candidate that he/she will be dismissed if the behavior persists.

The NREMT has disciplinary policies in place to address irregular behavior during examinations
(visit [Link] The following may be sufficient cause to bar candidates from
future examinations, to terminate participation in an ongoing examination, to invalidate the
results of an examination, to withhold or revoke scores or certification, or to take other
appropriate action:
The giving or receiving of aid in the examination as evidence either by observation or by
statistical analysis of answers of one or more participants in the examination.
The unauthorized access to, possession, reproduction, disclosure or use of any
examination materials, including, but not limited to, examination questions or answers
before, during or after the examination.
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The making of threats toward NREMT staff, District EMS Division staff, and/or
Examination staff.
The use of unprofessional (foul) language when interacting with NREMT and/or District
EMS Division staff or Examination staff.
The offering of any benefit to any agent of the NREMT, District EMS Official,
Examination Staff or the testing service and/or a testing site administrator in return for
any aid or assistance in taking an examination.
The engaging in irregular behavior in connection with the administration of the
examination.

Dismissal from the Psychomotor Examination
Because of the need to maintain order and examination security in the examination process, you
have the authority to dismiss a candidate for misconduct as outlined above. However, dismissal
from the examination may have serious consequences for a candidate and should be a last resort.
In certain cases, you may be reluctant to recommend dismissal for fear of embarrassment,
disturbance to other candidates, or physical reprisal. Prior to making a decision for dismissal,
you must consult the Examination Section of the NREMT office and the District EMS
Official.

You may decide to dismiss when warranted, but you should use your best judgment in handling
the situation. Take no action until you are certain a candidate has given or received assistance;
used prohibited aids; disturbed others who were taking the examination; made threats toward
NREMT or District EMS Officials or Examination Staff; used unprofessional (foul) language
when interacting with NREMT or District EMS Officials or Examination Staff; attempted to take
or took any copyrighted NREMT examination materials; or engaged in irregular behavior in
connection with the administration of the examination. When you are sure of a violation,
immediately collect all of the candidates psychomotor examination material completed up until
that point and dismiss him/her/them from the examination site. Tell the candidate(s) only that
failure to abide by the examination regulations has made your actions necessary. Give a full
account of the incident on a report following the criteria outlined above. Return all examination
materials, indicating on the EMT Psychomotor Examination Report Form that the candidates
results have been subject to misconduct as documented in your incident report.


Examination Results
The Skill Station Examiners observe the candidates performance and record the observations on
the Skill Station Testing Sheets. These skill sheets are collected by the Examination Coordinator
and graded according to the pass/fail criteria provided by the Department of Health. The District
EMS Official will review the grading and enter the information on the Exam Roster and the
Candidate Reporting Form. The Skill Station Testing Sheets are to be kept on file with the class
records at the educational institution. The skill sheets must be kept on file at least one year (12
months).

Practical Exam Failures
The exam is graded in a Pass/Fail basis. In most cases, the pass/fail will be easily determined. If,
however, the pass/fail determination is not easily determined, the District EMS Official,
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 19 of 122 ORG: July 2012

Examination Coordinator, and the Skill Station Examiner should review the situation as a
committee before coming to a final decision. The patients comments, the Examiners
comments and the documentation on the skill evaluation should all be considered when
determining a final grade.

In many cases, retakes of failed skills are allowed. In accordance with current NREMT policies,
the skill station examiner will not explain any specific errors in any performance at the time of
the exam. The candidate should not receive a copy of their skill performance sheets. The results
should be reported to the candidate as either a pass or failure of the skill station.

If a candidate fails three (3) or less skill stations, they are entitled to retest those skills on the
same day. If the candidate fails four (4) or more skill stations, it shall be considered a failure of
the entire practical exam. He/she will be required to retest the entire practical skill examination at
a later date.

Retests of failed skills can be done on the same day if the hosting institution is able to
accommodate the additional testing. Educational institutions are not required to host same day
retests. Additionally, retesting can only be performed if the institution can accommodate all
students in need of retesting. The decision should be made as early as possible during the day of
the examination. The following factors should be considered:
Protection of all Skill Examiners and the Examination Coordinator. Unnecessary
animosity and undue retribution should be avoided at all costs.
Availability of qualified Skill Examiners to be reoriented to different skills. No candidate
may be retested on the same day in any skill by the original Skill Examiner.
Consensus and ability of the Skill Examiners to stay the additional time to complete all
retests.
Ability of the State EMS Official or approved agent to score all psychomotor results and
tabulate retest needs.
Total number of candidates who need to retest on the psychomotor exam.
Availability of the examination site to ensure completion of the retest and associated
logistics.
Travel considerations of the Skill Examiners.

Do not commit to administer a same-day retest until the final decision has been made, taking into
account the factors outlined above. After the decision has been made to conduct a same-day
retest, all candidates should be informed that a same-day retest will be made available. The
District EMS Official will inform all candidates that they will be entitled to only one (1) retest
attempt at that test. No candidate is permitted to complete the entire EMT Psychomotor
Examination again during a same-day retest attempt. The District EMS Official will remind all
candidates that no complaint will be valid if it is issued after being informed of his/her results.

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 20 of 122 ORG: July 2012

The following candidates would be eligible for a same-day retest if administered:
EMT candidates completing a full attempt (completes all seven [7] skills) who fail three
(3) or less skills
EMT candidates on Retest #1 attempt who fail any of the three (3) skills tested

The following candidates are not eligible for any same-day retesting:
EMT candidates completing a full attempt (completes all seven [7] skills) who fail four
(4) or more skills
EMT candidates on Retest #2 who fail any of the three (3) or less skills tested

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 21 of 122 ORG: July 2012

Failure of Three or Fewer Skill Stations - Decision Flow Chart


EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 22 of 122 ORG: July 2012

Failure of Four or More Skill Stations - Decision Flow Chart







EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 23 of 122 ORG: July 2012

The District EMS Official will privately and individually inform each candidate of his/her results
and offer each eligible candidate the option for a same-day retest if one is being administered.
Before informing the candidate of his/her results, the District EMS Official will ask one last
time, Do you have any complaints concerning equipment malfunction or discrimination? If
not, the District EMS Official will only show candidates the completed EMT Psychomotor
Examination Report Form and should in no way inform them as to the reason(s) for
failure. Retests should be completed in an all-or-none fashion.

Candidates are only permitted to complete the entire retest, not just a portion of the retest
to which they are entitled. It is the candidates decision to complete a same-day retest.
Candidates who are completing Retest #2 should be cautioned that failure of any skill on Retest
#2 constitutes complete failure of the entire psychomotor examination, requiring him/her to
complete the entire psychomotor examination (all seven [7] skills) on the next full attempt after
officially documenting remedial training in all skills. Remember that the retest must be within 12
months of the initial psychomotor examination (all seven [7] skills) to be accepted.
Informing candidates of the psychomotor examination results on the same day may create an
antagonistic response from the candidates who have failed any portion. The District EMS
Official and the Examination Coordinator must be made aware of this possibility. If neither are
prepared to uphold all evaluations of the Skill Examiners and the criteria for the psychomotor
examination, or if candidates become boisterous, unruly, and hostile upon being informed of
their results, no same-day retest should be offered. In this situation, it is best to dismiss all
remaining personnel from the examination site without giving out any more results. Suspend any
retesting if underway, inform all remaining candidates to expect their results by some other
method collect and secure all examination materials, and dismiss all personnel from the
examination site.

Completion of the Psychomotor Examination
The District EMS Official will be very busy scoring results, informing candidates of his/her
unofficial results, and coordinating any same-day retest as Skill Examiners begin to finish the
psychomotor examination and turn-in examination materials. The District EMS Official will
collect the psychomotor examination materials as outlined below to help ensure that no secure
materials will be lost:
1. As the Skill Examiner turns-in material, determine if there is any secure scenario
information this Skill Examiner should be turning-in. Remember that Patient
Assessment/Management Trauma and Patient Assessment/Management Medical will
have secure scenario information that needs to be collected before the Skill Examiner
leaves the site.
2. Re-inventory all secure information the Skill Examiner is turning-in. Immediately file the
secure information in a safe area.
3. Briefly interview the Skill Examiner concerning any problems or areas of confusion that
may have occurred before dismissing the Skill Examiner.
4. Return to transcribing results until the next Skill Examiner turns-in materials.

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 24 of 122 ORG: July 2012

After all the results have been transcribed onto the EMT Psychomotor Examination Report
Form, the Examination Coordinator should pick up the report forms in alphabetical order and
paper clip them to the completed roster. Do not staple anything to the EMT Psychomotor
Examination Report Forms and do not interfile any other materials with them. Then the stacks of
skill evaluation forms should be picked-up in alphabetical order and secured with a rubber band.

The District EMS Official should ensure the security of all psychomotor examination material
until the psychomotor examination concludes. Any secure psychomotor examination materials
should be inventoried upon completion of the psychomotor examination and again before leaving
the examination site. The District EMS Official will return all psychomotor examination
materials to the District EMS Office.

Reporting the Examination Results
The Examination Coordinator will receive a copy of the Practical Exam Roster with the
individual skill station results. The Examination Coordinator must report the results to the
Program Director and the Medical Director of the education institution. Upon completion of the
practical exam, the results must be reported to the National Registry. The District EMS Official
has the responsibility of reporting the results to the National Registry.
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 25 of 122 ORG: July 2012

Examination Stations Reference Charts

Skill Station Time Limits & Minimum Passing Scores

Station Skill to be Tested
Max Time
Limit
Minimum
Score
1 Patient Assessment Management Trauma 10 minutes 33 points
2 Patient Assessment Management Medical 15 minutes 33 points
3 Bag-Valve-Mask Ventilation of an Apneic Patient 5 minutes 13 points
4 Oxygen Administration by Non-rebreather Mask 5 minutes 8 points
5 Cardiac Arrest Management/AED 10 minutes 14 points
6 Spinal Immobilization Station - Supine Patient 10 minutes 11 points

7 Random Skill Verification
a. Spinal Immobilization Station - Seated Patient 10 minutes 9 points
b. Bleeding Control/Shock Management 10 minutes 5 points
c. Long Bone Immobilization 5 minutes 8 points
d. J oint Injury 5 minutes 7 points


Skill Station Staffing

Station Skill to be Tested
E
x
a
m
i
n
e
r
s

A
s
s
i
s
t
a
n
t
s

S
i
m

P
a
t
i
e
n
t
s

C
a
n
d
i
d
a
t
e
s
/
H
o
u
r

1 Patient Assessment Management Trauma 1 1 4
2 Patient Assessment Management Medical 1 1 3-4
3 Bag-Valve-Mask Ventilation of an Apneic Patient
1 4-5
4 Oxygen Administration by Non-rebreather Mask
5 Cardiac Arrest Management/AED 1 1 4
6 Spinal Immobilization Station - Supine Patient 1 1 1 4

7 Random Skill Verification
a. Spinal Immobilization Station - Seated Patient
1 1 1 4-5
b. Bleeding Control/Shock Management
c. Long Bone Immobilization
d. J oint Injury

Total Staff Flow
6 3 4 4/hour
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 26 of 122 ORG: July 2012

Examination Stations
Master Equipment List

Item Station (s)
Adult Bag-Valve-Mask device with reservoir 3
Adult Intubation Manikin 3, 4 (opt)
Adult Nasal Cannula 4, 7b
Adult Non-rebreather Mask 4, 7b
Armless chair 7a
Automated External Defibrillator 5
Bandages (various sizes) 7b
Blanket 1, 2, 6, 7a (2), 7b
Blood Pressure Cuff 1, 2
Cervical device 6, 7a
CPR manikin that can be defibrillated with the AED 5
Cravats (6) 7a, 7c, 7d
Disinfecting agent and related supplies 5
Examination Gloves 1, 2, 3, 4, 5, 6, 7a, 7b, 7c, 7d
Field Dressings (various sizes) 7b
Gauze pads (2x2, 4x4), etc 7b
Half-spine immobilization device 7a
Head immobilizer 6
Kling, Kerlex, etc 7b, 7c
Long spine immobilization device 6
Mouth to barrier device (disposable) 5
Oxygen connecting tubing 3, 4, 7b
Oxygen cylinder with regulator 3, 4, 7b
Padding (towels, clothes, etc) 6, 7a
Patient securing straps 6
Pen Light 1, 2
Rigid Splinting Material (various sizes) 7c
Scratch paper and pencil/pen 1, 2
Selection of adult oropharyngeal airways 3
Stethoscope 1, 2, 3, 4
Suction device (electric or manual) with rigid catheter and
appropriate suction tubing
3
Tape (2-inch or 3-inch) 7a, 7c
Tongue blade 3
Tourniquet 7b
Vest-type immobilization device 7a
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 27 of 122 ORG: July 2012











Examination Forms


Examination Stations Staffing Chart

Skill Station Position Area 1 Area 2 Area 3
1. Patient Assessment -
Trauma
Examiner
Patient
2. Patient Assessment
Medical
Examiner
Patient
3. B-V-M Ventilation
Examiner
4. Oxygen Admin
5. Cardiac Arrest
Management /AED
Examiner
EMT Asst.
6. Spinal
Immobilization
Supine
Examiner
EMT Asst.
Patient
Random Skill
7a. Spinal
Immobilization
Seated
Examiner
EMT Asst.
Patient
7b. Bleeding Control Examiner
EMT Asst.
Patient
7c. Long Bone
Immobilization
Examiner
EMT Asst.
Patient
7d. J oint Injury Examiner
EMT Asst.
Patient


EMT Practical Examination
Checklist

The purpose of this checklist is to help the examination coordinator establish a quality control
process for the examination and to provide a means of helping to assure standardization of
practical examinations. As each control criterion is completed, a check should be placed in the
space provided.

Examination Site: Date:

Organization of the Examination
Establish a minimum of seven (7) examination skill stations
Schedule the appropriate number of qualified skill examiners
Register and identify candidates to assure eligibility to participate in the examination
Review qualification of skill station examiners prior to the examination

Facilities
Skill stations have adequate room to conduct the examination without interference
All equipment is in working order
An adequate variety of equipment is provided

Orientation of Candidates and Skill Station Examiners
Orientation script was read and understood
Examiners understand they are to allow adequate time for candidates to ask questions
concerning the examination
Patients and EMT Assistants have been oriented

Skill Station Examiners
They have read and understand their role in the examination process
They understand that they are to remain objective in recording each candidates
performance
They will not introduce extraneous elements into the skill station
Instructions to the Candidate will be read to each individual tested
No preference will be displayed to any agency or individual for any reason

Candidates
Have been instructed concerning the practical examination retest policy
Have been instructed in how to file an official complaint

Scoring the Performance
Examiners understand the proper criteria for determining the final grade of the candidate
The candidates overall grade is recorded on the EMT Practical Exam Roster


Skill Station Rotation Cards
Name ________________________________
- Check box below when
Station station is completed
1. Patient Assessment - Trauma
2. Patient Assessment - Medical
3. B-V-M Apneic Patient
4. Oxygen Administration
5. Cardiac Arrest/AED
6. Spinal Immobilization - Supine
7. Random Skill
Name ________________________________
- Check box below when
Station station is completed
1. Patient Assessment - Trauma
2. Patient Assessment - Medical
3. B-V-M Apneic Patient
4. Oxygen Administration
5. Cardiac Arrest/AED
6. Spinal Immobilization - Supine
7. Random Skill
Name ________________________________
- Check box below when
Station station is completed
1. Patient Assessment - Trauma
2. Patient Assessment - Medical
3. B-V-M Apneic Patient
4. Oxygen Administration
5. Cardiac Arrest/AED
6. Spinal Immobilization - Supine
7. Random Skill
Name ________________________________
- Check box below when
Station station is completed
1. Patient Assessment - Trauma
2. Patient Assessment - Medical
3. B-V-M Apneic Patient
4. Oxygen Administration
5. Cardiac Arrest/AED
6. Spinal Immobilization - Supine
7. Random Skill
Name ________________________________
- Check box below when
Station station is completed
1. Patient Assessment - Trauma
2. Patient Assessment - Medical
3. B-V-M Apneic Patient
4. Oxygen Administration
5. Cardiac Arrest/AED
6. Spinal Immobilization - Supine
7. Random Skill
Name ________________________________
- Check box below when
Station station is completed
1. Patient Assessment - Trauma
2. Patient Assessment - Medical
3. B-V-M Apneic Patient
4. Oxygen Administration
5. Cardiac Arrest/AED
6. Spinal Immobilization - Supine
7. Random Skill


Candidates Statement

By my signature, I affirm that I was oriented to the psychomotor examination by the Districts
EMS Official. I agree to fully abide by all policies of the District of Columbias Department of
Healths EMS Division and the National Registry of Emergency Medical Technicians. I
understand that they reserve the right to delay processing or invalidate my results if I have not
complied with all rules. I also understand that my attendance at todays examination does not
guarantee my eligibility for certification by the National Registry of EMTs or subsequent District
certification.

I affirm that the psychomotor examination complaint process has been explained to me. I
understand that I must contact the Districts EMS Official or approved agent immediately if I
feel I have been discriminated against or experienced any type of equipment malfunction in any
skill. I further understand that my complaints will not be accepted if I do not file my
complaints today before leaving this site and before I am informed of my psychomotor
examination results. I understand that the National Registry of EMTs will not explain any
specific errors in my performance. All examination results are preliminary and unofficial until
they have been formally processed by the Districts EMS Official and reported to the National
Registry of EMTs by the educational institution.

I hereby affirm and declare that all information entered on this form is truthful, correct, and
matches my true identity which coincides with my entry on the official roster for this
examination. I am assuming all responsibility for completing all appropriate skill(s) based upon
the policies and procedures of the Districts EMS Division and the National Registry of EMTs in
conjunction with all of my previously reported official psychomotor examination results. I also
understand that making threats toward the Districts EMS Official, any agent of the educational
institution that is hosting this practical examination, or any examination staff; the use of
unprofessional (foul) language; or committing other types of irregular behavior may be sufficient
cause to invalidate the results of the examination, to terminate participation in an ongoing
examination, to withhold or revoke scores or certification, or to take other appropriate action. If
my name was not read as part of the official roster for todays examination, I am also assuming
all risks and consequences of possibly testing inappropriate skills today.


Print Name: ____________________________________________


Signature: _____________________________________________


Date: ________________




DC-DOH EMS Form 2012-0020B ORG: July 2012


EMT Practical Examination
Candidate Reporting Form

Name:

Address:

Exam Site: Date:

Skill Stations
Full Retest 1 Retest 2
P
a
s
s


F
a
i
l

P
a
s
s


F
a
i
l

P
a
s
s


F
a
i
l

1. Patient Assessment/ Management Trauma
2. Patient Assessment/ Management Medical
3. Bag-Valve-Mask Apneic Adult Patient
4. Oxygen Administration by Non-rebreather Mask
5. Cardiac Arrest Management/AED
6. Spinal Immobilization Supine Patient
7. Random Skill:
Overall Score
Pass
Retest
Fail
Pass
Retest

Pass
Fail


You will not receive a detailed critique of your performance on any skill. You will not receive a
copy of your skill performance sheets. The results will be reported to you as either passing or
failing the skill station.

You are eligible to retest if you fail three (3) or less skills when taking a full attempt.
You cannot retest today if you fail four (4) or more skills when taking a full attempt.
o If you are eligible for retest, you must retest all skill(s) marked as fail.
o Only one (1) retest attempt can be completed at this examination today if one is
offered.
o Failure of any skill on Retest #2 constitutes complete failure of the entire
psychomotor examination.
Failure of the entire psychomotor examination requires remedial training before attempting
the entire psychomotor examination (all seven [7] skills) on another date.
Passed examination results are only valid for up to twelve (12) months from the date of the
examination, provided all other Entry Requirements of NREMT are met.


Examination Coordinator:


District EMS Official:
DC-DOH EMS Form 2012-0020C ORG: July 2012


EMT Practical Examination
Complaint Form


I wish to file a formal complaint based upon the following information in accordance with
District of Columbia Department of Health EMS policy and NREMT policy that was explained
to me during the Candidates Orientation to the Psychomotor Examination. I fully understand
that the decision of the District EMS Official is final and agree to abide by the District EMS
Officials final and official decision.


Skill(s) in question:
______________________________________________________________________________


Summary of Circumstances:
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


Name: ___________________________________


Signature: ________________________________


Date: ____________________________________

NOTE:
Do not leave this site until the District EMS Official informs you of the official decision.

DC-DOH EMS Form 2012-0020D ORG: July 2012


EMT Practical Examination
Complaint Report Form

Candidate: _______________________ Exam Site: _________________________________

Date: ____________________________ Skill: ______________________________________

Examiner: _______________________________ Examiner Phone #:_____________________

After reviewing the facts as presented, the Districts official decision is as follows:
___ Nullify the results of the skill(s) in question regardless of the score and repeat the skill(s).
___ Complaint is not valid after consideration of the facts and all results in question stand as
reported.

_____________________________________________
Signature of District EMS Official

As the complainant, I have been informed of the Districts official and final decision.

_____________________________________________
Signature of Candidate

______________________
Date

Quality Assurance Committee.
In cases where a specific performance, treatment protocol, or other situations arise in which the
District EMS Official needs assistance to objectively make a final determination, he/she may
convene a meeting of the Quality Assurance Committee. The Committee has met and discussed
all matters related to the specific situation in question. Each member has one vote with the
majority vote ruling as the official decision of the Quality Assurance Committee. The District
EMS Official has completed the Quality Assurance Committee Review Form and will submit it
along with all other examination materials to the Districts EMS Division.

We the undersigned have reviewed the candidates complaint based upon all facts presented. The
candidate was informed of the official decision by the District EMS Official.

_____________________________________________
Signature or name of Districts State EMS Officer

_____________________________________________
Signature of Examination Coordinator

This form should be submitted to the District EMS Official with all examination materials.
DC-DOH EMS Form 2012-0020E ORG: July 2012


EMT Practical Examination
QA Committee Review Form

We, the Quality Assurance Committee, met to review the following situation and all related facts
as documented below:

Nature of Situation:

______________________________________________________________________________

______________________________________________________________________________

Summary of Facts (use back side of form if necessary):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

After reviewing the facts as presented, the Quality Assurance Committee's official decision is as
follows:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


_____________________________________________
Signature or Name of Districts State EMS Officer

_____________________________________________
Signature of Examination Coordinator

_____________________________________________
Signature of District EMS Official


Exam Site: ___________________________________ Date: ____________________________

This form will be submitted to the District EMS Division with all examination materials.

DC-DOH EMS Form 2012-0020F ORG: July 2012


District of Columbia EMT Practical Examination Roster Page 1 of 2

Date: Location: Course Number:

Skill Station and Minimum Points Guide
Mandatory Stations Time Min/Max Random Stations Time Min/Max
1. Patient Assessment Trauma 10 33/42 7a. Spinal Immobilization Seated Patient 10 9/12
2. Patient Assessment Medical 15 33/42 7b. Bleeding Control/Shock Management 10 5/7
3. B-V-M Apneic Patient 5 13/17 7c. Long Bone Immobilization 5 8/10
4. Oxygen Administration / NRB Mask 5 8/11 7d. J oint Injury 5 7/9
5. Cardiac Arrest Management / AED 10 14/18
6. Spinal Immobilization Supine Patient 10 11/14

Name:
(Last Name, First Name)

Phone or E-mail Date of Birth 1 2 3 4 5 6
7
a
7
b
7
c
7
d
Overall
Pass / Retest
/ Fail
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

DC-DOH EMS Form 2012-0020G P=Pass, R=Retest, F=Fail


District of Columbia EMT Practical Examination Page 2 of 2

Name:
(Last Name, First Name)

Phone or E-mail Date of Birth 1 2 3 4 5 6
7
a
7
b
7
c
7
d
Overall
Pass / Retest
/ Fail
16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

P=Pass, R=Retest, F=Fail

I certify the results of the EMT Basic Practical Exam listed above to be accurate and true.



Print Name Examination Coordinator Signature Examination Coordinator Date


Print Name District EMS Official Signature District EMS Official Date
Course Number:
DC-DOH EMS Form 2012-0020G ORG: July 2012
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 38 of 122 ORG: July 2012









Individual Examination Stations
Instructions and Scripts
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 39 of 122 ORG: July 2012
District EMS Official
Skill Examiner Orientation to the
Psychomotor Examination

Good [morning, afternoon, evening]. My name is [District EMS Officials name]. I will be
responsible for administration of this examination. On behalf of the EMS Division of the District
Department of Health and the National Registry of Emergency Medical Technicians, I would
like to thank you for serving as a Skill Examiner today. All data relative to a candidates
performance is based upon your objective recordings and observations. You were chosen as an
examiner today because of your expertise in the assigned skill and ability to fairly and accurately
observe and document various performances. All performances must be reported with the
greatest degree of objectivity possible. The forms you are using today have been designed by the
NREMT to assist you in objectively evaluating the candidates.

Let me emphasize that this examination is a formal verification procedure not designed for
teaching, coaching, or remedial training. Therefore, you are not permitted to give any
indication whatsoever of satisfactory or unsatisfactory performance to any candidate at any time.
You must not discuss any specific performance with anyone other than me. If you are unsure of
scoring a particular performance, notify me as soon as possible. Do not sign or complete any
evaluation form in which you have a question until we have discussed the performance. If Im
busy with other duties, make notes of the performance, notify the examination coordinator to get
my attention, and continue on with your evaluation of other candidates if possible.

Please act in a professional manner at all times, paying particular attention to the manner in
which you address candidates. The District of Columbia government and the NREMT does not
discriminate or harass and will not tolerate any type of discrimination or harassment by anyone
involved with administration of the psychomotor examination. You must be consistent, fair, and
respectful in carrying out your duties as a formal examiner. The safest approach is to limit your
dialogue to examination-related material only. Be careful of the manner in which you address
candidates as many will interpret your remarks as some indication of his/her performance. You
should develop a dialogue with candidates throughout his/her performance and should ask
questions for clarification purposes. These questions may not be leading but should be asked
when additional clarification is required. Do not ask for information that does not relate to the
evaluation criteria in your skill. For example, if a candidate states, Id now apply high flow
oxygen, your appropriate response might be, Please explain how you would do that. Do not
ask for additional information beyond the scope of the skill, such as having the candidate explain
the percentage of oxygen delivered by the device, contraindications to the use of the device, or
other knowledge-type information.

You may also have to stimulate a candidate to perform some action. If a candidate states, Id do
a quick assessment of the legs, you must interject and ask the candidate to actually perform the
assessment as he/she would in a field situation.

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 40 of 122 ORG: July 2012
We suggest you introduce yourself to each candidate as you call him/her into your room. No
candidate, at any time, is permitted to remain in the testing area while waiting for his/her
next skill. As the candidate enters, be sure he/she did not bring any books, pamphlets, brochures,
study materials, or any other electronic or mechanical devices. Take a few moments and clearly
print the candidates first and last name on the evaluation form as well as your name, the date,
and scenario number if required. We suggest you use ink pens and follow good documentation
practices when completing these forms. You should then read aloud the appropriate set of
Instructions to the Psychomotor Skills Candidate exactly as printed at the end of your essays.
Be sure to alternate the scenarios between candidates if required in your skill. You may not add
to or detract from these instructions but may repeat any portion as requested. The instructions
must be read to each candidate in the same manner to ensure consistency and fairness. Give the
candidate time to inspect the equipment if necessary and explain any specific design features of
the equipment if you are asked. If the candidate enters with any equipment, be sure I have
inspected it and you are familiar with its appropriate use prior to evaluating the candidate.

When the candidate begins his/her performance, please document the actual time started (not
elapsed times) on the appropriate space of the evaluation form. As the candidate progresses
through the skill, fill out the evaluation form in the following manner:
1. Place the point or points in the appropriate space at the time each item is completed.
2. Only whole points may be awarded for those steps performed in an acceptable manner.
You are not permitted to award fractions of a point.
3. Place a zero in the "Points Awarded" column for any step that was not completed or was
performed in an unacceptable fashion (inappropriate, haphazard, or non-sequential
resulting in excessive and potentially detrimental delay).

All forms should be filled-out in a manner that prohibits the candidate from directly observing
the points you award or comments you may note. Do not become distracted by searching for
specific statements on the evaluation form when you should be observing the candidates
performance. Ideally you should be familiar with these forms, but if this occurs, simply turn the
form over and concisely record the entire performance on the backside. After the candidate
finishes the performance, complete the front side of the evaluation form in accordance with the
documented performance. Some skill evaluation instruments are printed with areas provided for
performances to be documented. Please remember the most accurate method of fairly evaluating
any candidate is one in which your attention is devoted entirely to the performance of the
candidate.

Please observe and enforce all time limits for the skills. When the time limit has been reached,
simply stop the candidates performance promptly, document the actual time the performance
ended, and direct the candidate to move on to the next skill, making sure that no candidate takes
any notes or recordings of the skill (notes on vital signs, scenario information, etc.). If the
candidate is in the middle of a step when the time limit is reached, permit him/her to complete
only that step but not start another. You should then place a zero (0) in the Points Awarded
column for any steps that were not completed within the allotted time.

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After all points have been awarded, you must total them and enter the total in the appropriate
space on the form. Next, review all Critical Criteria statements printed on the evaluation form
and check all that apply to the performance you just observed. For each of the Critical Criteria
statements you check, please document your rationale on the reverse side of the evaluation form.
Do not be vague or contradictory and do not simply rewrite the statement that you have checked.
Factually document the candidates actions that caused you to check the respective statements.
You may also wish to document each step of the skill in which zero (0) points were awarded in
the same fashion. Be sure to sign the form in the appropriate space and prepare the equipment
and supplies to appear in the same fashion before accepting another candidate into your skill. Are
there any questions at this time?

Security & Setup
You are responsible for the security of all evaluation materials throughout the examination and
you must return all materials to me before you leave this site. If you need to take a break, inform
the Examination Coordinator or me and secure all evaluation instruments that were issued to
you. After you receive your materials, proceed to your skill and check the props, equipment, and
moulage to ensure all equipment is available and functioning properly. Please take a moment to
look around the room and remove any materials that may assist a candidate with the examination
process (charts, posters, algorithms, training materials, etc.). You should orient any Simulated
Patients over their roles today. The Simulated Patients should act as a similar patient would in a
field situation. Please emphasize the importance of their consistent and professional performance
throughout todays examination. You must read through the essay and instructions, brief your
Simulated Patients, program any high fidelity simulation manikins (if used), and review the
evaluation form prior to evaluating any candidate. Please wait until I have inspected your room
and answered any of your specific questions before opening your skill station. I will also be
visiting all skills during the examination and will try to avoid interference as much as possible.

Are there any questions before we dismiss?


[The District EMS Official will distribute all psychomotor examination materials
and dismisses all Skill Examiners and Simulated Patients to the skill stations.]

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District EMS Official
Candidate Orientation to the
Psychomotor Examination

Good [morning, afternoon, evening]. My name is [District EMS Officials name]. I will be
responsible for administration of this examination. The Examination Coordinator for this test is
[Exam Coordinator's name]. On behalf of the EMS Division of the District Department of
Health, the National Registry of Emergency Medical Technicians, and [Name of Sponsoring
Institution], I would like to welcome you here today. I would like to thank [Exam Coordinator]
for arranging and securing the facilities and personnel assisting with todays examination. We
extend our sincere wishes for your successful completion of this part of the certification process
and obtaining subsequent National and District EMS Certification as an EMT.

I will now read the roster to confirm attendance before we begin the orientation. Please identify
yourself when I call your name so that I may record your attendance on the official roster.

District EMS Official now calls the roll and marks the roster for attendance
( if present, N/S if no-show).

Continue reading to all candidates:

If I did not call your name, please identify yourself so that I can record your attendance today. I
suggest that everyone check with me before leaving this site to compare the skills you think you
need to complete with the official roster. It is your responsibility to complete all required skills.
The NREMT and the District EMS Office are not responsible for your incomplete attempt of the
psychomotor examination.

The State EMS Official or approved agent must read the following instructions to all
candidates for the psychomotor examination:

The instructions I am about to give pertain to the psychomotor examination. Please pay close
attention as these instructions will not be repeated at a later time.

The Skill Examiners utilized today were selected because of their expertise in the assigned skill.
The Skill Examiner is an observer and recorder of your actions. Each Skill Examiner documents
your performance in relationship to criteria established by the NREMT that adheres to the
National EMS Education Standards, AHA Guidelines and the National Trauma Triage Protocol
published by the U.S. Department of Health and Human Services Centers for Disease Control
and Prevention. These criteria have been adopted by the District of Columbia as our testing and
certification standard.

You will be routed from the staging area when a skill station is ready for testing. No candidate, at
any time, is permitted to remain in the testing area while waiting for his/her next skill. When you
get to the room, please knock on the door to let the Skill Examiner know that you are waiting to
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test. You are not permitted to take any books, pamphlets, brochures, study materials, calculators,
or any other electronic or mechanical devices. Any notes you take must be left in the room when
you complete the skill. At this time, all pagers, cellular telephones, personal digital
assistants, and similar electronic communication devices must be turned off and locked in
your vehicle or other secure area for the duration of the examination. If you attempt to use
any communication device during the examination for any reason whatsoever, you will be
immediately dismissed from the remainder of the examination.

As you enter the room, the Skill Examiner will greet you and ask for your first and last name.
Please provide the proper spelling of your name so that your results may be reported accurately.
The Skill Examiner will then read aloud the Instructions to the Psychomotor Skills Candidate
exactly as printed on the instructions provided by the NREMT and the District EMS Office. This
information is read to each of you in the same manner to ensure consistency and fairness. Please
pay close attention to the instructions as they correspond to similar information you might
receive on an EMS call and give you valuable information on what will be expected of you
during your performance. The Skill Examiner will ask if you understand the instructions and will
be happy to repeat any portion if necessary. Please do not ask the Skill Examiner to supply
additional information not contained in the instructions as this is not permitted.

The skill stations are supplied with several types of equipment for your selection. You will be
given three (3) minutes at the beginning of each skill to survey and select the equipment
necessary for the appropriate management of the patient. Do not feel obligated to use all of the
equipment. The Skill Examiners will offer to point out any specific operational features of the
equipment if you are unfamiliar with any device. If you brought any of your own equipment, I
must inspect and approve it for use before you enter the skill station.

As you progress through the psychomotor examination, each Skill Examiner will be observing
and documenting your performance. Do not let their documentation practices influence your
performance. There is no correlation between the volume of their documentation and the quality
of your performance. We encourage you to explain the things you are doing within the scope of
the time limit. The Skill Examiner may also ask questions for clarification purposes. Simply
answer any questions and do not assume they are meant to provide feedback on the quality of
your performance.

If the skill has an overall time limit, the examiner will inform you of this during the instructions.
When you reach the time limit, the Skill Examiner will direct you to stop your performance.
However, if you complete the skill before your allotted time, inform the Skill Examiner that you
have finished your performance. You may also be asked to help remove equipment from the
Simulated Patient before leaving the skill station. As you leave, please remember that you are not
permitted to make any copies or recordings of this examination at any time.

Candidates sometimes complain that Skill Examiners are abrupt, cold, or appear unfriendly. No
one is here to add to the stress and anxiety you already feel. It is important for you to understand
that the Skill Examiners have been instructed to avoid any casual conversation with you. This is
necessary to help ensure fair and equal treatment of all candidates throughout the exam. Please
recognize this behavior as professional and simply perform the skills to the best of your ability.
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We have instructed the Skill Examiners not to indicate to you in any way your performance in
any skill. Please do not interpret any remarks as an indication of your overall performance.

You are not permitted to discuss any specific details of any skill with each other at any time.
Please be courteous to the candidates who are testing by keeping all excess noise to a minimum.
Be prompt in reporting to each skill station so that we may complete this examination within a
reasonable time period.

Your official psychomotor results will be reported as pass/fail of each skill by the District EMS
Official. Your official results will also be electronically communicated to you by the NREMT,
provided you have created an Emergency Medical Technician account. An account can be
created by logging into their website at [Link] and following the instructions. If you
make any errors in your performance, the District EMS Official or approved agent will not
explain any specific errors in any performance. The purpose of certification by the NREMT is to
verify achievement of minimal competencies for safe and effective practice. Providing a specific
analysis of errors in your performance was the responsibility of your educational program during
the learning process and not the certification process. If you are unsuccessful in any skill today,
we recommend that you contact your educational institution for remedial training before
attempting to retest. Please remember todays examination is a formal verification process and
was not designed to assist with teaching or learning. The Skill Examiners have not played any
role in the establishment of pass/fail criteria, but merely observe and document your performance
in each skill.

If you feel you have a complaint concerning the psychomotor examination, a formal complaint
procedure does exist. You must initiate any complaint with me today. Complaints will not be
valid after today and will not be accepted if they are issued after you learn of your results
or leave this site. You may file a complaint for only two (2) reasons:

1. You feel you have been discriminated against. Any situation that can be documented in
which you feel an unfair evaluation of your abilities occurred might be considered
discriminatory.
2. There was an equipment problem or malfunction during your performance in any skill.

If you feel either of these two things occurred, you must contact me immediately to initiate the
complaint process. I will supply the necessary complaint form that you must complete in writing.
If necessary, a Quality Assurance Committee may be convened. The District EMS Officials will
review your concerns and make a final determination of your complaint.

I am here today to ensure that fair, objective, and impartial evaluations occur in accordance with
NREMT and District-approved policy. If you have any concerns, please notify me immediately
to discuss your concerns. I will be visiting all skills throughout the examination to verify
adherence to these guidelines. Please remember that if you do not voice your concerns or
complaints today before you leave this site or before I inform you of your results, your
complaints will not be accepted.

Does anyone have any questions concerning the psychomotor examination at this time?
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EMT Psychomotor Examination Report Form
The District EMS Official or approved agent should now distribute the EMT
Psychomotor Examination Report Form at this time and instruct the candidates to legibly
fill-in the following information:

Please print the following information legibly on the EMT Practical Examination Candidate
Reporting Form:
Name
Address
Examination site
Examination Date (Month, Day, Year)

Notice the skills listed in the chart. If you are taking the entire psychomotor examination today,
be sure to complete all seven (7) skills that are listed. If you are retesting three (3) or less skills
today, be sure to check with me before starting your psychomotor examination. Remember that
your retest must be within 12 months of your initial psychomotor examination (all seven [7]
skills) to be accepted. Whatever the case, it is your responsibility to complete all appropriate
skills.

If you are taking the entire psychomotor examination today, you can fail up to three (3) skills and
be eligible to retest just the skills failed. Failing more than three (3) skills will require remedial
training and repeating the entire psychomotor examination on another date. Remember that
examination results are only valid for twelve (12) months from the date of the examination. If
you are eligible for retesting, you have two (2) retest attempts to pass the failed skill(s) within
that twelve (12) month period. Note that you only need to retest the specific skill(s) failed. For
example, if you are here for your first attempt of the psychomotor examination and fail Patient
Assessment/ Management Medical, Bag-Valve-Mask Ventilation of an Apneic Adult Patient,
and Spinal Immobilization (Supine Patient), you only need to retest these three (3) skills. If we
conduct a same-day retest today, you must retest all skills that need retested or none at all.
We cannot score or report incomplete psychomotor examination attempts. The NREMT and the
District EMS Office do not mandate or guarantee same-day retest opportunities at any EMT
Psychomotor Examination site. Please note that all results are preliminary and unofficial until
they have been formally processed and reported to you by a District EMS Official.

Lastly, be sure to read the Candidates Statement form carefully before signing your legal
signature and filling-in todays date. Please note that unprofessional behavior, such as the use of
foul language, making threats, or other types of irregular behavior will not be tolerated and could
lead to immediate dismissal and other appropriate actions.

Continue reading to all candidates:

Please come up to turn-in your completed EMT Psychomotor Examination Report Form. I will
need to see some form of identification, such as your drivers license, as you turn-in these forms.
This would also be a good time to confirm the skills you think you need to complete with me
before we begin the examination. Please remember to turn off all of your electronic
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communication devices and lock them in your vehicle or other secure area before we start this
examination.


NOTE:
The District EMS Official should collect all EMT Practical Examination Candidate Reporting
Forms at this time and verify the candidates identity with an official form of photo identification
(government-issued identification such as a drivers license). If an imposter is discovered,
document the occurrence as outlined under the False Identification section on page 16.
Photocopies of any ID are not official and should not be accepted. If a candidate has no
acceptable form of ID and the Examination Coordinator or any other person in an official
capacity at the examination site cannot verify his/her true identity, the District EMS Official
should immediately dismiss the candidate from the psychomotor examination.


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Station 1
Patient Assessment Management Trauma


Do not open this skill for testing until the District EMS Official has provided an approved trauma
scenario. There must be a live Simulated Patient who is an adult or adolescent greater than
sixteen (16) years of age. The Simulated Patient should also be of average adult height and
weight. The Simulated Patient should be dressed in appropriate attire (shorts or swimsuit) down to
which he/she will be exposed. A high fidelity simulation manikin capable of responding as a real
patient given the scenario(s) utilized today may also be used as the Simulated Patient.

Time Limit
10 minutes

Equipment Listing
The following equipment must be available and must be working adequately throughout the
examination:
Examination gloves
Pen light
Blood pressure cuff
Stethoscope
Blanket
Scratch paper and pencil/pen

Personnel Required
Examiner
Patient

Minimum Passing Score
33 out of 42 possible points
No critical criteria failures
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Station 1
Patient Assessment Management Trauma

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This skill station is designed to evaluate the candidates ability to integrate patient assessment
and management skills on a patient with multiple system trauma. A high fidelity simulation
manikin capable of responding as a real patient given the scenario(s) utilized today may also be
used as the Simulated Patient. Since this is a scenario-based skill, it will require dialogue
between the Skill Examiner and the candidate. The candidate will be required to physically
perform all assessment steps listed on the evaluation instrument. However, all interventions
should be verbalized instead of physically performed.

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As you welcome a candidate into the room and read the Instructions to the Psychomotor Skills
Candidate and scenario information, be sure to do this in such a manner which does not permit
the candidate to view the Simulated Patient. Other candidates waiting to test the skill must not be
able to overhear any specific scenario information. It is easiest to have the candidate enter the
room and turn his/her back to the Simulated Patient. A partition set-up just inside of the entrance
to your room that screens the Simulated Patient from view also works well. After all instructions
and scenario information is read, the time limit would start when the candidate turns around and
begins to approach the Simulated Patient. A three (3) minute time period is provided for the
candidate to check and prepare any equipment he/she feels necessary before the actual timed
evaluation begins.

Candidates are required to perform a scene size-up just as he/she would in a field setting. When
asked about the safety of the scene, you must indicate the scene is safe to enter. If the candidate
does not assess the safety of the scene before beginning patient assessment or care, no points
should be awarded for the step, Determines the scene/situation is safe and the related Critical
Criteria statement must be checked and documented as required. Because of the limitations of
simulating any injuries, you must establish a dialogue with the candidate throughout this skill. If
a candidate quickly inspects, assesses or touches the Simulated Patient in a manner in which you
are uncertain of the areas or functions being assessed, you must immediately ask the candidate to
explain his/her actions. For example, if the candidate stares at the Simulated Patient's face, you
must ask what he/she is checking to precisely determine if he/she was checking the eyes, facial
injuries, or skin color. Any information pertaining to sight, sound, touch, smell, or any injury
which cannot be realistically simulated but would be immediately evident in a real patient
(sucking chest wound, paradoxical chest movement, etc.) must be supplied by the Skill Examiner
as soon as the candidate exposes or examines that area of the Simulated Patient. Your responses
must not be leading but should factually state what the candidate would normally see, hear, or
feel on a similar patient in the out-of-hospital setting. For example, upon exposure of a sucking
chest wound, your response should immediately be, You see frothy blood bubbling from that
wound and you hear noises coming from the wound site. You have provided an accurate and
immediate description of the exposed wound by supplying the visual and auditory information
normally present with this type of injury. An unacceptable response would be merely stating,
The injury you just exposed is a sucking chest wound.

Information pertaining to vital signs should not be provided until the candidate actually
takes the vital signs of the Simulated Patient (BP, P and R) using a stethoscope and a blood
pressure cuff. Each candidate must actually obtain vital signs on the patient, including blood
pressure, pulse rate and respiratory rate. Be sure to record the measured and reported vital signs
on the appropriate spaces of the skill evaluation form. Acceptable ranges for scoring purposes
are based upon the vital signs that you measure and record on the Simulated Patient:

Blood pressure: 10 mmHg
Pulse: 10 beats per minute
Respiratory rate: 5 breaths per minute


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Because of the dynamic nature of this scenario-based evaluation, you will need to supply logical
vital signs and update the candidate on the Simulated Patients condition in accordance with the
treatments he/she has provided. Clinical information not obtainable by inspection or palpation,
such as a blood pressure or breath sounds, should be supplied immediately after the candidate
properly demonstrates how this information would normally be obtained in the field. The sample
vital signs that you create with this scenario should serve as a sample of acceptable changes in
the Simulated Patients vital signs based upon the candidates treatment. They are not
comprehensive and we depend upon your expertise in presenting vital information that would
reflect an appropriate response, either positive or negative, to the treatment(s) provided.

It is acceptable for the candidate to call for immediate evacuation of the Simulated Patient based
upon the absence of distal pulses without obtaining an accurate BP measurement by
sphygmomanometer. If this occurs, please direct the candidate to complete his/her assessment
and treatment en route. All vital signs should be periodically reassessed en route. An accurate BP
should be obtained by sphygmomanometer during the initial assessment of the Simulated Patient.
This can occur during the on-scene segment or during the transport segment. Once the
candidate takes one real set of vital signs, the remainder are simulated.

You should continue providing a clinical presentation of shock (hypotension, tachycardia,
delayed capillary refill, etc.) until the candidate initiates appropriate shock management. It is
essential that you do not present a physiological miracle by improving the Simulated Patient
too much at too early a step. If on the other hand no treatments or inappropriate treatments are
rendered, you should supply clinical information representing a deteriorating patient. However,
do not deteriorate the Simulated Patient to the point where the candidate elects to initiate
CPR.

Because all treatments are voiced, a candidate may forget what he/she has already done to the
Simulated Patient. This may result in the candidate attempting to do assessment/treatment steps
on the Simulated Patient that are physically impossible. For example, a candidate may attempt to
assess the posterior thorax of the Simulated Patient after the Simulated Patient was log rolled and
secured to a long backboard. Your appropriate response in this instance would be, You have
secured the Simulated Patient to the long backboard. How would you assess the posterior
thorax? This also points out the need for you to ensure the Simulated Patient is actually rolling
or moving as the candidate conducts his/her assessment just like a real patient would be moved
during an actual assessment.

The evaluation form should be reviewed prior to testing any candidate. You should direct any
specific questions to the Districts EMS Official for clarification prior to beginning any
evaluation. As you look at the evaluation form, its format implies a linear, top-to-bottom
progression in which the candidate completes several distinct categories of assessment.
However, as you will recall, the goal of appropriate out-of-hospital trauma care is the rapid and
sequential assessment, evaluation, and treatment of life-threatening conditions to the airway,
breathing, and circulation (ABCs) of the patient with rapid transport to proper definitive care.
For this reason, perhaps the most appropriate assessment occurs when the candidate integrates
portions of the Secondary Assessment when appropriate within the sequence of the Primary
Survey/Resuscitation. For example, it is acceptable for the candidate who, after appropriately
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opening and evaluating the Simulated Patients airway, assesses breathing by exposing and
palpating the chest and quickly checks for tracheal deviation. With this in mind, you can see how
it is acceptable to integrate assessment of the neck, chest, abdomen/pelvis, lower extremities, and
posterior thorax, lumbar and buttocks area into the Primary Survey/Resuscitation sequence as
outlined on the evaluation form. This integration should not occur in a haphazard manner but
should fall in the appropriate sequence and category of airway, breathing, or circulatory
assessment of the Primary Survey/Resuscitation. These areas have been denoted by ** on the
skill evaluation form in the Secondary Assessment section. However, if the mechanism of
injury suggests potential spinal compromise, cervical spine precautions may not be disregarded
at any point. If this action occurs, deduct the point for the step, Considers stabilization of the
spine. Mark the appropriate statement under Critical Criteria and document your rationale as
required.

We strongly recommend that you concisely document the entire performance on the backside of
the evaluation form, especially if you find yourself too involved with the form in finding the
appropriate sections to note and mark during any performance. It is easier to complete the
evaluation form with all performances documented in this fashion rather than visually missing a
physical portion of the candidates assessment due to your involvement with the evaluation form.
This documentation may also be used to help validate a particular performance if questions arise
later.

Immediately upon determining the severity of the Simulated Patients injuries, the candidate
should call for immediate packaging and transport of the Simulated Patient. A request for a
transporting EMS service should not be delayed if prolonged extrication is not a consideration.
You should inform the candidate to continue his/her assessment and treatment while awaiting
arrival of the transporting unit. Be sure to remind the candidate that both partners are available
during transport. You should stop the candidate promptly when the ten (10) minute time
limit has elapsed. Some candidates may finish early and have been instructed to inform you
when he/she completes the skill. If the candidate has not voiced transport of the Simulated
Patient within this time limit, mark the appropriate statement under Critical Criteria on the
evaluation form and document this omission.

You should review the scenario you received and instructions with your Simulated Patient to
assist in his/her role as a programmed patient. A high fidelity simulation manikin capable of
responding as a real patient given the scenario(s) utilized today may also be used as the
Simulated Patient. You should program the high fidelity simulation manikin or discuss with the
live simulated patient the following parameters:
A clearly defined mechanism of injury must be included. The mechanism of injury must
indicate the need for the candidate to suspect multisystem trauma.
The patient must be on the floor. If any candidate insists on having the simulated patient
move to a different location, you should immediately dismiss the candidate and notify the
Districts EMS Official.
The patient must at least respond to pain by moaning or mumbling.
There will be at least one problem with the airway, breathing and circulatory status of the
patient.
There will be an additional associated soft tissue or musculoskeletal injury.
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Vital signs that represent a severely injured multisystem trauma patient.

Be sure to program your Simulated Patient or high fidelity simulation manikin to respond as a
real patient would given all injuries listed in the scenario. Also make sure the Simulated Patient
logrolls, moves, or responds appropriately given the scenario just as a real patient would. All
Simulated Patients should be adults or adolescents who are greater than sixteen (16) years of age.
All Simulated Patients should also be of average adult height and weight. The use of very small
children as Simulated Patients is not permitted in this skill. All Simulated Patients should
wear shorts or a swimsuit, as he/she will be exposed down to the shorts or swimsuit. Outer
garments should be provided which the candidate should remove to expose the Simulated
Patient. If prepared garments are not available, you should pre-cut all outer garments along the
seams and tape them together before any candidate enters your room. This will help ensure that
all candidates are evaluated fairly in his/her ability to expose and examine the Simulated Patient.
If using moulage pay particular attention to your moulage and make it as realistic as you would
expect in a similar out-of-hospital situation. For example, artificial blood should be soaked into
the garments worn over any soft tissue injury that would normally bleed in the field. A small tear
should be cut into the clothing to represent the location of the stab wound. Remember, realistic
and accurate moulage improves the quality of the examination by providing for more fair and
accurate evaluation of the candidates.

Please be conscientious of your Simulated Patients fatigue throughout the examination. Give
him/her appropriate breaks and be certain to wrap a blanket around your Simulated Patient to
cover any simulated injuries before dismissing him/her for a break. Also keep in mind that your
Simulated Patient may become uncomfortably cold during the examination from laying on the
floor and being disrobed throughout the day. A blanket is required equipment in this skill station
to help keep your Simulated Patient warm throughout the examination. For the comfort of the
Simulated Patient a mat may be used on hard floors.
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Station 1
Patient Assessment Management Trauma

Instructions to the Simulated Trauma Patient

The following should be reviewed by the skill station examiner with the person serving as
patient.

NOTE: In order to ensure a fair examination environment for each candidate, the simulated
patient should be an adult of average height and weight. For example, the use of very small
children is not allowed in this station.

Thank you for serving as the Simulated Patient at todays examination. Please be consistent in
presenting this scenario to every candidate who tests in your room today. It is important to
respond as would a real patient of a similar multiple trauma situation. The Skill Examiner will
help you understand your appropriate responses for todays scenario. For example, the level of
respiratory distress that you should act out and the degree of pain that you exhibit as the
candidate palpates those areas should be consistent throughout the examination. As each
candidate progresses through the skill, please be aware of any time that he/she touches you in
such a way that would cause a painful response in the real patient. If the scenario indicates you
are to respond to deep, painful stimuli and the candidate only lightly touches the area, do not
respond. Do not give the candidate any clues while you are acting as a Simulated Patient. It
is inappropriate to moan that your wrist hurts after you become aware that the candidate has
missed that injury. Be sure to move with the candidate as he/she moves you to assess various
areas of your body. For example, after the candidate calls for you to be log rolled, please log roll
towards the candidate unless he/she orders you to be moved in a different direction. Please
remember what areas have been assessed and treated because you and the Skill Examiner may
need to discuss the candidates performance after he/she leaves the room.

When you need to leave the examination room for a break, be sure to wrap a blanket around you
so that other candidates do not see any of your simulated injuries. A blanket will be provided for
you to keep warm throughout the examination. We suggest you wrap the blanket around you to
conserve body heat while the Skill Examiner is completing the evaluation form.
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Station 1
Patient Assessment Management Trauma

Instructions to the Candidate


Welcome to the Patient Assessment/Management - Trauma skill station. In
this skill station, you will have ten (10) minutes to perform your assessment
and voice treat all conditions and injuries discovered. At this time, please
take three (3) minutes to check your equipment and prepare whatever you
feel is necessary.

[After three (3) minutes or sooner if the candidate states, "I'm prepared," the
Skill Examiner continues reading the following:]

You should conduct your assessment as you would in the field, including
communicating with your Simulated Patient. You may remove the Simulated
Patients clothing down to his/her shorts or swimsuit if you feel it is
necessary. As you progress through this skill, you should state everything you
are assessing. Specific clinical information not obtainable by visual or
physical inspection, for example blood pressure, will be given to you only
when you ask and following demonstration of how you would normally
obtain that information in the field. You may assume you have two (2)
partners working with you who are trained to your level of care. They will
correctly perform the verbal treatments you indicate necessary. I will
acknowledge your treatments and may ask you for additional information if
clarification is needed. Do you have any questions?

[Skill Examiner now reads Mechanism of Injury from prepared scenario
and begins 10 minute time limit.]

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NREMT Skill Sheet: Patient Assessment/Management-Trauma Page 1

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NREMT Skill Sheet: Patient Assessment/Management-Trauma Page 2

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Station 2
Patient Assessment Management Medical

Do not open this skill for testing until the District EMS Official has provided an approved
medical scenario. There must be a live Simulated Patient who is an adult or adolescent greater
than sixteen (16) years of age. The Simulated Patient should also be of average adult height and
weight. The Simulated Patient should be dressed in appropriate attire (shorts or swimsuit) down to
which he/she will be exposed. A high fidelity simulation manikin capable of responding as a real
patient given the scenario(s) utilized today may also be used as the Simulated Patient.


Time Limit
15 minutes

Equipment Listing
The following equipment should also be available and you should ensure that it is working
adequately throughout the examination:
Examination gloves
Pen light
Blood pressure cuff
Stethoscope
Blanket
Scratch paper and pencil/pen

Personnel Required
Examiner
Patient

Minimum Passing Score
33 out of 42 possible points
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Station 2
Patient Assessment Management Medical

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This skill station is designed to evaluate the candidates ability to use appropriate interviewing
techniques and assessment skills for a patient whose chief complaint is of a medical nature. Since
this is a scenario-based skill using a live, programmed, Simulated Patient or a high fidelity
simulation manikin, it will require extensive dialogue between the candidate, the Simulated
Patient, and the Skill Examiner if necessary. The Simulated Patient will answer the candidates
questions based on the scenario being utilized today. The candidate will be required to physically
perform all assessment steps listed on the evaluation form. All interventions should be verbalized
instead of physically performed. You should also establish a dialogue with the candidate
throughout this skill. You may ask questions for clarification purposes and should also provide
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any information pertaining to sight, sound, touch, or smell that cannot be realistically simulated
but would be immediately evident in a real patient encounter of a similar nature. You should also
ensure the accuracy of the information the Simulated Patient is providing and should
immediately correct any erroneous information the Simulated Patient may accidentally provide.
This skill requires the presence of a live, programmed, Simulated Patient or a high fidelity
simulation manikin. The scenario will contain enough information for the candidate to form a
general impression of the Simulated Patients condition. Additionally, the Simulated Patient
should remain awake and able to communicate with the candidate throughout the scenario.
Please thoroughly brief the Simulated Patient over his/her roles for the examination. You should
ensure the Simulated Patient reads the Information for the Simulated Medical Patient provided
at the end of this essay. You should also role-play the scenario with him/her prior to evaluating
the first candidate to ensure familiarization with the approved scenario for todays examination.
Provide any specific information the candidate asks for as listed in the scenario. If the candidate
asks for information not listed in the scenario, you should provide an appropriate response based
on your expertise and understanding of the patients condition.

Information pertaining to vital signs should not be provided until the candidate actually
takes the vital signs of the Simulated Patient (BP, P and R) using a stethoscope and a blood
pressure cuff. Each candidate must actually obtain vital signs on the patient, including blood
pressure, pulse rate and respiratory rate. Be sure to record the measured and reported vital signs
on the appropriate spaces of the skill evaluation form. Acceptable ranges for scoring purposes
are based upon the vital signs that you measure and record on the Simulated Patient:

Blood pressure: 10 mmHg
Pulse: 10 beats per minute
Respiratory rate: 5 breaths per minute

After the candidate measures the actual vital signs of the Simulated Patient, you may need to
inform the candidate of adjusted vital signs based upon the approved testing scenario for the
examination as compared to the actual vital signs just obtained by the candidate.

As you welcome a candidate into the room and read the Instructions to the Candidate and
scenario information, be sure to do this in such a manner which does not permit the candidate to
view the Simulated Patient. Other candidates waiting to test the skill should not be able to
overhear any specific scenario information. It is easiest to have the candidate enter the room and
turn his/her back to the Simulated Patient. A partition set-up just inside of the entrance to your
room that screens the Simulated Patient from view also works well. After all instructions and
scenario information is read, the time limit would start when the candidate turns around and
begins to approach the Simulated Patient. A three (3) minute time period is provided for the
candidate to check and prepare any equipment he/she feels necessary before the actual timed
evaluation begins.

Candidates are required to evaluate the scene just as he/she would in a field setting. When asked
about the safety of the scene, you should indicate the scene is safe to enter. If the candidate does
not assess the safety of the scene before beginning patient assessment or care, no points should
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be awarded for the step, Determines the scene/situation is safe and the related Critical
Criteria statement should be checked and documented as required.

Because of the limitations of simulations and the ability of the Simulated Patient, you should
establish a dialogue with the candidate throughout this skill. If a candidate quickly inspects,
assesses or touches the Simulated Patient in a manner in which you are uncertain of the areas or
functions being assessed, you should immediately ask the candidate to explain his/her actions.
For example, if the candidate stares at the Simulated Patient's face, you should ask what he/she is
checking to precisely determine if he/she was checking the eyes, facial injuries, or skin color.
Any information pertaining to sight, sound, touch, smell, or any condition that cannot be
realistically simulated, but would be immediately evident in a real patient should be supplied by
the Skill Examiner as soon as the candidate exposes or examines that area of the Simulated
Patient. Your responses should not be leading, but should factually state what the candidate
would normally see, hear, or feel on a similar patient in the out-of-hospital setting. For example,
you should state, You see pink, frothy sputum coming from the patients mouth as he/she
coughs. You have provided an accurate and immediate description of the condition by
supplying a factual description of the visual information normally present in the patient but are
difficult to simulate. An unacceptable response would be merely stating, The patient is
experiencing left heart failure.

Because of the dynamic nature of this scenario-based evaluation, you will need to supply logical
vital signs and update the candidate on the Simulated Patients condition in accordance with the
treatments he/she has provided. Clinical information not obtainable by inspection or palpation,
such as a blood pressure, should be supplied immediately after the candidate properly
demonstrates how this information would normally be obtained in the field. The sample vital
signs included with the scenario should serve as a sample of acceptable changes in the Simulated
Patients vital signs based upon the candidates treatment. They are not comprehensive and we
depend upon your expertise in presenting vital information that would reflect an appropriate
response, either positive or negative, to the treatment(s) provided. You should continue
providing a clinical presentation of a patient with a significant medical complaint as outlined in
the scenario until the candidate initiates appropriate management. It is essential that you do not
present a physiological miracle by improving the Simulated Patient too much at too early a
step. If on the other hand no or inappropriate interventions are rendered, you should supply
clinical information representing a patient who does not improve. However, do not deteriorate
the Simulated Patient to the point where he/she can no longer communicate with the
candidate.

Two imaginary EMT assistants are available only to provide treatments as ordered by the
candidate. Because all treatments are voiced, a candidate may forget what he/she has already
done to the Simulated Patient. This may result in the candidate attempting to do
assessment/treatment steps on the Simulated Patient that are physically impossible. For example,
a candidate may attempt to assess the back of a Simulated Patient who was found supine in bed.
Your appropriate response in this instance would be, Please assess this Simulated Patient as you
would a real patient in the out-of-hospital setting. This also points out the need for you to ensure
the Simulated Patient is actually presenting and moving upon the candidates directions just like
a real patient would during an actual call.
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The evaluation form should be reviewed prior to evaluating any candidate. You should direct any
specific questions to the In-charge person for clarification prior to opening your skill station. As
you look at the evaluation form, its format implies a linear, top-to-bottom progression in which
the candidate completes several distinct categories of assessment. However, as you will recall,
after completing the Primary Survey/Resuscitation and determining that the patient does not
require immediate and rapid transport, the steps listed in the History Taking/Secondary
Assessment section may be completed in any number of acceptable sequences. If the
mechanism of injury suggests potential spinal compromise, immediate and continuous cervical
spine precautions should be taken. If not, deduct the point for the step, Considers stabilization
of spine, mark the appropriate statement under Critical Criteria and document your rationale
as required.

We strongly recommend that you concisely document the entire performance on the backside of
the evaluation form, especially if you find yourself too involved with the form in finding the
appropriate sections to note and mark during any performance. It is easier to complete the
evaluation form with all performances documented in this fashion rather than visually missing a
physical portion of the candidates assessment due to your involvement with the evaluation form.
This documentation may also be used to help validate a particular performance if questions
should arise later.

Immediately after completing the Primary Survey/Resuscitation, the candidate should make
the appropriate decision to continue assessment and treatment at the scene or call for immediate
transport of the patient. In the critical patient, transport to the nearest appropriate facility should
not be significantly delayed for providing interventions or performing other assessments if
prolonged extrication or removal is not a consideration. You should inform the candidate who
chooses to immediately transport the critical patient to continue his/her Secondary Assessment
while awaiting arrival of the EMS vehicle. Be sure to remind the candidate that both partners
are also available. You should stop the candidate promptly after he/she completes a verbal report
to an arriving EMS unit or when the fifteen (15) minute time limit has elapsed. Some candidates
may finish early and have been instructed to inform you when he/she completes the skill. If the
candidate has not voiced transport of the Simulated Patient within this time limit, mark the
appropriate statement under Critical Criteria on the evaluation form and document this
omission.

You should review the scenario and instructions with your Simulated Patient to assist in his/her
role as a programmed patient. A high fidelity simulation manikin capable of responding as a real
patient given the scenario(s) utilized today may also be used as the Simulated Patient. You
should discuss the following with the live simulated patient or program the high fidelity
simulation manikin with the following parameters:
There must be a clearly defined nature of the illness. The patient or a bystander should be
able to communicate relevant information to the candidate when asked.
The patients chief complaint must be clearly related to the nature of the illness.
The history of the present illness, past medical history, and physical findings in the
affected body systems must be related to the chief complaint and nature of the illness.
Vital signs should be prepared that represent the usual findings in a patient with these
pathologies.
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Be sure to discuss with the Simulated Patient or program your high fidelity simulation manikin
to respond as a real patient would given all conditions listed in the scenario that you have been
given. Also make sure the Simulated Patient acts, moves, and responds appropriately given the
scenario just as a real patient would. You may need to confirm a portion of the candidates
performance with the Simulated Patient to help ensure a thorough and complete evaluation. All
Simulated Patients should be adults or adolescents who are greater than sixteen (16) years of age.
All Simulated Patients should also be of average adult height and weight. The use of very small
children as Simulated Patients is not permitted in this skill. The Simulated Patient should
also be wearing shorts or a swimsuit, as he/she will be exposed down to the shorts or swimsuit.
Outer garments should be provided which the candidate should remove to expose the Simulated
Patient. If prepared garments are not available, you should pre-cut all outer garments along the
seams and tape them together before any candidate enters your room. This will help ensure that
all candidates are evaluated fairly in his/her ability to expose and examine the Simulated Patient.
Pay particular attention to your moulage and make it as realistic as you would expect in a similar
out-of-hospital situation. For example, the shirt should be soaked with water if the patients skin
is moist. Remember, realistic and accurate simulations improve the quality of the examination by
providing for more fair and accurate evaluation of the candidates.
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Station 2
Patient Assessment Management Medical

Instructions to the Simulated Medical Patient


Thank you for serving as the Simulated Patient at todays examination. In this examination, you
will be required to role-play a patient experiencing an acute medical condition. Please be
consistent in presenting this scenario to every candidate who tests in your room today. The level
of responsiveness, anxiety, respiratory distress, etc., which you act out should be the same for all
candidates. It is important to respond as a real patient with a similar medical complaint would.
The Skill Examiner will help you understand your appropriate responses for todays scenario.
For example, the level of respiratory distress that you should act out should be consistently
displayed throughout the examination.

As each candidate progresses through the skill, please be aware of any questions you are asked
and respond appropriately given the information in the scenario. Do not overact or provide
additional signs or symptoms not listed in the scenario. It is very important to be completely
familiar with all of the information in todays scenario before any candidate enters your room for
testing. The Skill Examiner will be role-playing several practice sessions with you to help you
become comfortable with your roles today as a programmed patient. If any candidate asks for
information not contained in the scenario, the Skill Examiner will supply appropriate responses
to questions if you are unsure of how to respond. Do not give the candidate any clues while you
are acting as a patient. For example, it is inappropriate to moan that your belly really hurts after
you become aware that the candidate has not assessed your abdomen. Be sure to move as the
candidate directs you to move so he/she may assess various areas of your body. For example, if
the candidate asks you to sit up so he/she may assess your back, please sit up as a cooperative
patient would. Please remember what areas have been assessed and treated because you and the
Skill Examiner may need to discuss the candidates performance after he/she leaves the room.

When you need to leave the examination room for a break, be sure to wrap a blanket around you
so that other candidates do not see any of simulations being used. A blanket will be provided for
you to keep warm throughout the examination. We suggest you wrap the blanket around you to
conserve body heat while the Skill Examiner is completing the evaluation form.
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Station 2
Patient Assessment Management Medical

Instructions to the Candidate

This is the Patient Assessment/Management - Medical skill. In this skill, you
will have fifteen (15) minutes to perform your assessment, patient interview,
and voice treat all conditions discovered. At this time, please take three (3)
minutes to check your equipment and prepare whatever you feel is necessary.

[After three (3) minutes or sooner if the candidate states, "I'm prepared," the
Skill Examiner continues reading the following:]

You should conduct your assessment as you would in the field, including
communicating with your Simulated Patient. You may remove the Simulated
Patients clothing down to his/her shorts or swimsuit if you feel it is
necessary.

As you progress through this skill, you should state everything you are
assessing. Specific clinical information not obtainable by visual or physical
inspection, for example blood pressure, will be given to you only when you
ask and following demonstration of how you would normally obtain that
information in the field. You may assume you have two (2) partners working
with you who are trained to your level of care. They can only perform the
interventions you indicate necessary and I will acknowledge all interventions
you order. I may also supply additional information and ask questions for
clarification purposes. Do you have any questions?

[Skill Examiner now reads Entry Information from approved scenario and
begins 15 minute time limit.]
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NREMT Skill Sheet: Patient Assessment/Management-Medical Page 1

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NREMT Skill Sheet: Patient Assessment/Management-Medical Page 2

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Station 3
Bag-Valve-Mask Ventilation of an
Apneic Patient

Time Limit
5 minutes

Equipment Listing
Do not open this skill station for testing until the following equipment is available. You must ensure
that all equipment is working adequately throughout the examination. All equipment must be
disassembled (reservoir disconnected and oxygen supply tubing disconnected when using only non-
disposable equipment, regulator turned off, etc.) before accepting a candidate for evaluation:
Examination gloves (may also add masks, gowns, and eyewear)
Intubation manikin (adult)
Bag-valve-mask device with reservoir (adult)
Oxygen cylinder with regulator
Oxygen connecting tubing
Selection of oropharyngeal airways (adult)
Suction device (electric or manual) with rigid catheter and appropriate suction tubing
Stethoscope
Tongue blade

Personnel Required
Examiner

Minimum Passing Score
13 out of 17 possible points

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Station 3
Bag-Valve-Mask Ventilation of an
Apneic Patient

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

In this skill, the candidate will have five (5) minutes to provide ventilatory assistance to an
apneic patient who has a weak carotid pulse and no other associated injuries. The patient is found
supine and unresponsive on the floor. The adult manikin must be placed and left on the floor
for these skills. If any candidate insists on moving the patient to a different location, you should
immediately dismiss the candidate and notify the District EMS Official present. For the purposes
of this evaluation, the cervical spine is intact and cervical precautions are not necessary. This
skill was developed to simulate a realistic situation where an apneic patient with a palpable
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carotid pulse is found. Bystander ventilations have not been initiated. A three (3) minute time
period is provided for the candidate to check and prepare any equipment he/she feels necessary
before the actual timed evaluation begins.

When the actual timed evaluation begins, the candidate must immediately assess the patients
responsiveness and breathing for at least 5 seconds but no more than 10 seconds in accordance
with 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care.
You should then inform the candidate that the patient is unresponsive and there are no signs of
breathing. After requesting additional EMS assistance, the candidate should check for a carotid
pulse for at least 5 seconds but no more than 10 seconds. You should then inform the candidate
that a weak carotid pulse of 60 is present. The candidate should next open the patients airway
and assess for breathing. Immediately you should inform the candidate that he/she observes
secretions and vomitus in the patients mouth. The candidate should attach the rigid suction
catheter to the suction unit and operate the equipment correctly to suction the patients mouth
and oropharynx. Either electrical or manual suction units are acceptable and must be working
properly in order to assess each candidates ability to suction a patient properly. If the suctioning
attempt is prolonged and excessive, you should check the related Critical Criteria and
document the exact amount of time the candidate suctioned the patient. After suctioning is
complete, you should then inform the candidate that the mouth and oropharynx are clear.

The candidate should then initiate ventilation using a bag-valve-mask device unattached to
supplemental oxygen. If a candidate chooses to set-up the reservoir and attach supplemental
oxygen to the BVM device prior to establishing a patent airway and ventilating the patient, it
must be accomplished within thirty (30) seconds after the completion of the suctioning of the
patient. The point for this step should be awarded and is explained on the skill evaluation form
(denote by **). Regardless of the candidates initial ventilatory assistance (either with room air
or supplemental oxygen attached), it must be accomplished after body substance isolation
precautions have been taken and within thirty (30) seconds after the completion of the suctioning
of the patient or the candidate has failed to ventilate an apneic patient immediately. It is
acceptable to insert an oropharyngeal airway prior to ventilating the patient with either room air
or supplemental oxygen. You must inform the candidate that no gag reflex is present when
he/she inserts the oropharyngeal airway.

After the candidate begins ventilation, you must inform the candidate that ventilation is being
performed without difficulty. It is acceptable to re-check the pulse at this point while ventilations
continue. The candidate should also call for integration of supplemental oxygen at this point in
the procedure if it was not attached to the BVM initially. You should now take over BVM
ventilation while the candidate gathers and assembles the adjunctive equipment and attaches the
reservoir to supplemental oxygen if non-disposable equipment is being used. If two or more
testing rooms are set-up and one is using a disposable BVM, be sure to leave the mask and
reservoir attached to all the non-disposable BVMs throughout the examination. To assist in
containing costs of the psychomotor examination, the oxygen tank used may be empty for this
skill. The candidate must be advised to act as if the oxygen tank were full. However, the
supplemental oxygen tubing, regulator, BVM, and reservoir should be in working order.

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After supplemental oxygen has been attached, the candidate must oxygenate the patient by
ventilating at a rate of 10 12 ventilations/minute with adequate volumes of oxygen-enriched
air. Ventilation rates in excess of 12/minute have been shown to be detrimental to patient
outcomes. It is important to time the candidate for at least one (1) minute to confirm the proper
ventilation rate. It is also required that an oxygen reservoir (or collector) be attached. Should the
candidate connect the oxygen without such a reservoir or in such a way as to bypass its function,
he/she will have failed to provide a high percentage (at least 85%) of supplemental oxygen. You
must mark the related statement under Critical Criteria and document his/her actions.

Determination of ventilation volumes is dependent upon your observations of technique and the
manikins response to ventilation attempts. For the purposes of this evaluation form, a proper
volume is defined as a ventilation that causes visible chest rise. Be sure to ask the candidate,
How would you know if you are delivering appropriate volumes with each ventilation? Be sure
to document any incorrect responses and check any related Critical Criteria statements. After
the candidate ventilates the patient with supplemental oxygen for at least one (1) minute, you
should stop the candidates performance.

Throughout this skill, the candidate should take or verbalize appropriate body substance isolation
precautions. At a minimum, examination gloves must be provided as part of the equipment
available in the room. Masks, gowns, and eyewear may be added to the equipment for these
skills but are not required for evaluation purposes in order to help contain costs of the
psychomotor examination. If the candidate does not protect himself/herself with at least gloves
before touching the patient or attempts direct mouth-to-mouth ventilation without a barrier,
appropriate body substance isolation precautions have not been taken. Should this occur, mark the
appropriate statement under Critical Criteria and document the candidates actions as required.

Oxygen Administration Timing Flow Chart

Responsiveness &
Breathing Assessment
5-10 seconds
Carotid Pulse Assessment
5-10 Seconds
Suctioning
10-15 seconds
B-V-M Ventilation
within 30-seconds of
completing suctioning
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Station 3
Bag-Valve-Mask Ventilation of an
Apneic Patient

Instructions to the Candidate

This skill is designed to evaluate your ability to provide immediate and
aggressive ventilatory assistance to an apneic adult patient who has no other
associated injuries. This is a non-trauma situation and cervical precautions
are not necessary. You are required to demonstrate sequentially all
procedures you would perform, from simple maneuvers, suctioning, adjuncts,
and ventilation with a BVM.

You must actually ventilate the manikin for at least one (1) minute with
each adjunct and procedure utilized. I will serve as your trained assistant
and will be interacting with you throughout this skill. I will correctly carry-
out your orders upon your direction. Do you have any questions?

At this time, please take three (3) minutes to check your equipment and
prepare whatever you feel is necessary.

[After three (3) minutes or sooner if the candidate states, "I'm prepared," the
Skill Examiner continues reading the following:]

Upon your arrival to the scene, you find a patient lying motionless on the
floor. Bystanders tell you that the patient suddenly became unresponsive. The
scene is safe and no hemorrhage or other immediate problem is found. You
have five (5) minutes to complete this skill.
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NREMT Skill Sheet: Bag-Valve-Mask Apneic Patient

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Station 4
Oxygen Administration by
Non-rebreather Mask

Time Limit
5 minutes

Equipment Listing
Do not open this skill station for testing until the following equipment is available. You must
ensure that all equipment is working adequately throughout the examination. All equipment
must be disassembled before accepting a candidate for evaluation:
Examination gloves (may also add masks, gowns, and eyewear)
Patient options
o Intubation manikin (must be anatomically complete and include ears, nose and
mouth - adult)
o Live simulated patient (adult)
Various supplemental oxygen delivery devices (nasal cannula, non-rebreather mask with
reservoir, etc. for an adult)
Oxygen cylinder with regulator
o Cylinder must be fully pressurized with air or oxygen in order to test oxygen
administration by non-rebreather mask.
Oxygen connecting tubing
Stethoscope

Personnel Required
Examiner
Patient (optional may use manikin)

Minimum Passing Score
8 out of 11 possible points

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Station 4
Oxygen Administration by
Non-rebreather Mask

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This skill is designed to test the candidates ability to correctly assemble the equipment needed
to administer supplemental oxygen in the out-of-hospital setting. The oxygen tank must be fully
pressurized for this skill (air or oxygen) and the regulator/flow meter must be functional. The
Simulated Patient may be a live person or a manikin. However, the manikin must be
anatomically complete and include ears, nose and mouth.


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A three (3) minute time period is provided for the candidate to check and prepare any equipment
he/she feels necessary before the actual timed evaluation begins. The candidate will then have
five (5) minutes to assemble the oxygen delivery system and deliver an acceptable oxygen flow
rate to a patient using a non-rebreather mask.

When the actual timed evaluation begins, the candidate will be instructed to assemble the oxygen
delivery system and administer oxygen to the Simulated Patient using a non-rebreather mask.
During this procedure, the candidate must check for tank or regulator leaks as well as assuring a
tight mask seal to the patients face. If any leak is found and not corrected, you should deduct the
point, check the related Critical Criteria and document the actions. You should do the same if
the candidate cannot correctly assemble the regulator to the oxygen tank or operate the regulator
and delivery device in a safe and acceptable manner.

Oxygen flow rates are normally established according to the patient history and patient
condition. Since this is an isolated skills verification of oxygen administration by non-rebreather
mask, oxygen flow rates of at least 10 L/minute are acceptable. Once the oxygen flow rate has
been set, you should direct the candidate to stop his/her performance and end the skill.

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Station 4
Oxygen Administration by
Non-rebreather Mask

Instructions to the Candidate

This skill is designed to evaluate your ability to provide supplemental oxygen
administration by non-rebreather mask to an adult patient. The patient has no
other associated injuries. This is a non-trauma situation and cervical
precautions are not necessary. You will be required to assemble an oxygen
tank and a regulator. You will then be required to administer oxygen to an
adult patient using a non-rebreather mask. I will serve as your trained
assistant and will be interacting with you throughout this skill. I will correctly
carry-out your orders upon your direction. Do you have any questions?

At this time, please take three (3) minutes to check your equipment and
prepare whatever you feel is necessary.

[After three (3) minutes or sooner if the candidate states, I'm prepared, the
Skill Examiner continues reading the following:]

A 45 year old male is short of breath. His lips are cyanotic and he is
confused. You have five (5) minutes to administer oxygen by non-rebreather
mask.

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NREMT Skill Sheet: Oxygen Administration by Non-rebreather Mask


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Station 5
Cardiac Arrest Management AED

Time Limit
10 minutes

Equipment Listing
Examination gloves
Mouth-to-barrier device (disposable)
Automated External Defibrillator (trainer model programmed with current AHA
Guidelines) with freshly charged batteries and spares
CPR manikin that can be defibrillated with an AED Trainer
Appropriate disinfecting agent and related supplies

Personnel Required
Examiner
EMT Assistant

Minimum Passing Score
14 out of 18 possible points

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Station 5
Cardiac Arrest Management AED

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This station is designed to test the candidates ability to effectively manage an unwitnessed out-
of-hospital cardiac arrest by integrating scene management skills, CPR skills, and usage of the
AED. The candidate arrives on scene to find an apneic and pulseless adult patient who is lying
on the floor. The manikin must be placed and left on the floor for this skill. A three (3) minute
time period is provided for the candidate to check and prepare any equipment he/she feels
necessary before the actual timed evaluation begins.
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This is an unwitnessed cardiac arrest scenario and no bystander CPR has been initiated. After
performing five (5) cycles of one (1) rescuer adult CPR, the candidate is required to utilize the
AED as he/she would at the scene of an actual cardiac arrest. The scenario ends after the first
shock is administered and CPR is resumed.

After arriving on the scene, the candidate should assess the patient and determine that the patient
is unresponsive. The candidate should then assess the patient for signs of breathing. If it is
determined that the patient is apneic or has signs of abnormal breathing, such as gasping or
agonal respirations, the candidate should next assess the carotid pulse. This pulse check must
take at least five (5) but no more than ten (10) seconds. As soon as pulselessness is verified, the
candidate should immediately begin chest compressions. The candidate should request additional
EMS assistance after determining that the patient is in cardiac arrest and CPR has been initiated.
All actions performed must be in accordance with the current AHA Guidelines for CPR
and Emergency Cardiovascular Care. Any candidate who elects to perform any other
intervention or assessment causing delay in chest compressions has not properly managed the
situation. You should check the related Critical Criteria and document the delay.

Each candidate is required to perform two (2) minutes of one (1) rescuer CPR. Because high-
quality CPR has been shown to improve patient outcomes from out-of-hospital cardiac arrest,
you should watch closely as the candidate performs CPR to assure adherence to the current
recommendations:
Adequate compression depth and rate
Allows the chest to recoil completely
Correct compression-to-ventilation ratio
Adequate volumes for each breath to cause visible chest rise
No interruptions of more than 10 seconds at any point

After five (5) cycles or two (2) minutes of one (1) rescuer CPR, the candidate should assess the
patient for no more than ten (10) seconds. As soon as pulselessness is verified, the candidate
should direct a second rescuer to resume chest compressions. The candidate then retrieves the
AED, powers it on, follows all prompts and attaches it to the manikin. Even though an AED
trainer should be used in this skill, safety should still be an important consideration. The
candidate should make sure that no one is touching the patient while the AED analyzes the
rhythm. The AED should then announce, Shock advised or some other similar command. Each
candidate is required to operate the AED correctly so that it delivers one shock for verification
purposes. As soon as the shock has been delivered, the candidate should direct a rescuer to
immediately resume chest compressions. At that point, the scenario should end and the candidate
should be directed to stop. Be sure to follow all appropriate disinfection procedures before
permitting the next candidate to use the manikin and complete the skill.

Please realize the Cardiac Arrest Management/AED Skill is device-dependent to a degree.
Therefore, give each candidate time for familiarization with the equipment in the room before
any evaluation begins. You may need to point out specific operational features of the AED, but
are not permitted to discuss patient treatment protocols or algorithms with any candidate.

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Candidates are also permitted to bring their own equipment to the psychomotor examination. If
any enter your skill station carrying their own AED, be sure that the District EMS Official on site
has approved it for testing and you are familiar with its appropriate operation before evaluating
the candidate with the device. You should also be certain that the device will safely interface
with the manikin. The manikin must be placed on the floor in this skill. It is not permissible to
move the manikin to a table, bed, etc. This presentation most closely approximates the usual
EMS response to out-of-hospital cardiac arrest and will help standardize delivery of the
psychomotor examination. If any candidate insists on moving the manikin to a location other
than the floor, you should immediately request assistance from the District EMS Official.
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Station 5
Cardiac Arrest Management AED

Instructions to the Candidate

This skill is designed to evaluate your ability to manage an out-of-hospital
cardiac arrest by integrating patient assessment/management skills, CPR
skills, and usage of an AED. You arrive on scene by yourself and there are no
bystanders present. You must begin resuscitation of the patient in accordance
with current American Heart Association Guidelines for CPR. You must
physically perform 1-rescuer CPR and operate the AED, including delivery
of any shock. While operating the AED a second rescuer will perform CPR.
The patients response is not meant to give any indication whatsoever as to
your performance in this skill. Please take a few moments to familiarize
yourself with the equipment before we begin and I will be happy to explain
any of the specific operational features of the AED. If you brought your own
AED, I need to make sure it is approved for testing before we begin.

[After an appropriate time period or when the candidate informs you he/she
is familiar with the equipment, the Skill Examiner continues reading the
following:]

You will have ten (10) minutes to complete this skill once we begin. I may
ask questions for clarification and will acknowledge the treatments you
indicate are necessary. Do you have any questions?

You respond to a call and find this patient lying on the floor. There are no
bystanders present.

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NREMT Skill Sheet: Cardiac Arrest Management/AED with Bystander CPR in Progress

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Station 6
Spinal Immobilization Station
Supine Patient

Time Limit
10 minutes

Equipment Listing
Examination gloves
Long spine immobilization device (long spine board, etc)
Cervical collar
Head immobilizer (commercial or improvised)
Padding (towels, cloths, etc)
Patient securing straps
Blankets

Personnel Required
Examiner
Patient
EMT Assistant(s)

Minimum Passing Score
11 out of 14 possible points
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Station 6
Spinal Immobilization Station
Supine Patient

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This skill is designed to evaluate the candidates ability to immediately protect and immobilize
the Simulated Patients spine by using a rigid long spinal immobilization device. The candidate
will be advised that the scene survey and primary survey have been completed and no condition
requiring further resuscitation efforts or urgent transportation is present. The Simulated Patient
will present lying on his/her back, arms straight down at his/her side, and feet together.
Candidates should not have to be concerned with distracters such as limb realignment, prone or
other unusual positions. The presenting position of the Simulated Patient must be identical
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for all candidates. A three (3) minute time period is provided for the candidate to check and
prepare any equipment he/she feels necessary before the actual timed evaluation begins.

The candidate will be required to treat the specific, isolated problem of a suspected unstable
spine. Primary and secondary assessments of airway, breathing, and central circulation are not
required in this skill. The candidate will be required to check motor, sensory, and circulatory
function in each extremity at the proper times throughout this skill. If a candidate fails to check
any of these functions in any extremity, a zero must be awarded for this step in the Points
Awarded column.

There are various long spine immobilization devices utilized in the EMS community. The
evaluation form was designed to be generic so it could be used to evaluate the candidate
regardless of the immobilization device used. You should have various long spine
immobilization devices available for this skill, specifically long spine immobilization devices
used in the local EMS system, long spine board, and a scoop stretcher. The candidate may
choose to bring a device with which he/she is familiar. The Districts EMS Official must approve
this device and you must be familiar with its proper use before evaluation of the candidate
begins. Do not indicate displeasure with the candidates choice of equipment. Be sure to evaluate
the candidate on how well he/she immobilizes and protects the Simulated Patients spine, not on
what immobilization device is used.

The candidate must, with the help of an EMT Assistant and the Skill Examiner, move the
Simulated Patient from the ground onto the long spinal immobilization device. There are various
acceptable ways to move a patient from the ground onto a long spinal immobilization device (i.e.
logroll, straddle slide, etc.). You should not advocate one method over the others. All methods
should be considered acceptable as long as spinal integrity is not compromised. Regardless of the
method used, the EMT Assistant should control the head and cervical spine while the candidate
and examiner move the Simulated Patient upon direction of the candidate.

Immobilization of the lower spine/pelvis in line with the torso is required. Lateral movement of
the legs will cause angulation of the lower spine and should be avoided. Additionally, tilting the
backboard when the pelvis and upper legs are not secured will ultimately cause movement of the
legs and angulation of the spine.

This skill requires that an assistant EMT be present during the evaluation. Candidates are to be
evaluated individually with the assisting EMT providing manual stabilization and immobilization
of the head and cervical spine. The assisting EMT should be told not to speak, but to follow the
commands of the candidate. The candidate is responsible for the conduct of the assisting EMT. If
the assisting EMT is instructed to provide improper care, areas on the score sheet relating to that
care should be deducted. At no time should you allow the candidate or assisting EMT to
perform a procedure that would actually injure the Simulated Patient.

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Station 6
Spinal Immobilization Station
Supine Patient

Instructions to the Candidate

This skill is designed to evaluate your ability to provide spinal
immobilization to a supine patient using a long spine immobilization device.
At this time, please take three (3) minutes to check your equipment and
prepare whatever you feel is necessary.

[After three (3) minutes or sooner if the candidate states, I'm prepared, the
Skill Examiner continues reading the following:]

You arrive on the scene with an EMT Assistant. The Assistant EMT has
completed the scene survey as well as the primary assessment and no critical
condition requiring any intervention was found. For the purposes of this
evaluation, the Simulated Patients vital signs remain stable. You are required
to treat the specific, isolated problem of a suspected unstable spine using a
long spine immobilization device. When moving the Simulated Patient to the
device, you should use the help of the Assistant EMT and me. The Assistant
EMT should control the head and cervical spine of the Simulated Patient
while you and I move the Simulated Patient to the immobilization device.
You are responsible for the direction and subsequent actions of the EMT
Assistant and me. You may use any equipment available in this room. You
have ten (10) minutes to complete this procedure. Do you have any
questions?
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NREMT Skill Sheet: Spinal Immobilization-Supine Patient

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Random Skill Stations 7a, 7b, 7c and 7d
Trauma Skills


General Instructions to the Practical Skills Examiner

All candidates must also test one (1) of the following skills:
Spinal Immobilization (Seated Patient)
Bleeding Control/Shock Management
Long Bone Immobilization
J oint Immobilization

Note
Candidates retesting any skill(s) must retest over the specific skill(s) previously failed.
Therefore, all equipment for all four (4) random EMT skills must be available and properly
functioning before beginning any evaluation. Should any candidate dispute any skill that you
direct him/her to complete, please contact the District EMS Official immediately for
clarification. Do not let the candidate leave the room until the matter is resolved with the District
EMS Official.
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Station 7a
Spinal Immobilization Station
Seated Patient

Time Limit
10 minutes

Equipment Listing
Examination gloves
Half-spine immobilization device* (wooden or plastic)
Vest-type immobilization device*
Padding material (pads or towels)
Armless chair
Cervical collars (correct sizes)
Cravats (6)
Kling, Kerlex, etc.
Long immobilization straps (6 of any type)
Tape (2" or 3" adhesive)
Blankets (2)

Personnel Required
Examiner
Patient
EMT Assistant(s)

Minimum Passing Score
9 out of 12 possible points


* It is required that the skill include one (1) plain wooden or plastic half board with tape, straps,
blankets, and cravats as well as one (1) common vest-type device (complete). Additional styles
and brands of devices and equipment may be included as a local option.
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Station 7a
Spinal Immobilization Station
Seated Patient

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This skill is designed to evaluate a candidates ability to provide spinal immobilization to a
seated patient in whom spinal instability is suspected. Each candidate will be required to
appropriately apply any acceptable half-spine immobilization device on a seated patient and
verbalize movement of the Simulated Patient to a long backboard.

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A three (3) minute time period is provided for the candidate to check and prepare any equipment
he/she feels necessary before the actual timed evaluation begins. The candidate is evaluated on
his/her ability to protect and provide immediate immobilization of the spine. The candidate will
be advised that the scene survey and primary survey have been completed and no condition
requiring further resuscitation efforts or urgent transportation is present.

A live Simulated Patient who is an adult or adolescent who is at least sixteen (16) years of age is
required in this skill. The Simulated Patient must be of average adult height and weight. The use
of very small children as Simulated Patients is not permitted in this skill. The Simulated Patient
will present seated in an armless chair, sitting upright with his/her back loosely touching the back
of the chair. The Simulated Patient will not present slumped forward or with the head held in any
grossly abnormal position. The position of the Simulated Patient must be identical for all
candidates.

The primary survey as well as reassessment of the Simulated Patient's airway, breathing, and
central circulation are not required in this skill. The candidate will be required to check motor,
sensory, and circulatory functions in each extremity at the proper times throughout this skill.
Once the candidate has immobilized the seated patient, simply ask him/her to verbally explain all
key steps he/she would complete while moving the Simulated Patient to the long backboard. The
candidate may check motor, sensory, and circulatory functions at anytime during the procedure
without a loss of points. However, if he/she fails to check motor, sensory, or circulatory function
in all extremities after verbalizing immobilization to a long backboard, a zero should be placed in
the Points Awarded column for this step. The related Critical Criteria statement would also
need to be checked and documented as required.

You should have various half-spine immobilization devices collected in the testing room that
represent those devices utilized in the local EMS system (KED, XP-1, OSS, half spine board,
Kansas board, etc.) or other accepted devices. It is required that at least one (1) rigid wooden or
plastic half-spine board and one (1) commercial vest-type immobilization device with all other
associated immobilization equipment provided by the manufacturer be available in this room.
You are responsible to check that all equipment listed is present and in proper working order (not
too frayed or worn, all buckles and straps are present, etc.). The candidate may choose to bring a
device with which he/she is familiar and the District EMS Official on site must approve these
devices. You must also be familiar with the proper use of these devices before any evaluation of
the candidate can occur. Be sure to give the candidate time to survey and check the equipment
before any evaluation begins. You must not indicate any displeasure with the candidate's choice
of any immobilization device.

The skill evaluation instrument was designed to be generic so it could be utilized to evaluate the
candidates performance regardless of the half-spine immobilization device utilized. All
manufacturers instructions describe varying orders in which straps and buckles are to be applied
when securing the torso for various commercial half-spine immobilization devices. This skill is
not designed to specifically evaluate each individual device but to generically verify a
candidates competence in safely and adequately securing a suspected unstable cervical spine in
a seated patient. Therefore, while the specific order of placing and securing straps and buckles is
not critical, it is imperative that the patients head be secured to the half-spine immobilization
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device only after the device has been secured to the torso. This sequential order most defensibly
minimizes potential cervical spine compromise and is the most widely accepted and defended
order of application to date regardless of the device. Placement of an appropriate cervical collar
is also required with any type of half-spine immobilization device. Given the chosen device, your
careful observation of the candidates technique and a reasonable standard of judgment should
guide you when determining if the device was appropriately secured to the torso before the head
was placed in the device. You must also apply the same reasonable standard of judgment when
checking to see if the device was applied too loosely or not appropriately fastened to the
Simulated Patient.

A trained EMT Assistant will be present in the skill to assist the candidate by applying manual
in-line immobilization of the head and cervical spine only upon the candidates commands. The
assistant must be briefed to follow only the commands of the candidate, as the candidate is
responsible for the actions that he/she directs the assistant to perform. When directed, the
assistant must maintain manual in-line immobilization as a trained EMT Assistant would in the
field. No unnecessary movement of the Simulated Patients head or other games will be
tolerated or are meant to be a part of this examination. However, if the assistant is directed to
provide improper care, points on the evaluation form relating to this improper care should be
deducted and documented. For example, if the candidate directs the assistant to let go of the head
prior to its mechanical immobilization, the candidate has failed to maintain manual, neutral, in-
line immobilization. You must check the related statement under Critical Criteria and
document your rationale. On the other hand, if the assistant accidentally releases immobilization
without an order, you should direct the assistant to again take manual in-line immobilization.
Immediately inform the candidate that this action will not affect his/her evaluation. At no time
should you allow the candidate or assistant EMT to perform a procedure that would
actually injure the Simulated Patient. The candidate should also verbally describe how he/she
would move and secure the Simulated Patient to the long backboard.

The Simulated Patient should be briefed on his/her role in this skill and act as a calm patient
would if this were a real situation. You may question the Simulated Patient about spinal
movement and overall care in assisting with the evaluation process after the candidate completes
his/her performance and exits the room.
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DC-DOH EMS Form 2012-0020A Page 94 of 122 ORG: July 2012
Station 7a
Spinal Immobilization Station
Seated Patient

Instructions to the Candidate

This skill is designed to evaluate your ability to provide spinal
immobilization to a sitting patient using a half-spine immobilization device.
At this time, please take three (3) minutes to check your equipment and
prepare whatever you feel is necessary.

[After three (3) minutes or sooner if the candidate states, I'm prepared, the
Skill Examiner continues reading the following:]

You arrive on the scene of an auto crash with an EMT Assistant. The scene is
safe and there is only one (1) patient. The Assistant EMT has completed the
scene survey as well as the primary assessment and no critical condition
requiring any intervention was found. For the purposes of this evaluation, the
Simulated Patients vital signs remain stable. You are required to treat the
specific, isolated problem of a suspected unstable spine using a half-spine
immobilization device. You are responsible for the direction and subsequent
actions of the EMT Assistant. Transferring and immobilizing the Simulated
Patient to the long backboard should be described verbally. You have ten (10)
minutes to complete this skill. Do you have any questions?
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 95 of 122 ORG: July 2012
NREMT Skill Sheet: Spinal Immobilization-Seated Patient

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 96 of 122 ORG: July 2012
Random Skill Station 7b
Bleeding Control/Shock Management

Do not open this skill for testing until you have one (1) EMT Assistant and one (1) Simulated Patient
who is an adult or adolescent at least sixteen (16) years of age. The Simulated Patient must also be of
average adult height and weight. An EMT Assistant is optional

Time Limit
10 minutes

Equipment Listing
Examination gloves
Field dressings (various sizes)
Bandages (various sizes)
Tourniquet (commercial or improvised)
Oxygen cylinder with delivery system (tank may be empty)
Oxygen delivery devices (nasal cannula, simple face mask, non-rebreather mask)
Blanket
Gauze pads (2x2, 4x4, etc.)
Kling, Kerlex, etc.

Personnel Required
Examiner
Patient
EMT Assistant (optional)

Minimum Passing Score
5 out of 7 possible points


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DC-DOH EMS Form 2012-0020A Page 97 of 122 ORG: July 2012
Random Skill Station 7b
Bleeding Control/Shock Management

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This skill is designed to evaluate the candidates ability to treat a life-threatening arterial
hemorrhage from an extremity and subsequent hypoperfusion. This skill will be scenario-based
and will require some dialogue between you and the candidate. The candidate will be required to
properly treat a life-threatening arterial hemorrhage from an extremity in accordance with
recommendations by the American College of Surgeons. A three (3) minute time period is
provided for the candidate to check and prepare any equipment he/she feels necessary before the
actual timed evaluation begins.

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 98 of 122 ORG: July 2012
This skill requires the presence of a live Simulated Patient. The Simulated Patient must be an
adult or adolescent who is at least sixteen (16) years of age. The Simulated Patient must also be
of average adult height and weight. The use of very small children as Simulated Patients is
not permitted in this skill. The Simulated Patient will present with an arterial bleed from a
severe laceration of the extremity. A simple simulation aid may enhance the visual cue for the
location of the wound but is not required in this skill. You will direct the actions of the candidate
at predetermined intervals as indicated on the evaluation form. The candidate will be required to
provide the appropriate intervention at each interval as the Simulated Patients condition
changes. It is essential, due to the purpose of this skill that the Simulated Patients condition
does not deteriorate to a point where CPR would be initiated. This skill is not designed to
evaluate CPR skills.

Due to the scenario format of this skill, you are required to supply information to the candidate at
various times during the exam. When the candidate initially applies direct pressure to the wound,
you should inform the candidate that the wound continues to bleed. If the candidate applies a
pressure dressing and bandage, you should inform the candidate that the wound continues to
bleed. In accordance with recommendations by the American College of Surgeons, application of
a tourniquet proximal to the injury is the reasonable next step if hemorrhage cannot be controlled
with pressure. If the candidate delays applying a tourniquet and applies additional dressings over
the first, you should again inform him/her that the wound continues to bleed. If the candidate
attempts to elevate the extremity or apply pressure to the related arterial pressure point, you
should inform the candidate that the wound continues to bleed. There is no published evidence
that supports controlling arterial hemorrhage from an extremity with elevation or pressure to an
arterial pressure point. If the candidate delays application of the tourniquet, you should check the
related Critical Criteria statement and document his/her delay in treating the hemorrhage in a
timely manner as required on the skill evaluation form. After the candidate properly applies an
arterial tourniquet, you should inform him/her that the bleeding is controlled. Once the bleeding
is controlled in a timely manner, you should provide signs and symptoms of hypoperfusion
(restlessness; cool, clammy skin; BP 100/80, P 118, R 30).
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DC-DOH EMS Form 2012-0020A Page 99 of 122 ORG: July 2012
Random Skill Station 7b
Bleeding Control/Shock Management

Instructions to the Candidate

This skill is designed to evaluate your ability to control hemorrhage. At this
time, please take three (3) minutes to check your equipment and prepare
whatever you feel is necessary.

[After three (3) minutes or sooner if the candidate states, I'm prepared, the
Skill Examiner continues reading the following:]

This is a scenario-based evaluation. As you progress through the scenario,
you will be given various signs and symptoms appropriate for the Simulated
Patients condition. You will be required to manage the Simulated Patient
based on these signs and symptoms. You may use any of the supplies and
equipment available in this room. You have ten (10) minutes to complete this
skill. Please take a few moments and familiarize yourself with this equipment
before we begin. Do you have any questions?

[Skill Examiner now reads Scenario from the prepared scenario and
begins 10 minute time limit.]
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 100 of 122 ORG: July 2012
NREMT Skill Sheet: Bleeding Control-Shock Management

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 101 of 122 ORG: July 2012
Random Skill Station 7c
Immobilization Skills - Long Bone Injury

Do not open this skill for testing until you have one (1) Simulated Patient who is an adult or
adolescent at least sixteen (16) years of age. The Simulated Patient must also be of average adult
height and weight. One (1) EMT Assistant is also required in this skill.

Time Limit
5 minutes

Equipment Listing
Examination gloves
Rigid splint material (various sizes)
Long spine board (optional)
Roller gauze
Cravats (6)
Tape

Personnel Required
Examiner
EMT Assistant
Patient

Minimum Passing Score
8 out of 10 possible points
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DC-DOH EMS Form 2012-0020A Page 102 of 122 ORG: July 2012
Random Skill Station 7c
Immobilization Skills - Long Bone Injury

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This skill is designed to evaluate a candidates ability to immobilize a suspected long bone
fracture properly using a rigid splint. The candidate will be advised that a primary survey has
been completed on the victim and that a suspected long bone fracture was discovered during the
secondary survey. The Simulated Patient will present with a non-angulated, closed, suspected
long bone fracture of the upper or lower extremity, specifically a suspected fracture of the radius,
ulna, tibia, or fibula. You should alternate injury sites throughout todays examination.

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 103 of 122 ORG: July 2012
A three (3) minute time period is provided for the candidate to check and prepare any equipment
he/she feels necessary before the actual timed evaluation begins. The candidate will then be
required to treat the specific, isolated injury. The primary survey as well as reassessment of the
patients airway, breathing, and central circulation are not required in this skill. The candidate
will be required to check motor, sensory, and circulatory functions in the injured extremity prior
to splint application and after completing the splinting process. Additionally, the use of traction
splints, pneumatic splints, and vacuum splints is not permitted and should not be available
for use.

The candidate is required to Secure the entire injured extremity after the splint has been
applied. There are various methods of accomplishing this particular task. Long bone fractures of
the upper extremity may be secured by tying the extremity to the torso after a splint has been
applied. Long bone fractures of the lower extremity may be secured by placing the victim
properly on a long backboard or applying a rigid long board splint between the victims legs and
then securing the legs together. Any of these methods should be considered acceptable and
points should be awarded accordingly.

When splinting the upper extremity, the candidate is required to immobilize the hand in the
position of function. A position that is to be avoided is one in which the hand is secured with the
palm flattened and fingers extended. The palm should not be flattened. Additionally, the wrist
should be dorsiflexed about 20 30 and all the fingers should be slightly flexed.

When splinting the lower extremity, the candidate is required to immobilize the foot in a position
of function. Two positions that are to be avoided are gross plantar flexion or extreme
dorsiflexion. No points should be awarded if these positions are used.
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 104 of 122 ORG: July 2012
Random Skill Station 7c
Immobilization Skills - Long Bone Injury

Instructions to the Candidate

This skill is designed to evaluate your ability to properly immobilize a closed,
non-angulated suspected long bone fracture. You are required to treat only
the specific, isolated injury. At this time, please take three (3) minutes to
check your equipment and prepare whatever you feel is necessary.

[After three (3) minutes or sooner if the candidate states, I'm prepared, the
Skill Examiner continues reading the following:]

The scene survey and primary survey have been completed and a suspected,
closed, non-angulated fracture of the ___________________ (radius, ulna,
tibia, or fibula) is discovered during the secondary survey. Continued
assessment of the patients airway, breathing, and central circulation is not
necessary in this skill. You may use any equipment available in this room.
You have five (5) minutes to complete this skill. Do you have any questions?
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 105 of 122 ORG: July 2012
NREMT Skill Sheet: Immobilization Skills-Long Bone Injury

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 106 of 122 ORG: July 2012
Random Skill Station 7d
Immobilization Skills - Joint Injury

Do not open this skill for testing until you have one (1) Simulated Patient who is an adult or
adolescent at least sixteen (16) years of age. The Simulated Patient must also be of average adult
height and weight. One (1) EMT Assistant is also required in this skill.

Time Limit
5 minutes

Equipment Listing
Examination gloves
Cravats (6) to be used as a sling and swathe

Personnel Required
Examiner
EMT Assistant
Patient

Minimum Passing Score
7 out of 9 possible points
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 107 of 122 ORG: July 2012
Random Skill Station 7d
Immobilization Skills - Joint Injury

Instructions to the Practical Skills Examiner

Thank you for serving as a Skill Examiner at todays examination. Before you read the specific
essay for the skill station you will be evaluating today, please take a few moments to review your
general responsibilities as a Skill Examiner:
Conducting examination-related activities on an equal basis for all candidates, paying
particular attention to eliminate actual or perceived discrimination based upon race, color,
national origin, religion, gender, age, disability, position within the local EMS system, or
any other potentially discriminatory factor. The Skill Examiner must help ensure that the
EMT Assistant and/or Simulated Patient conducts himself/herself in a similar manner
throughout the examination.
Objectively observing and recording each candidates performance
Acting in a professional, unbiased, non-discriminating manner, being cautious to avoid
any perceived harassment of any candidate
Providing consistent and specific instructions to each candidate by reading the
Instructions to the Candidate exactly as printed in the material provided by the
Districts EMS Division. Skill Examiners must limit conversation with candidates to
communication of instructions and answering of questions. All Skill Examiners must
avoid social conversation with candidates or making comments on a candidates
performance.
Recording, totaling, and documenting all performances as required on all skill evaluation
forms
Thoroughly reading the specific essay for the assigned skill before actual evaluation
begins
Checking all equipment, props, and moulage (if applicable) prior to and during the
examination
Briefing any Simulated Patient and EMT Assistant for the assigned skill
Assuring professional conduct of all personnel involved with the particular skill
throughout the examination
Maintaining the security of all issued examination material during the examination and
ensuring the return of all material to the Districts EMS Official

This skill station is designed to evaluate a candidates ability to immobilize a suspected shoulder
injury using a sling and swathe. The candidate will be advised that a primary survey has been
completed on the victim and that a suspected shoulder injury is discovered during the secondary
survey. The Simulated Patient will present with the upper arm positioned at his/her side while
supporting the lower arm at a 90 angle across his/her chest with the uninjured hand. For the
purposes of this skill, the injured arm should not be positioned away from the body, behind the
body, or in any complicated position that could not be immobilized by using a sling and swathe.

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 108 of 122 ORG: July 2012
A three (3) minute time period is provided for the candidate to check and prepare any equipment
he/she feels necessary before the actual timed evaluation begins. The candidate will then be
required to treat the specific, isolated injury. The primary survey as well as reassessment of the
patients airway, breathing, and central circulation are not required in this skill. The candidate
will be required to check motor, sensory, and circulatory functions in the injured extremity prior
to splint application and after completing the splinting process.

Additionally, the only splint available in this skill is a sling and swathe. Any other splint,
including a long backboard, may not be used to complete this skill. If a candidate asks for a long
backboard, simply inform the candidate that the only acceptable splinting material approved for
completion of this skill is a sling and swathe.
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 109 of 122 ORG: July 2012
Random Skill Station 7d
Immobilization Skills - Joint Injury

Instructions to the Candidate

This skill is designed to evaluate your ability to properly immobilize an
uncomplicated shoulder injury. You are required to treat only the specific,
isolated injury to the shoulder. At this time, please take three (3) minutes to
check your equipment and prepare whatever you feel is necessary.

[After three (3) minutes or sooner if the candidate states, I'm prepared, the
Skill Examiner continues reading the following:]

The scene survey and primary survey have been completed and a suspected
injury to the __________________ (left, right) shoulder is discovered during
the secondary survey. Continued assessment of the patients airway,
breathing, and central circulation is not necessary. You may use any
equipment available in this room. You have five (5) minutes to complete this
skill. Do you have any question?
EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 110 of 122 ORG: July 2012
NREMT Skill Sheet: Immobilization Skills-Joint Injury

EMS Educational Institution EMT Practical Examination Handbook


DC-DOH EMS Form 2012-0020A Page 111 of 122 ORG: July 2012









Individual Examination Station Signs


Skill Station 1

Patient Assessment
Management:
Trauma



Skill Station 2

Patient Assessment
Management:
Medical



Skill Station 3

Bag-Valve-Mask
Ventilation of an
Apneic Patient



Skill Station 4

Oxygen
Administration by
Non-rebreather Mask



Skill Station 5

Cardiac Arrest
Management and
AED



Skill Station 6

Spinal Immobilization
of the
Supine Patient



Skill Station 7a

Spinal Immobilization
of the
Seated Patient



Skill Station 7b

Bleeding Control
and
Shock Management



Skill Station 7c

Long Bone
Immobilization





Skill Station 7d

J oint
Injury





Candidate
Staging
Area