KCEMT

KENYA COUNCIL OF EMERGENCY MEDICAL TECHNICIANS

P.O Box 24780-00100 Nairobi Tel 0202359359, 0720486728, 0722861099,
Email secretary@kcemt.co.ke
http://www.kcemt.co.ke
Kabarnet Road – Jamuhuri Cresent – kubana Court – Suite No. 8

EMT 1 CURRICULUM
 EMT 1 CURRICULUM

Prepared by:

The KCEMT

References

Curriculum

1. Haynes, Bruce, Pritting, John, (1996). EMT 1Trial Study. Imperial

County Emergency Medical Services Agency

2. U. S. Department of Transportation, (1999). EMT-Intermediate: National

Standard Curriculum

Skills Sheets:

1. AHA, (2011). Basic Life Support Skills . (KCEMT is an approved AHA centre)
 Table of Contents

Introduction…………………………………………………………………………………..….. 1

Course Overview………………………………………………………..…………………….... 2

Module 1 Preparatory
Foundations of the EMT 1……………………………….…………............ 3
Overview of Human Systems……...................................................................…..15
Emergency Pharmacology……………………………………………………………..20
Venous Access and Medication Administration……………………………………..26
Venous Access and Medication Administration Lab………………………………..33
Intramuscular Injection Skill – Instructor Resource………………………………....37
Intramuscular Injection Skill Sheet…………………………………………………....40
Intravenous Bolus Medications Skill – Instructor Resource……………………......42
Intravenous Bolus Medications Skill Sheet………………………………………......45
Intravenous Therapy Skill – Instructor Resource…………………………….……...47
Intravenous Therapy Skill Sheet………………………………………………...........51
Metered Dose Inhaler Skill – Instructor Resource………………………………......54
Metered Dose Inhaler Skill Sheet…………………………………………………......58
Nebulized Medication Administration Skill – Instructor Resource………………....62
Nebulized Medication Administration Skill Sheet…………………………………....66
Nitrogylcerine Administration Skill – Instructor Resource………………………......69
Nitrogylcerine Administration Skill Sheet…………………………………………......74
Oral Medication Administration Skill – Instructor Resource………………………...78
Oral Medication Administration Skill Sheet…………………………………………...81
Saline Lock Insertion Skill – Instructor Resource…………………………………....83
Saline Lock Insertion Skill Sheet……………………………………………………....87
Subcutaneous Injection Skill – Instructor Resource………………………………....90
Subcutaneous Injection Skill Sheet……………………………………………..….....93
Withdrawal of Medication from Ampule or Vial Skill – Instructor Resource……....95
Withdrawal of Medication from Ampule or Vial Skill Sheet………………………....98

Module 2 Airway Management

Airway Management and Ventilation…………………………………………...….…...3
Airway Lab………………………………………………………………………..……....10
Esophageal-Tracheal Airway Skill - Instructor Resource……………………….......15
Esophageal-Tracheal Airway Skill Sheet…………………………………………......19

Module 3 Patient Assessment

History Taking and Patient Assessment…………………………………………..…....2
Communications…………………………………………………………………….…...25
Documentation…………………………………………………………………………...33
History Taking and Patient Assessment Lab……………………………………........39
Communication Lab………………………………………………………………...…...44
Documentation Lab………………………………………………………………...…....46

1
Module 3 Patient Assessment (continued)
Patient Assessment and Management Skill – Instructor Resource.…..……….....48
Patient Assessment and Management Skill Sheet………………………………....61

Module 4 Trauma
Trauma……………………………………………………………………………….…....2
Hemorrhage and Shock………………………………………………………………....6
Trauma Assessment Lab………………………………………………………..……..10

Module 5 Medical
Respiratory Emergencies…………………………………………………………..…...3
Cardiovascular Emergencies……………………………………………………….....16
Diabetic Emergencies……………………………………………………………….....28
Allergic Reactions……………………………………………………………………....33
Poisoning / Overdose Emergencies……………………………………………….....37
Environmental Emergencies…………………………………………………………...40
Medical Assessment Lab……………………………………………………………....50
Automated External Defibrillator Skill – Instructor Resource……………………....54
Automated External Defibrillator Skill Sheet……...………………………………....57
Blood Glucose Test (Chemstrip) Skill – Instructor Resource……………………....60
Blood Glucose Test (Chemstrip) Skill Sheet……………………………………..…..62
Blood Sample From Finger Stick Skill – Instructor Resource………………….…..64
Blood Sample From Finger Stick Skill Sheet………………………………….……..66
Venous Blood Draw From Angiocath Skill – Instructor Resource………………....68
Venous Blood Draw From Angiocath Skill…………………………………………...71

Clinical Training
Clinical Objectives……………………………………………………………………......1
Clinical Performance Standards……………………………………………………......4
Daily Clinical Evaluation Form……………………………………………………….....8
Major Clinical Evaluation Form………………………………………………………....9

Field Internship
Field Internship Performance Standards……………………………………………...1
Daily Field Internship Evaluation Form
Major Field Internship Evaluation Form
Clinical / Field Skills Check Off Form

2
1
Course Overview
 EMT 1Course Curriculum Overview

This curriculum for the EMT 1Course was developed by The Kenya Council Of Emergency
Medical Technicians

Prerequisites
EMT-I (or EMT-Basic) certification is the only prerequisite for the EMT 1curriculum.

Program Planning/Communities of Interest

The EMT 1education program was planned, executed and evaluated in a continuous
quality improvement model. As part of the planning process, the program regularly
assessed the communities of interest, and established objectives to best serve them.
This was originally accomplished by establishing an advisory board consisting of
representatives from various communities of interest within Kenya and questioning them
as to their expectations of entry level EMT 1. The program used this information for
program planning and to clarify how to achieve program goals and objectives. The
EMT-II Task Force, a multidisciplinary group of KCEMT EMS constituents, expanded
the educational program, that was initially developed by abstracting relevant topics of
instruction from the U. S. Department of Transportation’s EMT-Intermediate National
Standard Curriculum.

Program Goal
The goal of the EMT 1Education program is to produce competent, entry level EMT 1 to
serve in career and volunteer positions.

Program Objectives
Program Cognitive Objective:

At the completion of the program, the student will demonstrate the ability to
comprehend, apply, and evaluate the clinical information relative to his/her role
as an entry level EMT 1in Kenya.

Program Psychomotor Objective:

At the completion of the program, the student will demonstrate technical proficiency in
all skills necessary to fulfill the role of entry level EMT 1.

Program Affective Objective:

At the completion of the program, the student will demonstrate personal

behaviors consistent with professional and employer expectations for the entry
level EMT 1.

KCEMT
EMT 1Model Curriculum
Course Overview 1
Course Design
The EMT 1program consists of four components of instruction: didactic instruction, skills
laboratory, clinical education, and field internship. The first two occur concurrently
followed by the clinical education and then the field internship, which serves as a
verification that the student is serving as a competent, entry-level practitioner.

Didactic Instruction
The didactic instruction represents the delivery of primarily cognitive material. Although
this is often delivered as lecture material, instructors are strongly encouraged to utilize
alternate delivery methods (video, discussion, demonstration, simulation, etc.) as an
adjunct to traditional classroom instruction. The continued development and increased
sophistication of computer-aided instruction offers many options for the creative
instructor. It is not the responsibility of the instructor to cover all of the material in a
purely didactic format, but it is the responsibility of the program director to assure that all
students are competent over the material identified by the declarative section.

Skills Laboratory
The skills laboratory is the section of the curriculum that provides the student with the
opportunity to develop the psychomotor skills of the EMT 1. The skills laboratory has
been integrated into the curriculum in such a way as to present skills in a sequential,
building fashion. Initially, the skills are typically taught in isolation, and then integrated
into simulated patient care situations. Toward the latter part of the program, the skills
lab should is used to present instructional scenarios to emphasize the application and
integration of didactic and skills into patient management.

Clinical Education
Clinical education represents the most important component of EMT 1education since this
is where the student learns to synthesize cognitive and psychomotor skills. Clinical
education reinforces the didactic and skills laboratory components of the program. Clinical
instruction follows sound educational principles, is logically sequenced to
proceed from simple to complex tasks, has specific objectives, and is closely supervised
and evaluated.

Hospital Clinical - Because of the unpredictable nature of emergency medicine,

the hospital environment offers two advantages in EMT 1education: volume and
specificity. In the hospital setting, the EMT 1student can see many more patients than
is possible in the field. This is a very important component in building up a library of
patient care experiences to draw upon in clinical decision-making.

Clinical affiliations must be established and confirmed in written affiliation agreements

with institutions that provide clinical experience under appropriate medical direction and
clinical supervision. During the clinical phase of training, students work in hospital
emergency departments where they have access to patients who present with common

KCEMT
EMT 1Model Curriculum
Course Overview 2
problems distributed by age and sex. Supervision is provided by instructors or
preceptors approved by the program. The clinical site is periodically evaluated with
respect to its continued appropriateness and efficacy in meeting the expectations of the
programs. Clinical affiliates shall be accredited by the Joint Commission on
Accreditation of Healthcare Organizations.

Field Internship
The final ability to integrate all of the didactic, psychomotor skills, and clinical instruction
into the ability to serve as an entry level EMT 1is conducted during the field internship
phase of the program. The field internship occurs toward the end of the program, after the
completion of all other instruction to assure that the student is able to serve as an entry
level EMT 1. During the field internship the student will be under the close supervision of
an field preceptor. Field personnel are under direct medical control of
on-line physicians or utilize standing orders. Timely medical audits and close medical
supervision provide for quality improvement. Affiliations have also been established
and confirmed in written agreements with agencies that provide field experience.

Student Assessment
The educational program includes several methods for assessing student achievement.
Quizzes of the cognitive and psychomotor domains are provided for regularly and
frequently enough to provide the students and the faculty with valid and timely indicators
of the student’s progress toward and the achievement of the competencies and
objectives stated in the curriculum. The program director is responsible for the design,
development, administration and grading of all written and practical examinations. This
task is often delegated to others.

The primary purpose of this course is to meet the entry-level job expectations. Each
student, therefore, must demonstrate attainment of knowledge, attitude, and skills in
each area taught in the course. It is the responsibility of the educational institution,
program director, medical director, and faculty to assure that students obtain proficiency
in all content areas. If after counseling and remediation a student fails to demonstrate
the ability to learn specific knowledge, attitudes and skills, the student will be dismissed
from the program. The level of knowledge, attitudes and skills attained by a student in
the program will be reflected in his performance on the job as an EMT 1. This is
ultimately a reflection on the program director, primary instructor, medical director
and educational institution.

Requirements for successful completion of the course are as follows:

Cognitive - Students must demonstrate competency of all content areas. This is

done using quizzes, regular topical exams, and a comprehensive final exam.
Special remedial sessions are utilized to assist in the completion of a unit
instruction when necessary.

KCEMT
EMT 1Model Curriculum
Course Overview 3
Affective - Students must demonstrate professionalism, conscientiousness and
interest in learning. Affective evaluation instruments will be incorporated into all
four components of the program: didactic, practical laboratory, clinical and field
internship. Students who fail to meet the affective evaluations will be counseled
while the course is in progress in order to provide them the opportunity to
develop and exhibit the proper attitude expected of an EMT 1.

Psychomotor - Students must demonstrate proficiency in all skills. A complete

list of skill competencies to be completed within the program will be available to
each student. Students will know pass/fail score of any instrument utilized in the
program. Scenarios will be medically accurate and flow as they would in a
typical EMS call. In clinical and field internship all instructional staff will be
familiar with psychomotor instruments and expectations. Course ending skills
examinations will be administered as part of the comprehensive final exam.
Special remedial sessions will be utilized to assist in the completion of a unit of
instruction. Pass/fail scores will be in accordance with accepted practices.

Program Personnel

Program Director
The Program Director is the individual responsible for course planning, organization,
administration, periodic review, program evaluation, continued development, and
effectiveness.

The program director will have appropriate training and experience to fulfill the role.
They shall have at least equivalent academic training and preparation and hold all
credentials for which the students are being prepared, or hold comparable credentials
which demonstrate at least equivalent training and experience.

The program director shall have training and education in education and evaluation and
be knowledgeable in administration of education and related legislative issues for EMT
1education. The program director shall assume ultimate responsibility for the
administration of the didactic, clinical, and field internship phases of the program. It is
the program director’s responsibility to monitor all phases of the program and assure
that they are appropriate and successful. The minimum requirements for the program
director are contained in the KCEMT Code of Regulations

Program Medical Director

The Medical Director of the EMT 1program shall be a physician with emergency
medical experience who will act as the ultimate medical authority regarding course
content, procedures, and protocols.

KCEMT
EMT 1Model Curriculum
Course Overview 4
During the program the Medical Director will be responsible for reviewing the quality of
care rendered by the EMT 1student in the clinical and field setting. The Course
Medical Director shall review all course content material and examinations.
The medical director should periodically observe lectures and practical laboratories, field
and clinical internships. The medical director should participate in clinical instruction,
student counseling, psychomotor and oral testing, and summative evaluation.

Most importantly, the Course Medical Director is responsible to verify student

competence in the cognitive, affective and psychomotor domains. Students shall not be
awarded course completion certificates unless the medical director and program
director can assure through documentation of completion of terminal competencies that
each student has completed the full complement of education. Documentation of
completion of course competencies shall be affixed to the student file with signatures of
the medical director and program director at the completion of the course.

Program Faculty
Course instructors shall be approved by the course director in coordination with the
program medical director as qualified to teach those sections of the course to which
s/he is assigned as specified in the KCEMT Code of Regulations,

Program Evaluation
On-going evaluation will be conducted to identify instructional or organizational
deficiencies which affect student performance. The evaluation process shall include
both objective and subjective methods. Main methods of objective evaluation are:
1) Graduates’ performance on standardized examinations, and
2) Graduates’ performance in practice in accordance with established standards of care.

Subjective evaluation shall be conducted at regular intervals by providing students with

written questions on their opinions of the program's strengths and weaknesses. The
purpose of this evaluation process is to strengthen future educational efforts.

Facilities
The physical environment for the provision of the EMT 1program is a critical
component for the success of the overall program. The facility shall provide sufficient
space for seating all students. Abundant space shall be made available for
demonstration during the presentation of the course material.

Equipment and Supplies

Sufficient supplies and equipment to be used in the provision of instruction shall be
available and consistent with the needs of the curriculum and adequate for the students

KCEMT
EMT 1Model Curriculum
Course Overview 5
enrolled. The equipment will be in proper working order and sufficient to demonstrate
skills of patients in various age groups.

RECOMMENDED COURSE HOURS

The following time frames are meant only as a guide to help in program planning.
Training institutes must adjust these times based on their individual needs, goals and
objectives. These times are only recommendations, and should NOT be interpreted as
minimums or maximums. Those agencies responsible for program oversight are
cautioned against using these hours as a measure of program quality or having satisfied
minimum standards. Competence of the graduate, not adherence to arbitrary time
frames, is the only measure of program quality.

Based on the results of the Kenya EMT 1Trial Study, it is suggested that the course be
planned for approximately 88 total hours of instruction (48 hours of classroom/practical
laboratory, 16 hours clinical, and a minimum of 24 hours field internship. Additional
clinical and field hours may be required to achieve competency.)

Section 1. Preparatory
1 EMS Systems EMS Systems 4
Research
Public Health
2 Workforce Safety and Wellness 4
3 Medical, Legal, and Ethical Issues
Medical/Legal and Ethics 4
4 Communication and Documentation
Documentation 4
EMS System Communication 2
Therapeutic Communication 2
5 The Human Body
Anatomy and Physiology 20
Pathophysiology 8
6 Life Span Development 4
Section 2. Pharmacology
7 Principles of Pharmacology 8
Medication Administration 20
Emergency Medications 8
Section 3: Patient Assessment
8 Patient Assessment Scene Size-Up 8
Primary Assessment 8
History-Taking 4
Secondary Assessment 8
Monitoring Devices 16
Reassessment 4
Section 4. Airway
9 Airway Management 12
Advanced Airway Management 12
 Respiration 8
Artifi cial Ventilation 4
Section 5. Shock and Resuscitation
10 Shock and Resuscitation 8
11 BLS Resuscitation Shock and Resuscitation 18
Section 6. Medical
12 Medical Overview 8
Infectious Diseases 8
13 Respiratory Emergencies 4
14 Cardiovascular Emergencies 4
15 Neurologic Emergencies 4
16 Gastrointestinal and Urologic Emergencies 5
Abdominal and Gastrointestinal Disorders 4
Genitourinary/Renal 4
17 Endocrine and Hematologic Emergencies Endocrine Disorders 4
Hematology 4
18 Immunologic Emergencies 4
Immunology
19 Toxicology 4
20 Psychiatric Emergencies 4
21 Gynecologic Emergencies 4
Section 7. Trauma
22 Trauma Overview 4
Multi-System Trauma
23 Bleeding 8
24 Soft-Tissue Injuries 8
Soft Tissue Trauma
25 Face and Neck Injuries 6
Head, Facial, Neck, and Spine Trauma
26 Head and Spine Injuries 6
Head, Facial, Neck, and Spine Trauma
Nervous System Trauma
27 Chest Injuries Chest Trauma 8
28 Abdominal and Genitourinary 6
Injuries Abdominal and Genitourinary Trauma
29 Orthopaedic Injuries 8
Non-Traumatic Musculoskeletal Disorders
Orthopedic Trauma
30 Environmental Emergencies 4
Section 8. Special Patient Populations
31 Obstetrics and Neonatal Care 16
Obstetrics
Neonatal Care
Special Considerations in Trauma
32 Pediatric Emergencies 15
 Pediatrics
Special Considerations in Trauma
33 Geriatric Emergencies 15
Geriatrics
Special Considerations in Trauma
34 Patients With Special Challenges
Special Considerations in Trauma 6
Section 9. EMS Operations
35 Lifting and Moving Patients 6
Workforce Safety and Wellness
36 Transport Operations
Principles of Safely Operating a Ground Ambulance 4
Air Medical 2
37 Vehicle Extrication and Special Rescue 16
Vehicle Extrication
38 Incident Management
Multiple-Casualty Incidents 44
Hazardous Materials Awareness 4
39 Terrorism and Disaster Management Mass-Casualty Incidents due to 8
Terrorism and Disaster
Section 10: ALS Techniques
40 ALS Assist 8

Additional Modules
EMS safety Procedures 16
Introduction to EMS Leadership & Management 20
Emergency Medical Dispatcher & Customer service 20
Emergency Vehicle Operators Course 20
Infection Control In EMS 12
553

KCEMT
EMT 1Model Curriculum
Course Overview 6
KCEMT
EMT 1Model Curriculum
Course Overview 7
Module 1
 MODULE
1:
PREPARATOR
Y

MODULE 1:
PREPARATORY

MODULE TERMINAL OBJECTIVES:

At the completion of this module the EMT 1student as an active participant will be able to
successfully:

1. Understand his or her roles and responsibilities within an EMS system, and how
these roles and responsibilities differ from other levels of providers.

2. Understand the role of medical direction in the prehospital environment.

3. Understand and value the importance of personal wellness in EMS and serve as a
healthy role model for peers.

4. Understand the legal issues that impact decisions made in the prehospital
environment.

5. Value the role that ethics plays in decision making in the prehospital environment.

6. Understand basic anatomy and physiology and how it relates to the foundations of
medicine.

7. Understand the basic principles of pharmacology and be able to develop a drug

profile for common emergency medications.
8. Safely and precisely access the venous circulation and administer medications.
MODULE 1: PREPARATORY

Topic: FOUNDATIONS OF THE EMT 1Purpose:

This topic will give the EMT 1student an introduction of advanced life support and
how the EMT 1functions in the prehospital environment.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Identify his/her roles and responsibilities as an advanced level practitioner.

2. Describe the role of the EMT 1in the local EMS System.

3. Discuss the role of the EMS Medical Director.

4. Define on-line medical control, standing orders, and scope of practice.

5. Describe the components of continuous quality improvement.

6. Discuss the importance of continuous quality improvement in EMS to evaluate the

effectiveness and compliance with these protocols.

7. State the importance of using protocols in algorithm form for patient care.

8. Identify the EMT 1protocols included in this program.

9. Explain the components of wellness for the EMS provider.

10. Discuss the importance of universal precautions and body substance isolation
practices.

11. Describe the steps to take for personal protection from airborne and blood borne
pathogens.

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 3
Foundations of the EMT 1
continued

12. Understand the legal issues that impact decisions made in the prehospital setting.

a. Review the four elements that must be present in order to prove negligence.

b. Discuss the different types of patient consent and the steps to take for refusal of
care or transport.

c. Review the conditions under which the use of force, including restraint is
acceptable.

d. Advocate and practice the use of personal safety precautions in all scene
situations.

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 4
DECLARATIVE
MODULE 1: PREPARATORY
FOUNDATIONS OF THE EMT 1

I. Introduction to foundations of EMT 1: A. EMS

systems/ roles and responsibilities
B. Medical direction
C. Well-Being
D. Medical/ legal issues

II. EMS systems/ roles and responsibilities of the EMT 1A.

Introduction
1. Role of the EMT 1
2. Review of local EMS system

B. Overview of EMT 1Program

1. Competencies
2. Includes cognitive, psychomotor, affective objectives
3. Didactic/Clinical/Field requirements
4. Course length

C. Roles and responsibilities of the EMT 1

1. Primary responsibilities
a. Preparation
(1) Physical, mental, emotional
(2) Appropriate equipment and supplies
(3) Adequate knowledge and skill maintenance
b. Response
(1) Safety
(2) Timeliness
c. Scene assessment
(1) Safety
(2) Mechanism
d. Patient assessment
(1) Recognition of injury or illness
(2) Prioritization
e. Management
(1) Following protocols
(2) Interacting with medical direction physician, as needed
f. Appropriate disposition

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 5
Foundations of the EMT 1
continued
(1) Treat and transport
(a) Ground
(b) Air
(2) Selection of the proper receiving facility
(a) Requires knowledge of the receiving facilities
(b) Hospital designation / categorization
(c) Based on hospital resource capabilities with regard to optimal
patient care
g. Documentation
(1) Thorough, accurate patient care reports
(2) Completed in timely manner
h. Returning to service
(1) Preparation of equipment and supplies
(2) Preparing crew

D. Role of the EMS Medical Director:

1. Education and training of personnel
2. Participation in personnel selection process
3. Participation in equipment selection
4. Development of clinical protocols
5. Participation in quality improvement and problem resolution
6. Provides direct input into patient care
7. Interfaces between EMS systems and other health care agencies
8. Advocacy within the medical community
9. Types of medical direction ~
a. On-line/ direct
b. Off-line/ indirect

E. Medical Control
1. On-line
a. Concurrent
(1) Direct patient care
(2) Base hospital communication
2. Off-line
a. Prospective
(1) Development of protocols/ standing orders, training
(2) Selection of equipment, supplies and personnel
b. Retrospective
(1) Patient care report review

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 6
Foundations of the EMT 1
Continued

(2) Continuous quality improvement

III. Improving system quality

A. Develop a system for continually evaluating and improving care
B. Continuous quality improvement (CQI)
1. Focus on the system and not an individual
2. Fix system problems in areas such as
a. Medical direction
b. Financing
c. Training
d. Communication
e. Out-of-hospital treatment and transport
f. Inter-facility transport
g. Receiving facilities
h. Specialty care units
i. Dispatch
j. Public information and education
k. Audit and quality assurance
I. Disaster planning
m. Mutual aid

C. Dynamic process
1. Delineate system-wide problems identified
2. Elaborate on the cause(s) of the problem
3. Aid the problem and develop remedy(ies)
4. Layout plan to correct the problem
5. Enforce the plan of correction
6. Re-examine the problem

D. Appropriate EMS research can help enhance quality improvement efforts

IV. The well-being of the EMT 1

A. Review preventing disease transmission
1. Occupational Safety and Health Administration (OSHA) and Centers for Disease
Control and Prevention (CDC) Guidelines for blood borne pathogens
2. Terminology
a. Air/ blood borne pathogens
b. Exposure

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 7
 Foundations of the EMT 1
continued

(1) Contact with a potentially infectious body fluid substance

(2) Contact with other infectious agent
c. Cleaning, disinfection, sterilization
d. Body substance isolation, universal precautions
(1) Practices designed to prevent contact with body substances
(2) Practices designed to reduce contact with other agents
3. Common sources of exposure
a. Needle stick
b. Broken or scraped skin
c. Mucous membranes of the eyes, nose, or mouth
4. Protection from air/ blood borne pathogens
a. Follow engineering and work practices (1)
Puncture resistant containers
(2) Laundry
(3) Labeling
b. Body substance isolation/ universal precautions
(1) Gloves
(2) Mask, gown, eyewear
(3) Other equipment
c. Proper disposal of contaminated supplies
d. Cleaning and disinfecting of used materials/ equipment
5. Documenting and managing an exposure
a. Wash the area of contact thoroughly and immediately
b. Document the situation in which the exposure occurred
c. Describe actions taken to reduce chances of infection
d. Comply with all required reporting responsibilities and time frames
e. Complete medical follow-up

V. Medical/ legal issues

A. Review
1. Legal duties to the patient, medical director, and public
a. Set by statutes and regulations
b. Based on generally accepted standards
2. Failing to perform the job appropriately can result in civil or criminal liability
3. The best legal protection is provision of appropriate assessment and care
coupled with accurate and complete documentation
B. How laws affect the EMT 1
1. Scope of practice

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 8
Foundations of the EMT 1
continued

a. Range of duties and skills an EMT 1is allowed and expected to perform
when necessary
b. Usually set by state law or regulation and by local medical direction
2. Medical direction
a. Required for EMT 1practice
b. May be off-line or on-line, depending on state and local requirements
c. Each system should have a policy to guide EMT 1 in dealing with an on-scene
physician
3. Certification
a. Grants recognition to an individual who has met predetermined qualifications
to participate in an activity
b. Usually granted by a certifying agency or professional association, not
necessarily a government agency
C. Legal Issues
1. Accountability of the EMT 1
a. Responsible to act in a reasonable and prudent manner
b. Responsible to provide a level of care and transportation consistent with
education/ training
c. Negligence can result in legal accountability and liability
(1). Components of negligence
(a) Duty to act
(b) May be a formal contractual or an informal duty
(c) Duty may be undertaken voluntarily by beginning to care for a patient
(d) Duties include
i) Duty to respond and render care
ii) Duty to obey laws and regulations
iii) Duty to operate emergency vehicle reasonably and prudently
iv) Duty to provide care and transportation to the expected standard
v) Duty to provide care and transportation consistent with the scope of
practice and local medical protocols
vi) Duty to continue care and transportation through to its appropriate
conclusion
(2) Breach of duty
(a) Standard of care
i) Exercising the degree of care, skill, and judgement which would be
expected under like or similar circumstances by a similarly trained,
reasonable EMT- Intermediate in the location involved

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 9
Foundations of the EMT 1
continued
ii) Standard of care is established by court testimony and reference to
published codes, standards, criteria, and guidelines applicable to
the situation
(b) Breach of duty may occur by
i) Malfeasance -performing a wrongful or unlawful act
ii) Misfeasance -performing a legal act in a manner which is harmful
or injurious
iii) Non-feasance -failure to perform a required act or duty
(c) In some cases, negligence may be so obvious that it does not require
extensive proof
i) Res ipsa loquitur -the injury could only have been caused by
negligence
ii) Negligence per se -negligence is shown by the fact that a statute
was violated and injury resulted
(3) Damage to patient or other individual (i.e., the plaintiff)
(a) Proof that the plaintiff suffered compensable physical or psychological
damages, such as
i) Medical expenses
ii) Lost earnings
iii) Conscious pain and suffering
iv) Wrongful death
(b) Punitive (punishing) damages could be awarded
i) Awarded to punish gross negligence or willful and wanton
misconduct
ii) Punitive damages are usually not covered by malpractice insurance
(4) Proximate cause
(a) The action or inaction of the EMT 1was the cause of or
worsened the damage
(b) The fact that the EMT 1’s act or inaction would result in the damage
must have been reasonably foreseeable by the EMT 1
(c) Usually established by expert testimony
(5) Good Samaritan laws
(a) Do not generally protect providers from acts of gross negligence,
reckless disregard, or willful or wanton conduct
(b) Do not generally prohibit the filing of a lawsuit
(c) May provide coverage for paid or volunteer providers
(d) Varies from state to state
(6) Governmental immunity

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 10
Foundations of the EMT 1
continued

(a) Trend is toward limiting protection

(b) May only protect governmental agency, not provider
(c) Varies from state to state
(7) Statute of limitations
(a) Limit the number of years after an incident during which a lawsuit
can be filed
(b) Set by law and may differ for cases involving adults and children
(c) Varies from state to state

2. Consent
a. Conscious, competent patients have the right to decide what medical care and
transportation to accept
(1) Patient must be of legal age and able to make a reasoned decision
(2) Patient must be properly informed
(a) Nature of the illness or injury
(b) Treatment recommended
(c) Risks and dangers of treatment
(d) Alternative treatment possible and the risks
(e) Dangers of refusing treatment (including transport)
(f) May include death and permanent disability
(3) Conscious, competent patient can revoke consent at any time during care
and transport
b. Types of consent
(1) Expressed consent
(a) Patient directly agrees to treatment and gives permission to
proceed
(b) Consent can be expressed non-verbally by action or allowing care
to be rendered
(2) Informed consent -consent given based on full disclosure of information
(3) Implied consent
(a) Consent assumed from a patient requiring emergency intervention
who is mentally, physically or emotionally unable to provide
expressed consent; sometimes called emergency doctrine
(b) Is effective only until patient no longer requires emergency care or
regains competence to make decisions
(4) Involuntary consent
(a) Treatment allowed in certain situations granted by authority of law

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 11
Foundations of the EMT 1
continued

(b) Patients held for mental health evaluation or as directed by law

enforcement personnel who have the patient under arrest
c. Special consent situations
(1) Minors
(a) In most states, a person is a minor until age 18 unless
emancipated
(b) Emancipation may include
i) Minors who are married, parents, or in the armed services
ii) Individual living independently and self-supporting (e.g.,
college student not living at home or receiving financial aid
from parents)
(c) Unemancipated minors are not able to give or withhold consent -
consent of parent, legal guardian or court-appointed custodian is
usually required
(d) Emergency doctrine applies to minors when parent or guardian
cannot be contacted
(2) Mentally incompetent adults
(a) If there is a legal guardian, consent may be given or withheld by
the guardian
(b) Emergency doctrine applies if no one legally able to give consent
can be contacted
(3) Prisoners or arrestees
(a) Court or police who have custody may authorize emergency
treatment
(b) Usually limited to care needed to save life or limb
(4) Refusal of care or transport
(a) Patient must be conscious, competent, and able to make a
reasonable decision
(b) Make multiple attempts to convince the patient to accept care
(c) Enlist the help of others to convince the patient
(d) Assure that the patient is informed about the implication of the
decision and potential for harm
(e) Consult medical direction
(f) Request patient and a disinterested witness to sign a "release from
liability" form
(g) Advise the patient that he or she may call again for help if needed
(h) Attempt to get family or friends to stay with the patient
(i) Document situation and actions thoroughly on patient care report

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 12
Foundations of the EMT 1
continued

(5) Decisions not to transport

(a) Involve medical direction
(b) Thoroughly document reasons for decision
d. Legal complications related to consent
(1) Abandonment
(a) Terminating care when it is still needed and desired by the patient,
and without assuring that appropriate care continues to be
provided by another qualified provider
(b) May occur in the field or when a patient is delivered to the
emergency department
(2) False imprisonment
(a) May be charged by a patient who is transported without consent or
who is restrained without proper cause or authority
(b) May be a civil or criminal violation

3. Use of force
a. Unruly or violent patients
b. Use of restraints
c. Involve law enforcement, if possible
d. Use only force considered to be "reasonable" to prevent harm to the patient or
others
e. Must never be punitive
D. Resuscitation issues
1. Withholding or stopping resuscitation
a. Procedure should be established by local protocols
b. Role of medical direction should be clearly delineated
2. Advance directives
a. Status depends on state laws and local protocols
b. Written patient statements of preference for future medical treatment
(1) Living will
(2) Durable power of attorney for health care
(3) Do not resuscitate (DNR) orders
c. Authority granted in part by the Patient Self-Determination Act of 1990
d. Medical direction must establish and implement policies for dealing with
advance directives
(1) Policy should specify EMT 1care for the patient with an advance directive

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 13
 (2) Must provide for reasonable measures of comfort to the patient and
emotional support to family and loved ones

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 14
MODULE 1: PREPARATORY

Topic: OVERVIEW OF HUMAN SYSTEMS

Purpose:

This topic will give the EMT 1student a review of basic anatomy and
physiology and how it relates to the foundations of medicine.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be
able to successfully:

1. Define anatomy, physiology, and pathophysiology.

2. Review the levels of organization of the body from the simplest to the most
complex.

3. State the anatomical terms for the parts of the body.

4. Review the body cavities and the major organs within each.

5. Review the anatomy and function of the major body systems.

6. Appreciate how anatomy and physiology are the foundation of medicine.

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 15
DECLARATIVE
MODULE 1: PREPARATORY
OVERVIEW OF HUMAN SYSTEMS

I. Introduction
A. Define
1. Anatomy
2. Physiology
3. Pathophysiology
II. Organization of the body
A. Cells
B. Tissues
C. Organs
D. Systems
1. Integumentary system
2. Skeletal system
3. Muscular system
4. Nervous system
5. Respiratory system
6. Circulatory system
7. Lymphatic system
8. Digestive system
9. Excretory system
10. Endocrine system
11. Reproductive system
E. Homeostasis
F. Anatomical terminology
1. Descriptive terms for body parts and areas
2. Normal anatomical position
3. Body cavities
a. Cranial cavity
b. Spinal cavity
c. Thoracic cavity
d. Abdominal cavity
e. Pelvic cavity
4. Abdominal quadrants
a. Right upper (RUQ)
b. Left upper (LUQ)
c. Right lower (RLQ)
d. Left lower (LLQ)

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 16
Overview of Human Systems
continued

III. The nervous system

A. Function
1. Voluntary activity
2. Involuntary activity
B. Nervous system divisions
1. Central nervous system
2. Peripheral nervous system
C. Nerve types
1. Sensory
2. Motor
D. The central nervous system
1. The spinal cord
2. Brain
3. Meninges and cerebral spinal fluid
4. The autonomic nervous system
a. Sympathetic division
b. Parasympathetic division
c. Neuroreceptors
(1) Alpha
(2) Beta

IV. The endocrine system

A. Regulation of hormonal secretion
B. Function of hormones
C. Pancreatic hormones
1. Insulin
2. Glucagon
D. Adrenal hormones
1. Epinephrine

V. Blood
A. Characteristics of blood
B. Plasma
C. Blood cells
1. Red blood cells
2. White blood cells
3. Platelets

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 17
Overview of Human Systems
continued

VI. The heart

A. Location
B. Pericardium & Myocardium
C. Chambers, vessels, and valves
1. Right atrium
a. Vena cavae
(1) Superior vena cava
(2) Inferior vena cava
b. Tricuspid valve
2. Left atrium
a. Pulmonary veins
b. Mitral valves/ bicuspid
3. Right ventricle
a. Pulmonary artery
b. Pulmonary semilunar valve
4. Left ventricle
a. Aorta
b. Aortic semilunar valve
5. Coronary vessels
D. The cardiac cycle
1. Systole
2. Diastole
E. Cardiac output
1. Heart rate
2. Stroke volume

VII. The vascular system

A. Arteries, arterioles
B. Veins, venules
1. Valves
C. Capillaries
D. Gaseous exchange
E. Pathways of circulation
1. Pulmonary circulation
2. Systemic circulation
F. Blood pressure
1. Maintenance of systemic blood pressure
2. Regulation of blood pressure

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 18
Overview of Human Systems
continued

VIII. The lymphatic system and immunity

A. Functions
B. Immunity
1. Antigens and antibodies
2. Antibody response

IX. Respiratory system

A. Function
B. Anatomy
1 .Nose and nasal cavities
2. Pharynx
3. Larynx
4. Trachea and bronchial tree
5. Lungs and pleural membranes
6. Alveoli
C. The mechanics of breathing
1. Inhalation
2. Exhalation
D. Exchange of gases
E. Regulation of respiration

X. Fluids and electrolytes

A. Water compartments
1. Intracellular
2. Intravascular
rd
3. Interstitial (3 Space)
B. Fluid balance

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 19
MODULE 1: PREPARATORY

Topic: EMERGENCY PHARMACOLOGY

Purpose:

This topic will give the EMT 1student an understanding of the basic
principals of pharmacology.

Suggested Time Frame: 4 Hours

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be
able to successfully:

1. Explain the importance of developing expertise in the administration of

drugs.

2. Differentiate between the chemical, generic, official, and trade names of

drugs.

3. Discuss the EMT 1’s responsibilities to the administration of

medications.

4. List and describe the general properties of drugs.

5. List and differentiate routes of drug administration.

6. Discuss considerations for storing drugs.

7. List the components of a drug profile.

8. List and describe drugs the EMT 1may administer according to local
protocol.

9. Advocate the importance of safe administration of medications.

10. Given patient scenarios, identify correct medications and dosages to be

given per local protocol.

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 20
DECLARATIVE
MODULE 1: PREPARATORY
EMERGENCY PHARMACOLOGY

I. Names of drugs
A. Drugs -chemical agents used in the diagnosis, treatment, or prevention of disease
B. Pharmacology -the study of drugs and their actions on the body
C. Chemical name -a precise description of the drug's chemical composition and
molecular structure
D. Generic name or non-proprietary name
1. Official name approved by the FDA
2. Usually suggested by the first manufacturer
E. Trade or proprietary name -the brand name registered to a specific manufacturer or
owner
F. Official name -the name assigned by USP

II. Responsibilities of the EMT 1for medication administration

A. Responsible for safe and therapeutically effective drug administration
B. Responsible legally, morally, and ethically for each drug administered
C. EMT 1’s
1. Use correct precautions and techniques
2. Observe and document the effects of the drugs
3. Keep their knowledge current in pharmacology
4. Take a drug history from patients including
a. Prescribed medications
b. Over the counter medications
c. Vitamins
d. Drug reactions

II. General properties of drugs

A. Drugs modify existing functions on a tissue or organ in the body
B. Once administered, drugs go through four stages
1 .Absorption
2. Distribution
3. Metabolism
4. Excretion

III. Overview of drug administration

A. The mode of drug administration affects the rate at which onset of action occurs and
may affect the therapeutic response that results

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 21
Emergency Pharmacology
continued

B. The routes of drug administration are categorized as

1. Drugs administered by the inhalation route
a. Nebulized medications
2. Enteral (drugs administered along any portion of the gastrointestinal tract)
a. Sublingual
b. Oral
3. Parenteral (any medication route other than the alimentary canal)
a. Subcutaneous
b. Intramuscular
c. Intravenous
4. Endotracheal
C. Predictable responses
1. Desired action
2. Side effects
D. Unpredictable adverse responses
1. Hypersensitivity (drug allergy)
2. Anaphylactic reaction
3. Tolerance
7. Cumulative effect
9. Drug antagonism

IV. Drug storage

A. Certain precepts should guide the manner in which drugs are secured, stored,
distributed, and accounted for
B. Refer to local protocol
C. Drug potency can be affected by
1. Temperature
2. Light
3. Moisture
4. Shelf life

V. Components of a drug profile

A. Drug names
B. Classification
C. Mechanisms of action
D. Indications
E. Side/ adverse effects
F. Routes of administration

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 22
Emergency Pharmacology
continued

G. How supplied
H. Dosages
I. Contraindications
J. Considerations for pediatric patients, geriatric patients, pregnant patients, and other
special patient groups
K. Other profile components

VI. Drugs used in pharmacological management plans

A. Activated Charcoal
1. Drug names
2. Classification
3. Mechanism of actions
4. Indications
5. Contraindications
6. Side/ adverse effects
7. Routes of administration
8. How supplied
9. Dosages
10. Special considerations

B. Aspirin
1. Drug names
2. Classification
3. Mechanism of actions
4. Indications
5. Contraindications
6. Side/ adverse effects
7. Routes of administration
8. How supplied
9. Dosages
10. Special considerations

C. Albuterol
1. Drug names
2. Classification
3. Mechanism of actions
4. Indications
5. Contraindications

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 23
Emergency Pharmacology
continued

6. Side/ adverse effects

7. Routes of administration
8. How supplied
9. Dosages
10. Special considerations

D. Dextrose 50%
1. Drug names
2. Classification
3. Mechanism of actions
4. Indications
5. Contraindications
6. Side/ adverse effects
7. Routes of administration
8. How supplied
9. Dosages
10. Special considerations

E. Epinephrine (1:1,000)
1. Drug names
2. Classification
3. Mechanism of actions
4. Indications
5. Contraindications
6. Side/ adverse effects
7. Routes of administration
8. How supplied
9. Dosages
10. Special considerations

F. Glucagon
1. Drug names
2. Classification
3. Mechanism of actions
4. Indications
5. Contraindications
6. Side/ adverse effects
7. Routes of administration

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 24
Emergency Pharmacology
continued

8. How supplied
9. Dosages
10. Special considerations

G. Naloxone
1. Drug names
2. Classification
3. Mechanism of actions
4. Indications
5. Contraindications
6. Side/ adverse effects
7. Routes of administration
8. How supplied
9. Dosages
10. Special considerations

H. Nitroglycerine
1. Drug names
2. Classification
3. Mechanism of actions
4. Indications
5. Contraindications
6. Side/ adverse effects
7. Routes of administration
8. How supplied
9. Dosages
10. Special considerations

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 25
MODULE 1: PREPARATORY

Topic: VENOUS ACCESS AND MEDICATION ADMINISTRATION

Purpose:

This topic will give the EMT 1student the techniques to safely access
peripheral intravenous cannulation and administer medication

Suggested Time Frame: 2 Hour

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be
able to successfully:

1. Identify the routes medications can be delivered and explain the possible
complications and absorption rates for each.

2. Discuss formulas as a basis for performing drug calculations.

3. Calculate drug dosages for oral, sublingual, subcutaneous, intramuscular,

and intravenous routes.

4. Discuss the legal aspects and medical control regarding medication

administration.

5. Identify the 6 “Rights” of drug administration.

6. Describe the use of universal precautions and body substance isolation

procedures when administering medications.

7. Discuss medical asepsis and the use of antiseptics and disinfectants.

8. Describe the indications, equipment needed, techniques utilized,

precautions, and the general principals of peripheral venous cannulation.

9. Describe the indications, equipment needed, techniques utilized,

precautions, and the general principals of administering medications by the
following routes:

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 26
Venous Access and Medication Administration
continued

A. Oral
B. Nebulizer
C. Sublingual
D. Subcutaneous
E. Intramuscular
F. Intravenous

10. Describe the indications, equipment needed, techniques utilized,

precautions, and the general principals for obtaining a blood sample.

11. Describe disposal of contaminated items and sharps.

12. Explain the importance of evaluating a patient’s response to medications.

13. Comply with EMT 1standards of medication administration.

14. Advocate the importance of universal precautions, body substance

isolations, and disposing of contaminated items and sharps.

15. Demonstrate how to prepare for administrating medications from the

following:

A. Vials
B. Ampules
C. Preloaded syringes

16. Demonstrate the proper procedure for cannulation of peripheral veins.

17. Demonstrate the proper procedure for administering medications by the

following routes:

A. Oral
B. Nebulizer
C. Sublingual
D. Subcutaneous
E. Intramuscular
F. Intravenous

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 27
DECLARATIVE
MODULE 1: PREPARATORY
VENOUS ACCESS AND MEDICATION ADMINISTRATION

I. Calculating drug dosages

A. Calculation methods
1. Desired dose over available concentration method (Desired/Have)
B. Calculating dosages
1. Oral medications
a. Capsules and tablets
b. Liquids
2. Parenteral medications
a. Quantity (typically weight)
b. Volume
c. Units (i.e. insulin)
3. Intravenous infusions
a. Flow rates for infants and children
4. Calculating dosages for infants and children
a. Body weight
b. Use of tables, charts, and other adjuncts
c. Length-based resuscitation tapes

II. Medical direction

A. Medication administration is bound by the EMT 1’s on-line or off-line medical
direction
B. Patient management protocols
1. Written standing orders
C. Legal considerations -policies and procedures that specify regulations of medication
administration

III. Principles of medication administration

A. Local drug distribution system -policies which establish stocking and supply of drugs
B. EMT 1’s responsibility associated with the drug order
1. Verification of the drug order
C. The "six rights" of medication administration
1. "Right" patient
2. "Right" drug
3. "Right" dose
4. "Right" route
5. "Right" time
6. "Right" documentation

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 28
Venous Access and Medication Administration
continued

IV. Universal precautions and body substance isolation (BSI) in medication administration

V. Venous access
A. Peripheral intravenous cannulation
1. General principles
2. Indications
3. Precautions
4. Equipment
5. Technique
a. Extremity
(1) Indications
(2) Precautions
(3) Equipment
(4) Procedure

VI. Medications administered by the inhalation route

A. Bronchodilator (beta agonist) medications
1. Other medications
B. Equipment
1. Oxygen or compressed air source
2. Small volume nebulizer (SVN)
a. Other inhaler equipment
b. Other adapter equipment
c. Modified inhaler equipment
C. Administering medications by the inhalation route
1. Indications
2. Techniques
3. Precautions
4. General principles for administering medications by the inhalation route

VII. Enteral medication administration

A. Oral administration of medications
1. Dosage forms of solid-form and liquid-form oral medications
a. Pills (aspirin, NTG)
b. Syrups (activated charcoal)
2. Equipment
3. General principles for administration of solid-form and liquid-form oral
medications

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 29
Venous Access and Medication Administration
continued

VIII. Parenteral administration of medications

A. Parenteral routes used by EMT 1
1. Subcutaneous
2. Intramuscular
3. Intravenous bolus
4. Sublingual
B. Reasons for parenteral administration of medications
C. Equipment used in parenteral administration of medications
1. Syringes
a. Calibration of the syringe
b. Prefilled syringes
2. Needles
3. Selection of the syringe and needle
4. Packaging of syringes and needles
5. Packaging of parenteral medications
a. Ampules
b. Vials
c. Prefilled syringes
d. Other
6. Intravenous (IV) administration sets
a. Various types
b. Macrodrip chamber-type
c. Microdrip chamber-type
d. Variety of extensions and other pieces of equipment
e. Some IV administration sets are manufacturer specific
7. Intravenous (IV) solutions
a. Types of containers
b. Variety of volumes
D. Preparation of parenteral medication
1. Equipment needed for preparing a parenteral medication
2. Standard procedures for preparing all parenteral medications
a. Prefilled syringes
b. To prepare a medication from an ampule
c. Removal of a volume of liquid from a vial
d. Preparing a drug from a mix-o-vial
E. Administration of medication by the subcutaneous route
1. Subcutaneous route-injections are made into the loose connective tissue
between the dermis and muscle layer

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 30
Venous Access and Medication Administration
continued

2. Equipment needed for administration of a medication by the subcutaneous route

3. Locate anatomical sites
a. Upper arms
b. Anterior thighs
c. Abdomen
d. Sublingual injection
4. Technique for administration of medication by the subcutaneous route
5. Precautions
F. Administration of medication by the intramuscular route
1. Intramuscular route - injections are made by penetrating a needle through the
dermis and subcutaneous tissue into the muscle layer
2. Equipment needed for administration of a medication by the intramuscular route
3. Locate anatomical sites for adults and children
a. Vastus lateralis muscle
b. Rectus femoris muscle
c. Gluteal area
d. Deltoid muscle
4. Technique for administration of medication by the intramuscular route
5. Precautions
G. Administration of medication by intravenous bolus
1. Intravenous route
a. Places the drug directly into the bloodstream
b. Bypasses all barriers to drug absorption
2. Drugs are administered by direct injection with a needle and syringe into an
established peripheral line
3. Dosage forms for IV administration
4. General principles of IV medication administration
5. Steps in performing administration of medications into an established IV line
6. Steps in performing administration of medication by a heparin lock
7. Steps in changing to the next container of IV solution
8. Steps in administering medication by a venous access device
a. Equipment
b. Technique
9. Complications
a. Phlebitis or infection
b. Extravasation
c. Air in tubing
d. Circulatory overload and pulmonary edema

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 31
Venous Access and Medication Administration
continued

e. Allergic reaction
f. Pulmonary embolism
g. Failure to infuse properly
H. Administering medications by the sublingual route
1. Places where medications are commonly applied
a. Under the tongue (sublingual)
c. Dosage forms
(1) Tablets
(2) Liquid/Spray

IX. Obtaining a blood sample

A. Purposes for obtaining a blood sample
B. Equipment needed for obtaining a blood sample
C. Locations from which to obtain a blood sample
1. Anatomical sites
2. From the established intravenous catheter
3. Other locations
D. Steps to preparing equipment for obtaining a blood sample
E. Techniques for obtaining a blood sample
F. Complications

X. Disposal of contaminated items and sharps

A. Follow local protocol for disposal of contaminated items and sharps

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 32
MODULE 1: PREPARATORY

Topic: VENOUS ACCESS AND MEDICATION ADMINISTRATION LAB

Purpose:

This lab will give the EMT 1student the techniques to safely access peripheral
intravenous cannulation and administer medications.

Suggested Time Frame: 4 Hours

Objectives:

At the conclusion of this lab, the EMT 1student as an active participant will be able to
successfully:

18. Demonstrate how to prepare for administrating medications from the following:

D. Vials
E. Ampules
F. Preloaded syringes

19. Demonstrate the proper procedure for cannulation of peripheral veins.

20. Demonstrate the proper technique of disposing sharps and use of sharps containers.

21. Demonstrate the proper procedure for administering medications by the following
routes:

G. Oral
H. Nebulizer
I. Sublingual
J. Subcutaneous
K. Intramuscular
L. Intravenous

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 33
MODULE 1: PREPARATORY
VENOUS ACCESS AND MEDICATION ADMINISTRATION LAB

The EMT 1student in a lab setting with an instructor will demonstrate the following skills
either as a single skill or in a scenario based demonstration.

a. The preparation of administering medications.

i. Calculating the proper drug dosage
ii. Six rights of drug administration
iii. Proper BSI
iv. Select appropriate drug
v. Check ampule or vial for name, concentration, clarity, color, integrity,
expiration date
vi. Aseptic technique
vii. Break off tip of ampule while protecting fingers or remove protective cap
from vial, cleanse top with alcohol wipe
viii. Remove cap from needle
ix. Ampule – insert needle into open ampule without contamination, withdraw
correct amount of medication
x. Vial – inject appropriate amount of air into vial, withdraw correct amount of
medication
xi. Confirm drug order

b. Proper procedure for cannulation of peripheral veins

i. Proper BSI
ii. Checks IV fluid, proper fluid, clarity
iii. Selection of appropriate IV catheter
iv. Selection of proper administration set
v. Connects IV tubing to IV bag
vi. Prepares administration set (fills drip chamber and flushes tubing)
vii. Cuts tape
viii. Applies tourniquet
ix. Palpates suitable vein
x. Preparing site for cannulation
xi. Proper cannulation of vein using aseptic technique
xii. Releases tourniquet
xiii. Assures patency of IV
xiv. Secures catheter
xv. Adjusting appropriate flow rate
xvi. Proper disposal technique

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 34
VENOUS ACCESS AND MEDICATION ADMINISTRATION LAB
continued

xvii. Correct documentation

c. Administration of medications by following routes

i. Oral
1. Proper BSI
2. Confirm order
3. Verify patient’s allergies
4. Explain procedure to patient
5. Remove the proper dosage of medication (tablet or liquid)
6. Give medication to patient
7. Correct documentation
ii. Nebulizer
1. Indications of use
2. Proper BSI
3. Explain procedure to patient
4. Assembly of nebulizer
5. Procedure to add medication
6. Rate of oxygen source delivery
7. Dosage of albuterol – per protocol
8. Reassessment of lung sound
9. Correct documentation
iii. Sublingual
1. Proper BSI
2. Confirm order
3. Verify patient’s allergies
4. Explain procedure to patient
5. Remove tablet from container, check that it is intact
6. Instruct patient to open mouth and lift tongue
7. Place tablet under tongue
8. Instruct patient to allow tablet to dissolve and NOT swallow
9. Reassess blood pressure and pain response
iv. Subcutanous
1. Proper BSI
2. Confirm order
3. Verify patient’s allergies
4. Explain procedure to patient
5. Landmark identification
6. Selection of proper syringe and needle

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 35
VENOUS ACCESS AND MEDICATION ADMINISTRATION LAB
continued

7. Insertion technique and angle of insertion

8. Needle aspiration
9. Inject medication
10. Counter pressure with alcohol wipe, withdraw, apply direct pressure
11. Proper disposal technique
12. Correct documentation
v. Intramuscular
1. Proper BSI
2. Confirm order
3. Verify patient’s allergies
4. Explain procedure to patient
5. Landmark identification
6. Selection of proper syringe and needle
7. Spread skin around site without contamination
8. Insertion technique and angle of insertion
9. Needle aspiration
10. Inject medication
11. Counter pressure with alcohol wipe, withdraw, apply direct pressure
12. Proper disposal technique
13. Correct documentation
vi. Intravenous
1. Proper BSI
2. Verify patient’s allergies
3. Explain procedure to patient
4. Selects correct medication
5. Assures correct concentration of drug
6. Assembles prefilled syringe correctly, dispels air
7. Continues infection control precaurions
8. Cleanses injection site
9. Rechecks medication
10. Stops IV flow rate
11. Administers correct dose
12. Flushes tubing
13. Adjusts drip rate
14. Proper disposal technique
15. Reassess patient
16. Correct documentation

KCEMT
EMT 1Model Curriculum
Module 1: Preparatory 36
 EMT 1SKILL

INSTRUCTOR RESOURCE

INTRAMUSCULAR INJECTION
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in administering an intramuscular injection.
CONDITION
The examinee will be requested to appropriately administer an IM injection.
EQUIPMENT
Gloves, injection manikin, syringes (various sizes), alcohol preps, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond ( ) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

Take body substance isolation precautions

Confirm drug order
Check medication for:

Drug name

Integrity of container/medication

Concentration/Dose

Clarity

Expiration date

Check the six “rights” of patients

right patient

right drug

right amount/dose

right route

right time

right documentation

Ask if patient has any allergies

37
KCEMT
EMT 1Model Curriculum
Module 1: Preparatory
IM Injection Skill: Instructor Resource
 Skill Component Teaching Points

Explain procedure to patient · Reassure patient and explain the reason for the procedure.
This will help calm the patient and improve cooperation.

Select appropriate site and verify landmarks · Avoid areas that are bruised or scarred.

· Use either the deltoid muscle or the upper outer · Cleanse the site with alcohol wipe.
quadrant of the gluteal muscle.
· Start at the site itself and work outward in an expanding
· Prepare site using aseptic techniques circle. This pushes pathogens away from the puncture site.

· Allow the area to dry before penetrating the skin.

Select the appropriate syringe and withdraw volume

of medication appropriate for chosen site.

PROCEDURE

Remove cap from needle without contamination.

Spread skin around injection site with non-dominant

hand without contaminating the site.

Insert needle at 90 degree angle with bevel up.

· Aspirate and observe for blood return (if positive

for blood return, discontinue procedure and
begin again in another location)

Slowly inject medication.

Apply circular pressure with alcohol prep and quickly · Gentle circular pressure will help to disperse and absorb
withdraw needle. medication.

· Apply direct pressure over injection site.

· Apply bandage if needed.

Dispose syringe using appropriate technique.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment priority patients.

· Relevant portion of the focused assessment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Evaluate response to treatment changes in the patient’s condition are anticipated sooner.

· Compare results to baseline condition and vital · Priority patients are patients who have abnormal vital signs,
signs signs/symptoms of poor perfusion or if there is a suspicion that
the patient’s condition may deteriorate.

38
KCEMT
EMT 1Model Curriculum
Module 1: Preparatory
IM Injection Skill: Instructor Resource
 Skill Component Teaching Points

DOCUMENTATION

§ Document: · Documentation must be on an approved prehospital

care report form. Follow local policies and protocols.
· Medication

· Dosage

· Route

· Location

· Time and date

39
KCEMT
EMT 1Model Curriculum
Module 1: Preparatory
IM Injection Skill: Instructor Resource
 EMT 1SKILL

INTRAMUSCULAR INJECTION
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in administering an intramuscular injection.
CONDITION
The examinee will be requested to appropriately administer an IM injection.
EQUIPMENT
Gloves, injection manikin, syringes (various sizes), alcohol preps, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Confirm drug order

♦ Ask if patient has any allergies

♦ Explain procedure to patient

♦ Select appropriate site and verify landmarks

· Use either the deltoid muscle or the upper outer

quadrant of the gluteal muscle.

· Prepare site using aseptic techniques

♦ Select the appropriate syringe and withdraw volume

of medication appropriate for chosen site.

PROCEDURE

♦ Remove cap from needle without contamination.

♦ Spread skin around injection site with non-dominant

hand without contaminating the site.

40
KCEMT
EMT 1Model Curriculum
Module 1: Preparatory
IM Injection Skill: Student
 Skill Component Yes No Comments

♦ Insert needle at 90 degree angle with bevel up.

· Aspirate and observe for blood return (if positive

for blood return, discontinue procedure and
begin again in another location)

♦ Slowly inject medication.

♦ Apply circular pressure with alcohol prep and

quickly withdraw needle.

· Apply direct pressure over injection site.

· Apply bandage if needed

♦ Dispose syringe using appropriate technique.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

· Location

· Medication

· Dose

· Route

· Time and date

. Flow rate

41
KCEMT
EMT 1Model Curriculum
Module 1: Preparatory
IM Injection Skill: Student
 EMT 1SKILL

INSTRUCTOR RESOURCE
INTRAVENOUS BOLUS MEDICATIONS
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in administering an intravenous bolus of a medication.
CONDITION
The examinee will be requested to appropriately administer an IVP bolus.
EQUIPMENT
Gloves, existing intravenous line with medication port, syringes (various sizes), alcohol preps, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions

♦ Assure the primary IV line is patent and not

infiltrated

♦ Ask if patient has any allergies

♦ Confirm drug order and select the correct · Check medication for:
medication
· Drug name

· Integrity of container/medication

· Concentration/Dose

· Clarity

· Expiration date

· Check the six “rights” of patients

ƒ right patient

ƒ right drug

ƒ right amount/dose

ƒ right route

ƒ right time

· right documentation

42
KCEMT
EMT 1Model Curriculum
IV Bolus Medications Skill: Instructor Resource
 Skill Component Teaching Points

♦ Explain procedure to patient · Reassure patient and explain the reason for the procedure.
This will help calm the patient and improve cooperation.

PROCEDURE

♦ Draw up the medication or prepare a prefilled

syringe as appropriate, dispel air.

♦ Cleanse the medication port nearest the IV site with

an alcohol prep.

♦ Recheck medication.

♦ Insert the needle of syringe through the port

membrane.

♦ Pinch the IV line above the medication port. · This prevents the medication from traveling up towards the IV
bag, forcing it towards the patient.

♦ Inject the medication as appropriate.

♦ Remove the needle and syringe and release the

tubing.

♦ Open the flow regulator to allow a 20 cc fluid flush. · The fluid will push the medication into the patient’s circulatory
Then adjust flow rate of IV. system.

♦ Dispose needle and syringe using appropriate

technique.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment priority patients.

· Relevant portion of the focused assessment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Evaluate response to treatment changes in the patient’s condition are anticipated sooner.

· Compare results to baseline condition and vital · Priority patients are patients who have abnormal vital signs,
signs signs/symptoms of poor perfusion or if there is a suspicion that
the patient’s condition may deteriorate.

43
KCEMT
Advance EMT Model Curriculum
IV Bolus Medications Skill: Instructor Resource
 Skill Component Teaching Points

DOCUMENTATION

§ Document: · Documentation must be on an approved prehospital care

report form. Follow local policies and protocols.
· Medication

· Dosage

· Route

· Flow rate

· Time and date

44
KCEMT
EMT 1Model Curriculum
IV Bolus Medications Skill: Instructor Resource
 EMT 1SKILL

INTRAVENOUS BOLUS MEDICATIONS

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in administering an intravenous bolus of a medication.
CONDITION
The examinee will be requested to appropriately administer an IVP bolus.
EQUIPMENT
Gloves, existing intravenous line with medication port, syringes (various sizes), alcohol preps, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Assure the primary IV line is patent and not

infiltrated

♦ Ask if patient has any allergies

♦ Confirm drug order and select the correct

medication

♦ Explain procedure to patient

PROCEDURE

♦ Draw up the medication or prepare a prefilled

syringe as appropriate, dispel air.

♦ Cleanse the medication port syringe nearest the IV

site with an alcohol prep.

♦ Recheck medication.

♦ Insert the needle of syringe through the port

membrane.

45
KCEMT
EMT 1Model Curriculum
IV Bolus Medications Skill: Student
 Skill Component Yes No Comments

♦ Pinch the IV line above the medication port. · This prevents the medication from traveling
up towards the IV bag, forcing it towards
the patient.

♦ Inject the medication as appropriate.

♦ Remove the needle and release the tubing.

♦ Open the flow regulator to allow a 20 cc fluid flush. · The fluid will push the medication into the
Then adjust flow rate of IV. patient’s circulatory system.

♦ Dispose needle and syringe using appropriate

technique.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

· Route

· Type and amount of solution

· Time and date

. Flow rate

46
KCEMT
EMT 1Model Curriculum
IV Bolus Medications Skill: Student
 EMT 1SKILL

INSTRUCTOR RESOURCE

INTRAVENOUS THERAPY
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in establishing a peripheral IV on a manikin arm.
CONDITION
The examinee will be requested to appropriately establish an IV on a manikin arm with the appropriate IV solution, IV catheter and
establish the appropriate IV rate according to the scenario given by the proctor.
EQUIPMENT
Gloves, goggles, IV infusion arm, a selection of IV solutions, Administration sets, and IV catheters, tape, gauze pads, syringes
(various sizes), tourniquet, alcohol preps, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond ( ) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test
item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

Take body substance isolation precautions · Mandatory personal protective equipment.

Explain the procedure to the patient · Describe the procedure to the patient and what the patient
can expect to feel.
· Explain the need for the IV
· Understanding the procedure will help alleviate some of the
· Ask if the patient has any allergies patient’s anxiety. Anxiety can lead to a vasomotor response
or venous constriction.

· Pediatric patients may have unrealistic fears.

Check the selected IV solution for · Discard bag if solution is not clear, expired or damage to the
bag.

Proper fluid

Clarity

Expiration date

No damage to IV bag

Select appropriate catheter · Select the appropriate sized catheter according to scenario
used. 14-16 gauge for trauma, volume replacement, cardiac
arrest. 18-20 for medical conditions.

· Follow local protocols.

47
KCEMT
EMT 1Model Curriculum
IV Therapy Skill: Instructor Resource
 Skill Component Teaching Points

Select the proper administration set · Macrodrip for trauma, microdrip for medical conditions and
drug administration

· Follow local protocols.

Prepare the IV bag and administration set using · Dispose of the IV administration set if it becomes
aseptic technique contaminated.

Connect IV tubing to the IV bag · Leave the protective cap in place on the connector end of the
administration set until you are ready to connect it to the hub of

Fills drip chamber the catheter.

Flushes tubing

Cuts or tears tape

PROCEDURE

Apply Tourniquet · The tourniquet should be tied smoothly and snugly.

· The tourniquet should be kept as flat as possible.

· Avoid keeping in place for more than 2 minutes.

· A tourniquet that is too tight will impede arterial flow. Feel

for the patient’s radial pulse, if absent, the tourniquet is too
tight.

· Release the tourniquet as soon as the catheter is placed in

vein and blood samples drawn (if applicable). Bruising may
occur if tourniquet is kept in place too long.
Palpate suitable vein · Acceptable sites have clearly visible veins.

· Free of bruising or scarring.

· Avoid areas of vein where a valve is situated.

· Avoid veins that roll, feels hard or ropelike.

Cleanse the site appropriately · Cleanse the site with povidone -iodine or alcohol wipe.

· Start at the site itself and work outward in an expanding

circle. This pushes pathogens away from the puncture site.

· Allow the area to dry before penetrating the skin.

· It may be necessary to shave the hair around the site to

provide better adherence of the tape to secure the catheter

48
KCEMT
EMT 1Model Curriculum
IV Therapy Skill: Instructor Resource
 Skill Component Teaching Points

Performs venipuncture · With the non-dominant hand, pull skin taut to stabilize the vein
and prevent rolling.
· Inserts stylet, bevel up
· With the distal bevel of the metal stylet up, insert into vein at a
· Notes flashback 10 to 30 degree angle. Do not touch any portion of the
catheter, a contaminated catheter is not usable.
. Occludes vein proximal to catheter
· Continue until you feel a “pop” into the vein or see a flashback.
. Removes stylet
· Advance the catheter over the needle into the vein. (If
· Disposes needle into an approved container you meet resistance, do not force, withdraw the needle
and catheter as a unit.)
· Releases tourniquet
· Place a finger over the vein beyond the catheter tip to apply
. Connects IV tubing to catheter pressure to prevent blood from flowing from the catheter or
air entering.

· Carefully remove the metal stylet and promptly dispose into an

approved disposable container.

· Release tourniquet

· Connect the IV tubing to cannula. Tightly secure the needle

adapter into the cannula hub. Open the flow regulator to allow
fluid to run freely for a few seconds to assure patency.

Adjust the appropriate flow rate for the scenario

given.

Cover the site with povidone-iodine ointment and a

sterile dressing.

Secures catheter by taping IV appropria tely · Secure catheter, administration set tubing, and dressing
in place with tape.

· The tubing should be looped and secured with tape above

the IV canulation site. The loop gives the tubing more give
and helps prevent the catheter from becoming dislodged by
accidental pulling.

49
KCEMT
EMT 1Model Curriculum
IV Therapy Skill: Instructor Resource
 Skill Component Teaching Points

Adjusts flow rate as appropriate for scenario

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment priority patients.

· Relevant portion of the focused assessment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Evaluate response to treatment changes in the patient’s condition are anticipated sooner.

· Compare results to baseline condition and vital · Priority patients are patients who have abnormal vital signs,
signs signs/symptoms of poor perfusion or if there is a suspicion that
the patient’s condition may deteriorate.

DOCUMENTATON

§ Document: · Documentation must be on an approved prehospital care

report form. Follow local policies and protocols.
· Location

· Type and amount of solution

· Size of catheter

· Time and date

. Flow rate

50
KCEMT
EMT 1Model Curriculum
IV Therapy Skill: Instructor Resource
 EMT 1SKILL

INTRAVENOUS THERAPY
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in establishing a peripheral IV on a manikin arm.
CONDITION
The examinee will be requested to appropriately establish an IV on a manikin arm with the appropriate IV solution, IV catheter and
establish the appropriate IV rate according to the scenario given by the proctor.
EQUIPMENT
Gloves, goggles, IV infusion arm, a selection of IV solutions, Administration sets, and IV catheters, tape, gauze pads, syringes
(various sizes), tourniquet, alcohol preps, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Explain the procedure to the patient

· Explain the need for the IV

· Ask if the patient has any allergies

♦ Check the selected IV solution for

Proper fluid

Clarity

Expiration date

No damage to IV bag

♦ Select appropriate catheter

♦ Select the proper administration set

51

KCEMT
EMT 1Model Curriculum
IV Therapy Skill: Student
 ♦ Prepare the IV bag and administration set using
aseptic technique

Connect IV tubing to the IV bag

Fills drip chamber

Flushes tubing

♦ Cuts or tears tape

PROCEDURE

♦ Apply tourniquet

♦ Palpate suitable vein

♦ Cleanse the site appropriately

♦ Performs venipuncture

· Inserts stylet, bevel up

· Notes flashback

· Advance catheter over the stylet into the vein

· Occludes vein proximal

· Removes stylet

· Disposes needle into an approved container

· Releases tourniquet

· Connects IV tubing to catheter

♦ Adjust the appropriate flow rate for the scenario

given

♦ Cover the site with povidone-iodine ointment and a

sterile dressing

♦ Secures catheter by taping IV appropriately

♦ Adjusts flow rate as appropriate for scenario

52

KCEMT
EMT 1Model Curriculum
IV Therapy Skill: Student
 ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

· Location

· Type and amount of solution

· Size of catheter

· Time and date

. Flow rate

53

KCEMT
EMT 1Model Curriculum
IV Therapy Skill: Student
 EMT 1SKILL

INSTRUCTOR RESOURCE
MEDICATION ADMINISTRATION
BRONCHODILATOR METERED DOSE INHALER (MDI)
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in recognizing the indications, contraindications, criteria, and assist the patient with
the administration of a prescribed bronchodilator inhaler.
CONDITION
The examinee will be requested to establish that a simulated patient who is complaining of difficulty breathing meets the criteria
for administration of a bronchodilator inhaler. The examinee will assist the patient with administering the medication with or
without using a spacer device. Necessary equipment will be adjacent to the simulated patient.
EQUIPMENT
Simulated patient, oxygen tank with a flow meter, oxygen mask, blood pressure cuff, stethoscope, placebo bronchodilator inhaler
cartridge and plastic mouthpiece case, spacer device, timing device, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions · Mandatory personal protective equipment - gloves

· Situational - long sleeves, goggles, masks, gown

♦ Complete an initial assessment: · Any patient complaining of difficulty breathing should be

placed on oxygen as soon as possible.
· General impression
· Follow local protocol for administration of oxygen
· Life-threatening condition

· Assess mental status/stimulus response (AVPU)

· Assess/Manage airway

· Assess/Manage breathing

** Administer 100% oxygen

♦ Confirm order with Medical Control Consult with medical control or follow local policies
and protocols
♦ Confirm patient is not allergic to medication

54
KCEMT
EMT 1Model Curriculum
Metered Dose Inhaler Skill: Instructor Resource
 ♦ Check the six “rights” of patients ƒ It is important to always check the six “rights” to ensure
proper administration of medication in a correct and safe
ƒ right patient method.

ƒ right drug

ƒ right amount/dose

ƒ right route

ƒ right time

ƒ right documentation

♦ Verbalize the indications for administration of a · Symptoms include: shortness of breath, wheezing, coughing
bronchodilator inhaler: (usually dry and irritative), distressed breathing, and
difficulty speaking.
· Symptoms of respiratory distress
Follow local policies and protocols.
- shortness of breath

- wheezing

- coughing

- difficulty speaking.

♦ Verbalize the contraindications for administration of

a bronchodilator inhaler:

· Patient does not meet indication or criteria for

administration

· Patient has taken maximum prescribed dose

before EMS arrival

· Patient is unable to follow directions or use the

inhaler

PROCEDURE

♦ Check medication for: · Drug name - Trade and generic names include: albuterol,
® ® ® ® ®
Proventil , Ventolin , Atrovent , Alupent , Metaprel ,
® ®
· Drug name Brethaire , Bronchometer , etc

· Integrity of container/medication · Integrity of container/medication - Make sure container is NOT

broken
· Concentration/Dose
· Concentration/Dose - dose of a bronchodilator is the number
· Clarity metered sprays administered. (Concentration only refers to
liquid form of medications.)
· Expiration date
· Clarity -if container is transparent, the liquid should be clear

· Expiration date - not to be administered after this date

55
KCEMT
EMT 1Model Curriculum
Metered Dose Inhaler Skill: Instructor Resource
 ♦ Prepare Medication: · Inhaler cartridge should be already placed in the mouthpiece.
Teach student how to connect if first time use for medication.
· Remove the mouthpiece cover
· Always check mouthpiece to make sure there are no foreign
· Shake inhaler 5-6 times objects lodged in mouthpiece that may either be inhaled or plug
dispenser.
** Insert cartridge into plastic mouthpiece case - if not
done previously · If the inhaler has not been used for several days “test spray” it
into the air before use.
** Attach spacer - if needed

♦ Instruct patient to breath out normally (not

forcefully)

♦ Position the inhaler: · Ensure that spray opening is pointed toward patient

· Hold inhaler 2 finger-widths in front of open mouth · The cartridge should be on top and the mouthpiece on
the bottom.
OR
· Not everyone is able to use an inhaler effectively. Spacers may
Place inhaler inside of mouth, past the teeth, be used by patients who are older, have arthritis, or just cannot
above the tongue coordinate inhalation and medication administration activity.

OR

Attach a spacer to the mouth piece and close lips

around spacer

♦ Instruct patient to take a slow, deep breath and take in

as much air as possible on command

♦ Instruct patient to inhale: · Patient should not stop inhaling once the spray is delivered, but
continue to inhale as long as possible (usually 5-7 seconds).
Without Spacer
· This time frame mixes the medication with the incoming air and
· Inhale for 5-7 seconds and press the inhaler 1 time pulls it into the lungs slowly.

(1 spray or puff) · If using a spacer, there may be a whistling sound if the patient
inhales too rapidly.
With Spacer
· Avoid spraying into patient’s eyes or vision will be temporarily
· Press inhaler 1 time and have patient breath in and blurred.
out normally 3-4 breaths
· Dose of a bronchodilator is the numbered metered sprays that
** May repeat sprays as prescribed - if needed were administered.

♦ Instruct patient to hold breath for as long as

comfortable or up to 10 seconds before breathing out
slowly through pursed lips

♦ Remove inhaler and replace oxygen · Administer supplemental O2 before and after treatment
to decrease hypoxemia.

♦ Reassess respiratory function, breath sounds and · Medication will take effect in within 5 minutes and last 4-6
patient’s response after 3 minutes hours depending on medication administered.

56
KCEMT
EMT 1Model Curriculum
Metered Dose Inhaler Skill: Instructor Resource
 ♦ Monitor pulse periodically for irregularity · Hypoxic patients may experience dysrhythmias.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment priority patients.

· Relevant portion of the focused assessment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Evaluate response to treatment changes in the patient’s condition are anticipated sooner.

· Compare results to baseline condition and vital Priority patients are patients who have abnormal vital signs,
signs signs / symptoms of poor perfusion or if there is a suspicion
that the patient’s condition may deteriorate.

DOCUMENTATION

§ Verbalize/Document · Documentation must be on an approved prehospital care report

form.
· Assessment findings before and after administration
· Documenting reassessment information provides a
· Drug comprehensive picture of patient’s response to treatment.

- name · Last reassessment information (before patient care is

transferred) should be documented. Follow local protocols and
- dose policies regarding documentation.

- route

- site

- time

- who administered medication

· Repeat dose - if indicated

· Patient’s response to medication

· Respiratory status

· Cardiovascular status

· Mental status

· Vital signs

57
KCEMT
EMT 1Model Curriculum
Metered Dose Inhaler Skill: Instructor Resource
 EMT 1SKILL

MEDICATION ADMINISTRATION
BRONCHODILATOR METERED DOSE INHALER (MDI)

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in recognizing the indications, contraindications, criteria, and assist the patient with
the administration of a prescribed bronchodilator inhaler.
CONDITION
The examinee will be requested to establish that a simulated patient who is complaining of difficulty breathing meets the criteria
for administration of a bronchodilator inhaler. The examinee will assist the patient with administering the medication with or
without using a spacer device. Necessary equipment will be adjacent to the simulated patient.
EQUIPMENT
Simulated patient, oxygen tank with a flow meter, oxygen mask, blood pressure cuff, stethoscope, placebo bronchodilator inhaler
cartridge and plastic mouthpiece case, spacer device, timing device, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

1st 2nd 3rd (final)

PASS FAIL

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Complete an initial assessment:

· General impression

· Life-threatening condition

· Assess mental status/stimulus response (AVPU)

· Assess/Manage airway

· Assess/Manage breathing

** Administer 100% oxygen

♦ Confirm order with Medical Control

♦ Confirm patient is not allergic to medication

58
KCEMT
EMT 1Model Curriculum
Metered Dose Inhaler Skill: Student
 ♦ Check the six “rights” of patients

right patient

right drug

right amount/dose

right route

right time

right documentation

♦ Verbalize the indications for administration of a

bronchodilator inhaler:

· Symptoms of respiratory distress

- shortness of breath

- wheezing

- coughing

- difficulty speaking.

♦ Verbalize the contraindications for administration of

a bronchodilator inhaler:

· Patient does not meet indication or criteria for

administration

· Patient has taken maximum prescribed dose

before EMS arrival

· Patient is unable to follow directions or use the

inhaler

PROCEDURE

♦ Check medication for:

· Drug name

· Integrity of container/medication

· Concentration/Dose

· Clarity

· Expiration date

59
KCEMT
EMT 1Model Curriculum
Metered Dose Inhaler Skill: Student
 ♦ Prepare Medication:

· Remove the mouthpiece cover

· Shake inhaler 5-6 times

** Insert cartridge into plastic mouthpiece case - if not

done previously

** Attach spacer - if needed

♦ Instruct patient to breathe out normally (not

forcefully)

♦ Position the inhaler:

· Hold inhaler 2 finger-widths in front of open mouth

OR

Place inhaler inside of mouth, past the teeth,

above the tongue

OR

Attach a spacer to the mouth piece and close lips

around spacer

♦ Instruct patient to take a slow, deep breath and take in

as much air as possible on command

♦ Instruct patient to inhale:

Without Spacer

· Inhale for 5-7 seconds and press the inhaler 1 time

(1 spray or puff)

With Spacer

· Press inhaler 1 time and have patient breathe in and

out normally 3-4 breaths

** May repeat sprays as prescribed - if needed

♦ Instruct patient to hold breath for as long as

comfortable or up to 10 seconds before breathing out
slowly through pursed lips

♦ Remove inhaler and replace oxygen

♦ Reassess respiratory function, breath sounds and

patient’s response after 3 minutes

60
KCEMT
EMT 1Model Curriculum
Metered Dose Inhaler Skill: Student
 ♦ Monitor pulse periodically for irregularity

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Verbalize/Document

· Assessment findings before and after administration

· Drug

- name

- dose

- route

- site

- time

- who administered medication

· Repeat dose - if indicated

· Patient’s response to medication

· Respiratory status

· Cardiovascular status

· Mental status

· Vital signs

61
KCEMT
EMT 1Model Curriculum
Metered Dose Inhaler Skill: Student
 EMT 1SKILL INSTRUCTOR
RESOURCE MEDICATION
ADMINISTRATION
ADMINISTRATION OF NEBULIZED MEDICATION
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in recognizing the indications, contraindications, criteria, and assist the patient with
the administration of a nebulized medication.
CONDITION
The examinee will be requested to establish that a simulated patient who is complaining of difficulty breathing meets the criteria
for administration of a nebulized medication. The examinee will assist the patient with administering the nebulized medication.
Necessary equipment will be adjacent to the simulated patient.
EQUIPMENT
Simulated patient, oxygen tank with a flow meter, oxygen mask, blood pressure cuff, stethoscope, medication, handheld nebulizer,
T-tube, 6 inch flex tube, mouthpiece, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions Mandatory personal protective equipment – gloves

Situational - long sleeves, goggles, masks, gown

♦ Confirm the order with Medical Control Consult with medical control or follow local policies
and procedures
♦ Confirm patient is not allergic to medication

♦ Check the six “rights” of patients ƒ It is important to always check the six “rights” to ensure
proper administration of medication in a correct and safe
right patient method.

right drug

right amount/dose

right route

right time

ƒ right documentation

62
KCEMT
EMT 1Model Curriculum
Nebulized Medication Administration Skill: Instructor Resource
 ♦ Verbalize the indications for administering a nebulized Symptoms include: shortness of breath, wheezing, coughing
medication: (usually dry and irritative), distressed breathing, and
difficulty speaking.
Symptoms of respiratory distress
Follow local policies and procedures.
- shortness of breath

- wheezing

- coughing

- difficulty speaking.

♦ Explain procedure to the patient: Explain the procedure in a way the patient can understand.
The patient will need to assist you. If the patient is unable to
assist you properly and is done incorrectly the medication will
not be absorbed correctly and will be less effective.

PROCEDURE

♦ Check medication for: ƒ Drug name - Trade and generic names include:
® ® ®
albuterol, Proventil , Ventolin , Alupent
Drug name
ƒ Integrity of container/medication - Make sure container is NOT
Integrity of container/medication broken or damaged

Concentration/Dose ƒ Concentration/Dose – unit dose

Clarity ƒ Clarity -if container is transparent, the liquid should be clear

ƒ Expiration date ƒ Expiration date - not to be administered after this date

♦ Prepare Medication / Equipment:

Remove contents of nebulizer pack

Open nebulizer by twisting top and

bottom sections

Add medication to bottom portion

Close nebulizer and maintain in upright position

to avoid spilling

Fasten the T-tube to the nebulizer chamber

ƒ Connect the mouthpiece to one end of the T-tube

and the reservoir tube to the opposite end

ƒ Connect ends of O2 tubing to nebulizer and O2

source

ƒ Adjust oxygen to 6 liters per minute

ƒ Sit the patient upright as much as possible

63
KCEMT
EMT 1Model Curriculum
Nebulized Medication Administration Skill: Instructor Resource
 ♦ Have the patient hold the nebulizer or you may hold
the nebulizer if patient is unable to.

♦ Have patient firmly place mouthpiece in mouth and

seal lips tightly around mouthpiece

♦ Have the patient breathe as deeply as possible and

hold his/her breath for 3 to 5 seconds before
exhaling

♦ Reassess respiratory function, breath sounds and Medication will take effect in within 5-15 minutes and last 3-
patient’s response after 5 minutes 4 hours.

♦ Monitor pulse periodically for irregularity Hypoxic patients may experience dysrhythmias.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: ƒ The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
ƒ Initial assessment priority patients.

ƒ Relevant portion of the focused assessment ƒ Every patient must be re-evaluated at least every 5 minutes,
if any treatment was initiated or medication administered,
ƒ Evaluate response to treatment unless changes in the patient’s condition are anticipated
sooner.
ƒ Compare results to baseline condition and
vital signs Priority patients are patients who have abnormal vital signs,
signs / symptoms of poor perfusion or if there is a suspicion
that the patient’s condition may deteriorate.

64
KCEMT
EMT 1Model Curriculum
Nebulized Medication Administration Skill: Instructor Resource
 DOCUMENTATION

§ Verbalize/Document ƒ Documentation must be on prehospital field report form

per local policies and procedures.
ƒ Assessment findings before and
after administration ƒ Documenting reassessment information provides a
comprehensive picture of patient’s response to treatment.
ƒ Drug
ƒ Last reassessment information (before patient care
- name is transferred) should be documented.

- dose

- route

- site

- time

- who administered medication

ƒ Repeat dose - if indicated

ƒ Patient’s response to medication

ƒ Respiratory status

ƒ Cardiovascular status

ƒ Mental status

ƒ Vital signs

65
KCEMT
EMT 1Model Curriculum
Nebulized Medication Administration Skill: Instructor Resource
 EMT 1SKILL

ADMINISTRATION OF NEBULIZED MEDICATION

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in recognizing the indications, contraindications, criteria, and assist the patient with
the administration of a nebulized medication.
CONDITION
The examinee will be requested to establish that a simulated patient who is complaining of difficulty breathing meets the criteria
for administration of a nebulized medication. The examinee will assist the patient with administering the nebulized medication.
Necessary equipment will be adjacent to the simulated patient.
EQUIPMENT
Simulated patient, oxygen tank with a flow meter, oxygen mask, blood pressure cuff, stethoscope, medication, handheld nebulizer,
T-tube, 6 inch flex tube, mouthpiece, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Confirm the order with Medical Control

♦ Confirm patient is not allergic to medication

♦ Check the six “rights” of patients

right patient

right drug

right amount/dose

right route

right time

right documentation

66
KCEMT
EMT 1Model Curriculum
Nebulized Medication Administration Skill: Student
 ♦ Verbalize the indications for administering a nebulized
medication:

Symptoms of respiratory distress

- shortness of breath

- wheezing

- coughing

- difficulty speaking

♦ Explain procedure to the patient

PROCEDURE

♦ Check medication for:

Drug name

Integrity of container/medication

Concentration/Dose

Clarity

Expiration date

♦ Prepare Medication / Equipment:

Remove contents of nebulizer pack

Open nebulizer by twisting top and

bottom sections

ƒ Add medication to bottom portion

ƒ Close nebulizer and maintain in upright position to

avoid spilling

ƒ Fasten the T-tube to the nebulizer chamber

ƒ Connect the mouthpiece to one end of the T-tube

and the reservoir tube to the opposite end

ƒ Connect ends of O2 tubing to nebulizer and O2

source

ƒ Adjust oxygen to 6 liters per minute

ƒ Sit the patient upright as much as possible

67
KCEMT
EMT 1Model Curriculum
Nebulized Medication Administration Skill: Student
 ♦ Have the patient hold the nebulizer or you may hold
the nebulizer if patient is unable to.

♦ Have patient firmly place mouthpiece in mouth and

seal lips tightly around mouthpiece

♦ Reassess respiratory function, breath sounds and

patient’s response after 5 minutes

♦ Monitor pulse periodically for irregularity

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

ƒ Assessment findings before and

after administration

ƒ Drug

- name

- dose

- route

- site

- time

- who administered medication

ƒ Repeat dose - if indicated

ƒ Patient’s response to medication

ƒ Respiratory status

ƒ Cardiovascular status

ƒ Mental status

ƒ Vital signs

68
KCEMT
EMT 1Model Curriculum
Nebulized Medication Administration Skill: Student
 EMT 1SKILL INSTRUCTOR
RESOURCE MEDICATION
ADMINISTRATION
NITROGLYCERIN
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in recognizing the indications, contraindications, criteria, and assist the patient with
the administration of the prescribed medication nitroglycerin.
CONDITION
The examinee will be requested to establish that a simulated patient complaining of substernal chest discomfort meets the criteria
for administration of nitroglycerin and will administer either the nitroglycerin spray or tablet or two different patients may be
selected to demonstrate both methods of administration. Necessary equipment will be adjacent to the simulated patient.
EQUIPMENT
Simulated patient, oxygen tank with a flow meter, oxygen mask, blood pressure cuff, stethoscope, placebo nitroglycerin spray and
tablets, timing device, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions · Mandatory personal protective equipment - gloves

· Situational - long sleeves, goggles, masks, gown

♦ Complete an initial assessment and pertinent vital · Any patient complaining of difficulty breathing should be
signs: placed on oxygen as soon as possible.

· General impression · If in respiratory distress, patients with a history of COPD

should be placed on 15 Liters/minute via mask. DO
· Life-threatening condition NOT withhold oxygen from these patients.

· Assess mental status/stimulus response (AVPU) · Any patient complaining of chest pain should be placed
on oxygen as soon as possible.
· Assess/Manage airway
· Nitroglycerin may cause hypotension due to vasodilation.
· Assess/Manage breathing Always take blood pressure before administration and 5
minutes after administration.
· Blood pressure

** Administer 100% oxygen

** Obtain blood pressure

69
KCEMT
EMT 1Model Curriculum
Nitroglycerine Administration Skill: Instructor Resource
 ♦ Verbalize the criteria for assisting patients with
medications:

· Medication prescribed by a physician

· Medication prescribed for patient

· Meets indication for administration

· No contraindications are present for

administration

♦ Verbalize the indications for assisting the patient · Any degree of chest pain/discomfort should be treated with
with nitroglycerin: Nitroglycerin regardless how the patient rates the pain.

· Symptoms of chest pain/discomfort . Follow local protocols and policies

· Symptoms of congestive heart failure

· Systolic blood pressure > 100mm/Hg

♦ Verbalize the contraindications for administration of · If last dose of nitroglycerin exceeds 5 minutes, nitroglycerin
nitroglycerin: may be administered.

· Patient does not meet indication or criteria for · Follow local protocols and policies
administration

· Patient has taken 3 doses before EMS arrival

within the last 5 minutes

· Last dose was < 5 minutes ago

· Systolic blood pressure < 100mm/Hg

®
· Administration of Sildenafil citrate (Viagra ) or
similar medication within 24 hours

70
KCEMT
EMT 1Model Curriculum
Nitroglycerine Administration Skill: Instructor Resource
 PROCEDURE

NITROGLYCERIN TABLET OR SPRAY

♦ Check medication for: · Drug name - Trade names for nitroglycerin may include:
® ® ®
· Drug name Nitrolingual Spray , Nitrobid , Nitrostat

· Integrity of container/medication · Integrity of container/medication - Make sure container is NOT

broken and tablet is whole
· Concentration/Dose
· Concentration/Dose - dose of nitroglycerin is 0.4mg (grain
· Clarity 1/150) per tablet. (Concentration only refers to liquid form of
medications.)
· Expiration date
· Clarity - not applicable to tablets or unable to see liquid in spray
container
♦ Check the six “rights” of patients

right patient · Expiration date - not to be administered after this date

right drug It is important to always check the six “rights” to

ensure proper administration of medication in a correct
right amount/dose and safe method.

right route

right time

ƒ right documentation

♦ Prepare Medication: Tablet

Tablet · Make sure that tablet is intact for administration of

correct dose.
· Remove tablet from container and check that it is
intact · DO NOT contaminate medication. Pour tablet into lid of
container then into the palm for administration. Gloves should
Spray be worn when administering nitroglycerin.

· Remove top of spray canister Spray

· One spray delivers 0.4mg of nitroglycerin. DO NOT shake

container or it will alter the dose.

· Ensure that spray opening is pointed toward patient

♦ Remove oxygen mask and instruct patient to

open mouth and lift tongue

71
KCEMT
EMT 1Model Curriculum
Nitroglycerine Administration Skill: Instructor Resource
 ♦ Administer medication: Tablet

Tablet · If patient swallows the tablet it will change the absorption rate
and the amount of drug absorbed. Sublingual absorption is
· Place tablet under patient’s tongue faster than gastrointestinal absorption.

· Instruct patient to allow tablet to dissolve and NOT Spray

to swallow
· If patient inhales the spray it will change the absorption rate
Spray and the amount of drug absorbed. Sublingual absorption is
faster and more accurate than inhaling medication into lungs.
· Deliver one spray sublingually or transmucosal

· Instruct patient NOT to inhale spray

♦ Replace oxygen mask

♦ Reassess blood pressure and pain response in 5 · Use the pain scale of mild, moderate, severe or the 1-10 scale.
minutes

** Place patient in shock position - if indicated

· Nitroglycerin may cause hypotension due to vasodilation.

Always take blood pressure before administration and 5
minutes after administration.

· In life-threatening situations, an ALS Unit must be enroute or

BLS should consider transport if ALS arrival is longer
than transport time.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment priority patients.

· Relevant portion of the focused assessment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Evaluate response to treatment changes in the patient’s condition are anticipated sooner.

· Compare results to baseline condition and vital · Priority patients are patients who have abnormal vital signs,
signs signs/symptoms of poor perfusion or if there is a suspicion that
the patient’s condition may deteriorate.

72
KCEMT
EMT 1Model Curriculum
Nitroglycerine Administration Skill: Instructor Resource
 DOCUMENTATION

§ Verbalize/Document · Documentation on an approved Prehospital Care Report.

· Assessment findings before and after administration . Follow local Policies and Protocols.

· Blood pressure before administration

· Drug

- name

- dose

- route

- site

- time

- who administered medication

· Patient’s response to medication

· Blood pressure 5 minutes after administration

73
KCEMT
EMT 1Model Curriculum
Nitroglycerine Administration Skill: Instructor Resource
 EMT 1SKILL

MEDICATION ADMINISTRATION
NITROGLYCERIN
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in recognizing the indications, contraindications, criteria, and assist the patient with
the administration of the prescribed medication nitroglycerin.
CONDITION
The examinee will be requested to establish that a simulated patient complaining of substernal chest discomfort meets the criteria
for administration of nitroglycerin and will assist the patient by administering either the nitroglycerin spray or tablet or two
different patients may be selected to demonstrate both methods of administration. Necessary equipment will be adjacent to the
simulated patient.
EQUIPMENT
Simulated patient, oxygen tank with a flow meter, oxygen mask, blood pressure cuff, stethoscope, placebo nitroglycerin spray and
tablets, timing device, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Complete an initial assessment and pertinent vital

signs:

· General impression

· Life-threatening condition

· Assess mental status/stimulus response (AVPU)

· Assess/Manage airway

· Assess/Manage breathing

· Blood pressure

** Administer 100% oxygen

** Obtain blood pressure

74
KCEMT
EMT 1Model Curriculum
Nitroglycerine Administration Skill: Student
 Skill Component Yes No Comments

♦ Verbalize the indications for administration of

nitroglycerin:

· Symptoms of chest pain/discomfort

· Systolic blood pressure > 100mm/Hg

♦ Verbalize the contraindications for administration of

nitroglycerin:

· Patient does not meet indication or criteria for

administration

· Patient has taken 3 doses before EMS arrival

within the last 5 minutes

· Last dose was < 5 minutes ago

· Systolic blood pressure < 100mm/Hg

®
· Administration of Sildenafil citrate (Viagra ) or
similar medication within 24 hours

PROCEDURE

NITROGLYCERIN TABLET OR SPRAY

♦ Check medication for:

· Drug name

· Integrity of container/medication

· Concentration/Dose

· Clarity

· Expiration date

♦ Check the six “rights” of patients

right patient

right drug

right amount/dose

right route

right time

right documentation

75
KCEMT
Advanced Model Curriculum
Nitroglycerine Administration Skill: Student
 Skill Component Yes No Comments

♦ Prepare Medication:

Tablet

· Remove tablet from container and check that it is

intact

Spray

· Remove top of spray canister

♦ Remove oxygen mask and instruct patient to

open mouth and lift tongue

♦ Administer medication:

Tablet

· Place tablet under patient’s tongue

· Instruct patient to allow tablet to dissolve and NOT

to swallow

Spray

· Deliver one spray sublingually or transmucosal

· Instruct patient NOT to inhale spray

♦ Replace oxygen mask

♦ Reassess blood pressure and pain response in 5

minutes

** Place patient in shock position - if indicated

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

76
KCEMT
EMT 1Model Curriculum
Nitroglycerine Administration Skill: Student
 Skill Component Yes No Comments

DOCUMENTATION

§ Verbalize/Document

· Assessment findings before and after administration

· Blood pressure before administration

· Drug

- name

- dose

- route

- site

- time

- who administered medication

· Patient’s response to medication

· Blood pressure 5 minutes after administration

77
KCEMT
EMT 1Model Curriculum
Nitroglycerine Administration Skill: Student
 EMT 1SKILL INSTRUCTOR

RESOURCE
ORAL MEDICATION ADMINISTRATION
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in administering a medication orally.
CONDITION
The examinee will be requested to appropriately administer an oral medication.
EQUIPMENT
Gloves, medication tablet or liquid, medicine cup.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions

♦ Confirm drug order Check medication

for:

Drug name

Integrity of container/medication

Concentration/Dose

Clarity

Expiration date

Check the six “rights” of patients

right patient

right drug

right amount/dose

right route

right time

right documentation

♦ Ask if patient has any allergies.

♦ Explain procedure to patient. Reassure patient and explain the reason for the procedure.

78
KCEMT
EMT 1Model Curriculum
Oral Medication Administration Skill: Instructor Resource
 This will help calm the patient and improve cooperation.

♦ Gather any necessary equipment – medicine cup,

syringe.

♦ Prepare medication if necessary. Mix liquid

medication if necessary.

♦ Have your patient sit upright if not contraindicated.

PROCEDURE

♦ Uncap container and removed the correct amount of

medication.

♦ If a liquid medication is being given, pour the correct

amount of liquid in a calibrated medicine cup.

♦ Place the medication into your patient’s mouth. Allow self-administration when possible. Assist the
patient when needed.

♦ Give the patient 4-8 ounces of water or other liquid

and direct the patient to swallow the tablet.

♦ When giving a liquid medication, instruct the patient

to swallow the liquid.

♦ Ensure the patient has swallowed the medication. Sometimes it is necessary to check with the patient to
make sure the medication is not hidden in their mouth and
they have swallowed the medication.

♦ Dispose of any containers appropriately.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

Initial assessment

Relevant portion of the focused assessment

Evaluate response to treatment

Compare results to baseline condition and

vital signs

79
KCEMT
EMT 1Model Curriculum
Oral Medication Administration Skill: Instructor Resource
 DOCUMENTATION

§ Document: ƒ Documentation must be on an approved prehospital

care report form. Follow local policies and protocols.
ƒ Medication

ƒ Dosage

ƒ Route

ƒ Time and date

80
KCEMT
EMT 1Model Curriculum
Oral Medication Administration Skill: Instructor Resource
 EMT 1SKILL

ORAL MEDICATION ADMINISTRATION

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in administering a medication orally.
CONDITION
The examinee will be requested to appropriately administer an oral medication.
EQUIPMENT
Gloves, medication, tablet or liquid, medicine cup.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

1st 2nd 3rd (final)

PASS FAIL

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Confirm drug order

♦ Ask if patient has any allergies

♦ Explain procedure to patient

♦ Gather any necessary equipment – medicine cup,

syringe.

Prepare medication if necessary. Mix liquid

medication if necessary.

♦ Have your patient sit upright if not contraindicated.

PROCEDURE

♦ Uncap container and removed the correct amount of

medication.

♦ If a liquid medication is being given, pour the correct

amount of liquid in a calibrated medicine cup.

81
KCEMT
EMT 1Model Curriculum
Oral Medication Administration Skill: Student
 Skill Component Yes No Comments

♦ Place the medication into your patient’s mouth.

♦ Give the patient 4-8 ounces of water or other liquid

and direct the patient to swallow the tablet.

♦ When giving a liquid medication, instruct the patient

to swallow the liquid.

♦ Ensure the patient has swallowed the medication.

♦ Dispose of any containers appropriately.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

Initial assessment

Relevant portion of the focused assessment

ƒ Evaluate response to treatment

ƒ Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

ƒ Medication

ƒ Dosage

ƒ Route

ƒ Time and date

82
KCEMT
EMT 1Model Curriculum
Oral Medication Administration Skill: Student
 EMT 1SKILL INSTRUCTOR

RESOURCE
SALINE LOCK INSERTION
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in establishing a saline lock, administer an IVP medication and IV fluid administration
on a manikin arm.
CONDITION
The examinee will be requested to appropriately establish a saline lock, administer an IVP medication and IV fluid administration
on a manikin arm appropriately
EQUIPMENT
Gloves, goggles, IV infusion arm, saline lock, IV catheters, tape, gauze pads, syringes with 3-5 cc sterile saline, tourniquet,
alcohol preps, packaged medication, transfer needles or needleless device, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions · Mandatory personal protective equipment.

♦ Explain the procedure to the patient · Describe the procedure to the patient and what the patient
can expect to feel.
· Explain the need for the saline lock
· Understanding the procedure will help alleviate some of the
· Ask if the patient has any allergies patient’s anxiety. Anxiety can lead to a vasomotor response
or venous constriction.

· Pediatric patients may have unrealistic fears.

♦ Select the venipuncture site · Acceptable sites have clearly visible veins.

· Free of bruising or scarring.

· Avoid areas of vein where a valve is situated.

· Avoid veins that roll, feels hard or ropelike.

♦ Select appropriate IV catheter

83
KCEMT
EMT 1Model Curriculum
Saline Lock Skill: Instructor Resource
 Skill Component Teaching Points

PROCEDURE

♦ Apply Tourniquet · The tourniquet should be tied smoothly and snugly.

· The tourniquet should be kept as slat as possible.

· Avoid keeping in place for more than 2 minutes.

· A tourniquet that is too tight will impede arterial flow. Feel

for the patient’s radial pulse, if absent, the tourniquet is too
tight.

· Release the tourniquet as soon as the catheter is placed in

vein and blood samples drawn (if applicable). Bruising may
occur if tourniquet is kept in place too long.

♦ Cleanse the site appropriately · Cleanse the site with povidone-iodine or alcohol wipe.

· Start at the site itself and work outward in an expanding

circle. This pushes pathogens away from the puncture site.

· Allow the area to dry before penetrating the skin.

· It may be necessary to shave the hair around the site to

provide better adherence of the tape to secure the catheter

♦ Performs venipuncture · With the non-dominant hand, pull skin taut to stabilze the
vein and prevent rolling.
· Inserts stylet
· With the distal bevel of the metal stylet up, insert into vein at
· Notes flashback a 10 to 30 degree angle. Do not touch any portion of the
catheter, a contaminated catheter is not usable.
. Occludes vein proximal to catheter
· Continue until you feel a “pop” into the vein or see a
. Removes stylet flashback.

· Disposes needle into an approved container · Advance the catheter over the needle into the vein. (If you
meet resistance, do not force, withdraw the needle and
catheter as a unit.)
· Releases tourniquet
· Place a finger over the vein beyond the catheter tip to apply
pressure to prevent blood from flowing from the catheter or
air entering.

· Carefully remove the metal stylet and promptly dispose into

an approved disposable container.

· Release tourniquet

♦ Attach heparin lock tubing to the angiocatheter hub

♦ Cleanse the medication port and inject 3-5 ml of . Patency is indicated by easy flow of the saline and no edema
sterile saline into the lock. or swelling at the puncture site.

. If you meet resistance or edema occurs at the site, remove

catheter and restart the procedure with new equipment.

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KCEMT
EMT 1Model Curriculum
Saline Lock Skill: Instructor Resource
 Skill Component Teaching Points

♦ Apply antibiotic ointment to the site and cover with · Follow local protocol.
an adhesive bandage or other commercial device.

IVP MEDICATION ADMINISTRATION

♦ Confirm the medication to be given, indication,

dose.

♦ Draw up medication or prepare a prefilled syringe

as appropriate.

♦ Cleanse the injection port with an alcohol wipe.

♦ Insert the needle of a syringe or needleless device . If resistance is met during aspiration, or the patient complains
with 3 cc of saline to injection port. of pain or discomfort, or there is signs of infiltration, remove
the saline lock and replace the saline lock in another location.
♦ Aspirate for blood return.
. If none of the signs above are present you may go ahead and
♦ If blood returns, slowing start injecting the flush administer the medication.
solution.

♦ Slowly inject the medication into the injection port.

♦ Follow the medication with a 3 cc sterile saline flush.

♦ Dispose of the syringes appropriately.

IV FLUID ADMINISTRATION

♦ Prepare the appropriate IV solution and tubing.

♦ Cleanse the injection port with an alcohol wipe.

♦ Attach IV tubing to saline lock with an 18 g needle, or

needleless device.

♦ Set the appropriate IV flow rate and tape securely in

place.

♦ Dispose of equipment using an approved container.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment priority patients.

· Relevant portion of the focused assessment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Evaluate response to treatment changes in the patient’s condition are anticipated sooner.

· Compare results to baseline condition and vital · Priority patients are patients who have abnormal vital signs,
signs signs/symptoms of poor perfusion or if there is a suspicion that
the patient’s condition may deteriorate.

85
KCEMT
EMT 1Model Curriculum
Saline Lock Skill: Instructor Resource
 Skill Component Teaching Points

DOCUMENTATION

§ Document: · Documentation must be on an approved prehospital care

report form. Follow local policies and protocols.
· Location

· Size of catheter

· Time and date

. IV fluid

. Medication, route and dosage

86
KCEMT
EMT 1Model Curriculum
Saline Lock Skill: Instructor Resource
 EMT 1SKILL

SALINE LOCK INSERTION

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in establishing a saline lock, administer an IVP medication and IV fluid administration
on a manikin arm.
CONDITION
The examinee will be requested to appropriately establish a saline lock, administer an IVP medication and IV fluid administration
on a manikin arm appropriately
EQUIPMENT
Gloves, goggles, IV infusion arm, saline lock, IV catheters, tape, gauze pads, syringes with 3-5 cc sterile saline, tourniquet,
alcohol preps, packaged medication, transfer needles or needleless device, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Explain the procedure to the patient

· Explain the need for the IV

· Ask if the patient has any allergies

♦ Select the venipuncture site

♦ Select appropriate IV catheter

PROCEDURE

♦ Apply Tourniquet

♦ Cleanse the site appropriately

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KCEMT
EMT 1Model Curriculum
Saline Lock Skill: Student
 Skill Component Yes No Comments

♦ Performs venipuncture

· Inserts stylet

· Notes flashback

. Occludes vein proximal to catheter

. Removes stylet

· Disposes needle into an approved container

· Releases tourniquet

. Connects IV tubing to catheter

♦ Attach heparin lock tubing to the angiocatheter hub

♦ Cleanse the medication port and inject 3-5 ml of

sterile saline into the lock.

♦ Apply antibiotic ointment to the site and cover with

an adhesive bandage or other commercial device.

IVP MEDICATION ADMINISTRATION

♦ Confirm the medication to be given, indication,

dose.

♦ Draw up medication or prepare a prefilled syringe

as appropriate.

♦ Cleanse the injection port with an alcohol wipe.

♦ Insert the needle of a syringe or needleless device

with 3 cc of saline to injection port.

♦ Aspirate for blood return.

♦ If blood returns, slowing start injecting the flush

solution.

♦ Slowly inject the medication into the injection port.

♦ Follow the medication with a 3 cc sterile saline flush.

♦ Dispose of the syringes appropriately.

IV FLUID ADMINISTRATION

♦ Prepare the appropriate IV solution and tubing.

♦ Cleanse the injection port with an alcohol wipe.

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KCEMT
EMT 1Model Curriculum
Saline Lock Skill: Student
 Skill Component Yes No Comments

Attach IV tubing to saline lock with an 18 g needle, or

needleless device.

♦ Set the appropriate IV flow rate and tape securely in

place.

♦ Dispose of equipment using an approved container.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

· Location

· Size of catheter

· Time and date

. IV fluid

. Medication, route and dosage

89
KCEMT
EMT 1Model Curriculum
Saline Lock Skill: Student
 EMT 1SKILL INSTRUCTOR

RESOURCE
SUBCUTANEOUS INJECTION
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in administering a subcutaneous injection.
CONDITION
The examinee will be requested to appropriately administer a subcutaneous injection.
EQUIPMENT
Gloves, injection manikin, syringes (various sizes), alcohol preps, sterile gauze, package medication, approved sharps
container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions

♦ Confirm drug order · Check medication for:

· Drug name

· Integrity of container/medication

· Concentration/Dose

· Clarity

· Expiration date

· Check the six “rights” of patients

right patient

right drug

right amount/dose

right route

right time

· right documentation

♦ Ask if patient has any allergies

90
KCEMT
EMT 1Model Curriculum
Subcutaneous Injection Skill: Instructor Resource
 Skill Component Teaching Points

♦ Explain procedure to patient · Reassure patient and explain the reason for the procedure.
This will help calm the patient and improve cooperation.

♦ Select appropriate site and verify landmarks · Sites should be free of superficial blood vessels, nerves,
tendons, Avoid areas with tattoos or bruising.
· Prepare site using aseptic techniques
· Cleanse the site with alcohol wipe.

· Start at the site itself and work outward in an expanding

circle. This pushes pathogens away from the puncture site.

· Allow the area to dry before penetrating the skin.

♦ Select the appropriate syringe and withdraw 0.5 cc

of medication.

PROCEDURE

♦ Remove cap from needle without contamination.

♦ Pinch skin around injection site with non-dominant

hand without contaminating the site.

♦ Insert needle at 45 degree angle with bevel up.

· Aspirate and observe for blood return (if positive

for blood returen, discontinue procedure and
begin again in another location)

♦Slowly inject medication.

♦ Apply circular pressure with alcohol prep and · Gentle circular pressure will help to disperse and absorb
quickly withdraw needle. medication.

· Apply direct pressure over injection site.

· Apply bandage if needed.

♦ Dispose syringe using appropriate technique.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment priority patients.

· Relevant portion of the focused assessment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Evaluate response to treatment changes in the patient’s condition are anticipated sooner.

· Compare results to baseline condition and vital · Priority patients are patients who have abnormal vital signs,
signs signs/symptoms of poor perfusion or if there is a suspicion that
the patient’s condition may deteriorate.

91
KCEMT
EMT 1Model Curriculum
Subcutaneous Injection Skill: Instructor Resource
 Skill Component Teaching Points

DOCUMENTATION

§ Document: · Documentation must be on an approved prehospital care

report form. Follow local policies and protocols.
· Medication

· Dosage

· Route

· Location

· Time and date

92
KCEMT
EMT 1Model Curriculum
Subcutaneous Injection Skill: Instructor Resource
 EMT 1SKILL

SUBCUTANEOUS INJECTION
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in administering a subcutaneous injection.
CONDITION
The examinee will be requested to appropriately administer a subcutaneous injection.
EQUIPMENT
Gloves, injection manikin, syringes (various sizes), alcohol preps, sterile gauze, packaged medication, approved sharps
container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Confirm drug order

♦ Ask if patient has any allergies

♦ Explain procedure to patient

♦ Select appropriate site and verify landmarks

· Prepare site using aseptic techniques

♦ Select the appropriate syringe and withdraw 0.5 cc

of medication

PROCEDURE

♦ Remove cap from needle without contamination.

♦ Pinch skin around injection site with non-dominant

hand without contaminating the site.

93
KCEMT
EMT 1Model Curriculum
Subcutaneous Injection Skill: Student
 Skill Component Yes No Comments

♦ Insert needle at 45 degree angle with bevel up.

· Aspirate and observe for blood return (if positive

for blood return, discontinue procedure and
begin again in another location)

♦ Slowly inject medication.

♦ Apply circular pressure with alcohol prep and

quickly withdraw needle.

· Apply direct pressure over injection site.

· Apply bandage if needed

♦ Dispose syringe using appropriate technique.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

· Location

· Medication

· Dose

· Time and date

. Route

94
KCEMT
EMT 1Model Curriculum
Subcutaneous Injection Skill: Student
 EMT 1SKILL

INSTRUCTOR RESOURCE

WITHDRAWAL OF MEDICATION FROM AMPULE OR VIAL

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in withdrawing a medication from an ampule and vial for in preparation of
administering a medication.
CONDITION
The examinee will be requested to appropriately withdraw a medication from an ampule and vial for in preparation
of administering a medication.
EQUIPMENT
Gloves, syringes (various sizes), alcohol preps, packaged medications, approved sharps containe r.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond ( ) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PROCEDURE - AMPULE

Take body substance isolation precautions

Confirm drug order · Check medication for:

Select appropriate drug · Drug name

Ask if patie nt has any allergies · Integrity of container/medication

· Concentration/Dose

· Clarity, Color

· Expiration date

· Check the six “rights” of patients

right patient

right drug

right amount/dose

right route

right time

· right documentation

95
KCEMT
EMT 1Model Curriculum
Medication Withdrawal Skill: Instructor Resource
 Skill Component Teaching Points

Shake the ampule or tap the stem and top to shift

the fluid to the bottom.

Place a gauze square or alcohol wipe over the · Protect your fingers with the gauze or wipe.
ampule’s neck and snap the top off.
. Once ampule is opened, the contents must be used or
discarded, the contents can not be kept sterile.

Remove cap from needle and insert the needle into

the open ampule without touching the sides, and
draw up the medication into the syringe.

Invert the syringe (needle pointing up) and tap the

syringe barrel to get the air bubbles to the top.

Push on the plunger to expel any trapped air.

Recap the needle, being careful not to contaminate it.

PROCEDURE - VIAL

Take body substance isolation precautions

Confirm drug order · Check medication for:

Select appropriate drug · Drug name

Ask if patient has any allergies · Integrity of container/medication

· Concentration/Dose

· Clarity, Color

· Expiration date

· Check the six “rights” of patients

right patient

right drug

right amount/dose

right route

right time

right documentation

Clean the rubber stopper with an alcohol wipe.

96
KCEMT
EMT 1Model Curriculum
Medication Withdrawal Skill: Instructor Resource
 Skill Component Teaching Points

Remove cap from needle, invert the vial.

Insert the needle through the rubber stopper and

inject the appropriate a mount of air into vial

Withdrawal the desired amount of medication from

the vial. Remove the needle from the vial

Invert the syringe (needle pointing up) and tap the

syringe barrel to get the air bubbles to the top.

Push on the plunger to expel any trapped air.

Recap the needle, being careful not to contaminate it.

Reconfirm the drug, type, concentration, and dose.

DOCUMENTATION

§ Document: · Documentation must be on an approved prehospital care

report form. Follow local policies and protocols.
· Medication

· Dosage

· Route

· Location

· Time and date

97
KCEMT
EMT 1Model Curriculum
Medication Withdrawal Skill: Instructor Resource
 EMT 1SKILL

WITHDRAWAL OF MEDICATION FROM AMPULE OR VIAL

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in withdrawing a medication from an ampule and vial for in preparation of
administering a medication.
CONDITION
The examinee will be requested to appropriately withdraw a medication from an ampule and vial for in preparation of
administering a medication.
EQUIPMENT
Gloves, syringes (various sizes), alcohol preps, packaged medications, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PROCEDURE - AMPULE

♦ Take body substance isolation precautions

♦ Confirm drug order

♦ Select appropriate drug

♦ Ask if patient has any allergies

♦ Shake the ampule or tap the stem and top to shift

the fluid to the bottom.

♦ Place a gauze square or alcohol wipe over the

ampule’s neck and snap the top off.

♦ Remove cap from needle and insert the needle into

the open ampule without touching the sides, and
draw up the medication into the syringe.

♦ Invert the syringe (needle pointing up) and tap the

syringe barrel to get the air bubbles to the top.

♦ Push on the plunger to expel any trapped air.

♦ Recap the needle, being careful not to contaminate

98
KCEMT
EMT 1Model Curriculum
Medication Withdrawal Skill: Student
 Skill Component Yes No Comments
it.

PROCEDURE - VIAL

♦ Take body substance isolation precautions

♦ Confirm drug order

♦ Select appropriate drug

♦ Ask if patient has any allergies

♦ Clean the rubber stopper with an alcohol wipe.

♦ Remove cap from needle, invert the vial.

♦ Insert the needle through the rubber stopper and

inject the appropriate amount of air into vial.

♦ Invert the syringe (needle pointing up) and tap the

syringe barrel to get the air bubbles to the top.

♦ Push on the plunger to expel any trapped air.

♦ Recap the needle, being careful not to contaminate

it.

♦ Reconfirm the drug, type, concentration, and dose.

DOCUMENTATION

§ Document:

· Medication

· Dosage

· Route

· Location

. Time and date

99
KCEMT
EMT 1Model Curriculum
Medication Withdrawal Skill: Student
Module 2
 MODULE 2:
AIRWAY MANAGEMENT

Number of Lecture Hours: 2 Hours

Topics:

1. Airway Management and Ventilation 2 Hours

Labs/Workshops: Number of Hours: 3 Hours

1. Airway Lab 3 Hours

Testing: 2 Hours

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 1
 MODULE 2:
AIRWAY MANAGEMENT

MODULE TERMINAL OBJECTIVES:

At the completion of this module the EMT 1student will be able to successfully:

1. Establish and maintain a patent airway using basic life support and advanced life
support measures.

2. Establish and maintain a patent airway, oxygenate, and ventilate a patient.

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 2
MODULE 2: AIRWAY MANAGEMENT

Topic: AIRWAY MANAGEMENT AND VENTILATION

Purpose:

This topic will give the EMT 1student an understanding and techniques of
airway management and ventilation.

Suggested Time Frame: 2 Hours

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will
be able to successfully:

1. Explain the primary objective of airway maintenance.

2. Identify the anatomy and describe the functions of the upper airway.

3. Identify the anatomy and describe the functions of the lower airway.

4. List factors that affect respiratory rate and depth.

5. Define normal respiratory rates for adult, child, and infant.

6. Discuss the causes of respiratory distress.

7. Describe a tracheostomy, stoma, and tracheostomy tube.

8. Describe the indications, contraindications, advantages, disadvantages,

complications, and technique for ventilating a patient by the bag-valve-mask.

9. Discuss the indications and techniques for suctioning the upper airway.

10. Describe how to ventilate and suction a patient with a stoma.

11. Describe the indications, contraindications, advantages, disadvantages,

complications, and technique for inserting an oropharyngeal and nasopharyngeal
airways.

12. Describe the indications, contraindications, advantages, disadvantages,

complications, and technique for using the dual lumen airway.

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 3
AIRWAY MANAGEMENT AND VENTILATION
continued

13. Describe the special considerations in airway management and ventilation for
patients with facial injuries.

14. Describe the special considerations in airway management and ventilation for
pediatric patients.

15. Describe the necessity of establishing and/or maintaining patency of a patient’s

airway.

16. Demonstrate the proper technique of ventilating a patient with a bag-valve-mask.

17. Demonstrate the proper technique of suctioning the upper airway.

18. Demonstrate the proper technique of suctioning a stoma.

19. Demonstrate the proper technique of inserting an oropharyngeal and

nasopharyngeal airways.

20. Demonstrate the proper technique to ventilate a pediatric patient.

21. Demonstrate the proper technique to insert a dual lumen airway.

22. Perform an assessment to confirm correct placement of a dual lumen airway.

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 4
DECLARATIVE
MODULE 2: AIRWAY MANAGEMENT
AIRWAY MANAGEMENT AND VENTILATION

I. Introduction
A. The body's need for oxygen
B. Primary objective of emergency care
1. Ensure optimal ventilation
a. Delivery of oxygen
b. Elimination of CO2
C. Brain death occurs within 6 to 10 minutes
D. Major prehospital causes of preventable death
1. Early detection
2. Early intervention
3. Lay-person BLS education
E. Most often neglected of prehospital skills
1. Basics taken for granted
2. Poor techniques
a. BVM seal
b. Improper positioning
c. Failure to reassess

II. Anatomy of Upper Airway

A. Pharynx
1. Nasopharynx
2. Orophayrnx
B. Larynx

III. Anatomy of Lower Airway

A. Trachea
B. Bronchi
C. Bronchioles
D. Alveoli
E. Lungs
F. Pleura

IV. Airway evaluation

A. Essential parameters
1. Rate
a. Normal resting rate in:
(1) Adult
(2) Child
(3) Infant
2. Regularity

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 5
AIRWAY MANAGEMENT AND VENTILATION
continued

a. Steady pattern
b. Irregular respiratory patterns are significant until proven otherwise
3. Effort
a. Breathing at rest should be effortless
b. Effort changes may be subtle in rate or regularity
c. Patients often compensate by preferential positioning
(1) Upright sniffing
(2) Semi-Fowlers
(3) Frequently avoid supine
B. Recognition of airway problems
1. Respiratory distress
a. Upper and lower airway obstruction
b. Inadequate ventilation
c. Impairment of the respiratory muscles
d. Impairment of the nervous system
2. Difficulty in rate, regularity, or effort is defined as dyspnea
3. Dyspnea may be the result of or result in hypoxia
a. Hypoxia -lack of oxygen
b. Hypoxemia -lack of oxygen to tissues
c. Anoxia -total absence of oxygen
4. Recognition and treatment of dyspnea is crucial to patient survival
a. Expert assessment and management is essential
(1) The brain can survive only a few minutes of anoxia
(2) All therapies fail if airway is inadequate
5. Visual techniques
a. Position
(1) Tripod positioning
(2) Orthopnea
b. Rise and fall of chest
c. Gasping
d. Color of skin
e. Flaring of nares
f. Pursed lips
g. Retraction
(1) Intercostal
(2) Suprasternal notch
(3) Supraclavicular fossa
(4) Subcostal
6. Auscultation techniques
a. Air movement at mouth and nose
b. Bilateral lung fields equal

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 6
AIRWAY MANAGEMENT AND VENTILATION
continued

7. Palpation techniques
a. Air movement at mouth and nose
b. Chest wall
(1) Paradoxical motion
(2) Retractions
8. Bag-valve-mask
a. Resistance or changing compliance with bag-valve-mask ventilations
9. History
a. Evolution
(1) Sudden
(2) Gradual over time
(3) Known cause or "trigger"
b. Duration
(1) Constant
(2) Recurrent
c. Ease -what makes it better?
d. Exacerbate -what makes it worse?
e. Associate
(1) Other symptoms (productive cough, chest pain, fever, etc.)
f. Interventions
(1) Evaluations/ admissions to hospital
(2) Medications (include compliance)

V. Ventilation
A. Bag-Valve-Mask
1. Fixed volume self-inflating bag can deliver adequate tidal volumes and O2
enrichment
2. Indications
a. Apnea from any mechanism
b. Unsatisfactory respiratory effort
3. Contraindication
a. Awake, intolerant patients
4. Advantages
a. Excellent blood / body fluid barrier
b. Good tidal volumes
c. Oxygen enrichment
d. Rescuer can ventilate for extended periods without fatigue
5. Disadvantages
a. Difficult skill to master
b. Mask seal may be difficult to obtain and maintain
c. Tidal volume delivered is dependent on mask seal integrity

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 7
AIRWAY MANAGEMENT AND VENTILATION
continued

6. Complications
a. Inadequate tidal volume delivery with
(1) Poor technique
(2) Poor mask seal
(3) Gastric distention
7. Method for use
a. Position appropriately
b. Choose proper mask size -seats from bridge of nose to chin
c. Position, finger spread / mold / seal mask
d. Hold mask in place
e. Squeeze bag completely over 1.5 to 2 seconds for adults
f. Avoid overinflation,
g. Reinflate completely over several seconds
8. Special considerations
a. Medical
(1) Observe for:
(a) Gastric distension
(b) Changes in compliance of bag with ventilation
(c) Improvement or deterioration of ventilation status (i.e., color change,
responsiveness, air leak around mask)
b. Trauma
(1) Very difficult to perform with cervical spine immobilization in place

VI. Airway Management

A. Multi-lumen airways
1. Combitube
a. Pharyngeal and endotracheal tube molded into a single unit
b. Indication
(1) Alternative airway control when conventional intubation measures are
unsuccessful or unavailable
c. Contraindications
(1) Children too small for the tube
(2) Esophageal trauma or disease
(3) Caustic ingestion
d. Advantages
(1) Rapid insertion
(2) No special equipment
(3) Does not require sniffing position
e. Disadvantages
(1) Impossible to suction trachea when tube is in esophagus
(2) Adults only
(3) Unconscious only

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 8
AIRWAY MANAGEMENT AND VENTILATION
continued

(4) Very difficult to intubate around

f. Method
(1) Head -neutral position
(2) Pre-intubation precautions
(3) Insert with jaw-lift at midline
(4) Inflate pharyngeal cuff with 100 cc's of air
(5) Inflate distal cuff with 10-15 cc's of air
(6) Ventilate through longest tube first (pharyngeal)
(a) Chest rise indicates esophageal placement of distal tip
(b) No chest rise indicates tracheal placement, switch ports and ventilate
g. Special considerations
(1) Good assessment skills are essential to confirm proper placement
(2) Mis-identification of placement has been reported
(3) Reinforce multiple confirmation techniques

VII. Special patient considerations

A. Airway Management Considerations for Patients with Facial Injuries
1. Facial injuries lend to a high suspicion of cervical spine injury
a. In-line stabilization
(1) Trauma technique same as endotracheal intubation
2. Foreign body/ blood in oropharynx
a. Suction airway
3. Inability to ventilate/ intubate orally
a. May require surgical intervention

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 9
MODULE 2: AIRWAY MANAGEMENT

Topic: AIRWAY MANAGEMENT AND VENTILATION LAB

Purpose:

This lab will give the EMT 1student the techniques of airway management
and ventilation.

Suggested Time Frame: 3 Hours

Objectives:

At the conclusion of this lab, the EMT 1student as an active participant will be
able to successfully:

1. Demonstrate the proper technique of ventilating a patient with a bag-valve-mask.

2. Demonstrate the proper technique of suctioning the upper airway.

3. Demonstrate the proper technique of suctioning a stoma.

4. Demonstrate the proper technique of inserting an oropharyngeal and

nasopharyngeal airways.

5. Demonstrate the proper technique to ventilate a pediatric patient.

6. Demonstrate the proper technique to insert a dual lumen airway.

7. Perform an assessment to confirm correct placement of a dual lumen airway.

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 10
MODULE 2: AIRWAY MANAGEMENT
AIRWAY MANAGEMENT LAB

The EMT 1student in a lab setting with an instructor will demonstrate the
following skillseither as a single skill or in a scenario based demonstration.

I. Demonstrate ventilation with a bag-valve-mask.

A. Proper BSI precautions
B. Select appropriate size mask and bag
C. Assemble bag-valve-mask
D. Connect oxygen source
E. Turn oxygen to deliver 15L/min
F. Open airway
G. Insert OPA or NPA
H. Secure mask over mouth and nose, with a tight seal
I. Ventilate patient with appropriate tidal volume
J. Reassess patient
K. Documentation

II. Demonstrate the proper technique of suctioning the upper airway.

A. Proper BSI precautions
B. Check equipment, ensure proper functioning
C. Hyperventilate patient with 100% oxygen
D. Determine depth of catheter insertion by measuring from patient’s earlobe
to lips.
E. With suction turned off, insert catheter into patient’s pharynx to
predetermined depth.
F. Turn on suction unit and place thumb over suction control orifice
G. Suction while withdrawing catheter, no more than 10 seconds
H. Hyperventilate patient with 100% oxygen
I. Reassess patient
J. Documentation

III. Demonstrate the proper technique of suctioning a stoma.

A. Proper BSI
B. Check equipment, ensure proper functioning
C. Hyperventilate patient with 100% oxygen
D. Turn on suction machine, select soft catheter
E. If mucus is thick, inject 3-5 cc of normal saline through stoma to break up
the mucus plug
F. With thumb off air vent, insert catheter through stoma until resistance is
met
G. Place thumb over air vent, withdrawing and rotating catheter
H. Maximum suction time 10 seconds for adults, 5 second for pediatrics

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 11
AIRWAY MANAGEMENT LAB
continued

I. Hyperventilate patient with 100% oxygen

J. Reassess patient
K. Documentation

IV. Demonstrate the proper technique of inserting an oropharyngeal and

nasopharyngeal airways.

A. Oropharyngeal airway
1. Proper BSI
2. Open airway – head tilt/chin lift or jaw thrust
3. Select proper size of OPA – from corner of mouth to earlobe, or
from the corner of the mouth to the angle of the jaw
4. Open patient’s mouth using cross-finger technique
5. Insert the airway, with tip pointing towards roof of mouth, slide
along the roof of the mouth, past the uvula or until resistance is
met. Be careful not to push tongue back
6. Gently rotate the airway 180 degrees. Continue until airway lies flat
on tongue and flange rest against the patient’s mouth
7. Reassess patient’s airway and begin ventilations as necessary
8. Documentation
B. Nasopharyngeal airway
1. Proper BSI
2. Open airway – head tilt/chin lift or jaw thrust
3. Select proper size of OPA – from tip of nose to earlobe
4. Apply a water-soluble lubricant
5. Open patient’s mouth using cross-finger technique
6. Gently insert the airway bevel pointing toward nasal septum.
Advance the tip directed along floor of nasal cavity
7. Advance until flange rests against the patient’s nostril. Tip should
be in the nasopharynx
8. Reassess patient’s airway and breathing
9. Documentation

V. Demonstrate the proper technique to ventilate a pediatric patient.

A. Proper BSI
B. Position the patient properly using an appropriate airway maneuver
C. Insert an OPA or NPA if appropriate
D. Select the appropriate mask size
1. The proper size fits from bridge of nose to cleft of the chin
2. Broselow Tape can be used to determine size
3. Proper size and adequate seal is important

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 12
AIRWAY MANAGEMENT LAB
continued

4. Flat nasal bridge makes it challenging for an adequate mask seal

E. Place mask on patient’s face with narrow end (apex) over bridge of nose
and wide end (base) in the groove between lower lip and chin. Avoid
compressing the patient’s eyes
F. Using one hand, place your thumb on the mask at the apex and index
finger on the mask at the chin (C-grip).
1. Chin-lift maneuver should be used when ventilating if no cervical
trauma is suspected. Infants use the sniffing position.
G. With gentle pressure, push down on mask to establish an adequate seal.
Maintain airway by lifting the bony prominence of chin with remaining
fingers forming an E.
1. Take care not to push too hard on the soft tissue under the chin, it may
move the tongue into an obstructing position.
H. Squeeze the bag with one hand. Obtain chest rise with each breath.
Compression of the bag should be a smooth, steady action to avoid
overinflating the lungs. Begin ventilation and say “Squeeze”. Provide just
enough volume to initiate chest rise. DO NOT OVERVENTILATE
1. Ventilation rate 20 per minute
I. Allow adequate time for exhalation. Release bag and say, “Release,
release”. Continue ventilations using “squeeze, release, release” method.
J. Watch for adequate chest rise
K. Assess for improvement in color and/or heart rate
L. Documentation

VI. Demonstrate the proper technique to insert a dual lumen airway and assess the
patient for proper placement
A. Proper BSI
B. Open patient’s airway. Insert OPA
C. Confirm patient for proper age and size
D. Assemble and check equipment, check for air leaks.
E. Lubricate the distal end of the tube
F. Keep patient supine, head in a neutral position, or in-line position for
trauma.
G. Hyperventilate patient
H. Open airway, remove OPA
I. Insert dual lumen airway into patient’s mouth and gently insert the airway.
If resistance is met, do not force tube.
J. Advance tube until the airway’s black rings meet the level of the patient’s
teeth.
K. With the large syringe, inflate the pharyngeal cuff, (blue) with 100 cc of air
and remove the syringe
L. With the smaller syringe, inflate the distal cuff (clear) with 15 cc of air and

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 13
AIRWAY MANAGEMENT LAB
continued

remove the syringe

M. Attach the BVM to tube #1 (blue) and begin ventilations
N. Assess breath sounds bilaterally, watch for chest rise and listen for
gurgling sounds over the stomach. If breath sounds are heard bilaterally,
see chest rise and fall and no gurgling sounds are heard over the
stomach, ventilate patient through tube #1 (blue).
O. If breath sounds are absent, the chest does not rise and fall and there is
gurgling sounds over the stomach, remove the BVM from tube #1 and
attach BVM to tube #2 (clear) and ventilate through tube #2.
P. Reassess breath sounds bilaterally, the rise and fall of the chest and no
gurgling sounds over the stomach.
Q. Document findings

KCEMT
EMT 1Model Curriculum
Module 2: Airway Management 14
 EMT 1SKILL INSTRUCTOR
RESOURCE
AIRWAY MANAGEMENT ESOPHAGEAL
TRACHEAL COMBITUBE
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in the insertion of an esophageal tracheal Combitube.
CONDITION
The examinee will be requested to insert an esophageal tracheal Combitube in a manikin. Necessary equipment will be adjacent
to the simulated patient.
EQUIPMENT
Manikin, oxygen tank with a flow meter, oxygen mask, BVM and reservoir, Combitube, water-soluble lubricant, 100 cc syringe, 20
cc syringe, blood pressure cuff, stethoscope, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions Mandatory personal protective equipment – gloves and
eye protection are required, a gown may be needed if there
are large amounts of blood or fluid present.

♦ Verbalize the indications for insertion of a

Combitube

Patient is unconscious

Patient has no gag reflex

♦ Verbalize contraindications for insertion of a

Combitube

Patients younger than 16 years of age

Patients less than 5 feet tall or over 7 feet tall

Patients are conscious or has a gag reflex

Suspected hydrocarbon or caustic ingestion

Suspected esophageal disease

♦ Place patient in supine position It is important to maintain proper anatomical alignment.

The Comibtube was designed to use in patients in supine
position only.

♦ Open patient’s airway Open airway manually suing the head-tilt / chin-lift or
jaw- thrust maneuver

15
KCEMT
EMT 1Model Curriculum
Esophageal-Tracheal Combitube Skill: Instructor Resource
 Skill Component Teaching Points

♦ Suction if needed Prevents aspiration of materials and/or fluids into the

upper airway. This will prevent the patient from getting the
proper oxygenation.
♦ Preoxygenate with bag-valve-mask device supplied
with 100% oxygen.

PROCEDURE

♦ Position yourself at the patient’s head This is the best location for placement of the tube.

♦ Select the appropriate equipment, check and Checking the equipment now is important to prevent
assemble components any problems later during the insertion process.

Make sure you maintain the equipment in a clean

♦ Inflate cuff#1 (blue) with 100 ml of air and
environment, to prevent the patient from obtaining an infection
remove syringe
later.
♦ Check integrity of cuff then remove air, leave Lubrication allows for easier insertion of the tube and
syringe attached with 100 ml of air reduces the risk of trauma during insertion.

♦ Inflate cuff#2 (clear) with 15 ml of air and remove

syringe

♦ Check for integrity of cuff then remove air, leave

syringe attached with 15 ml of air

♦ Lubricate tube distal to the air holes

♦ Position patient’s head Maintaining the head in neutral position is important to

maintain proper anatomical alignment for proper insertion.
No trauma – neutral position

Trauma – neutral position with in-line stabilization

♦ Ventilate the patient for a few minutes Ventilating the patient can reduce the chance of the
patient becoming hypoxic during insertion.
Remove OPA if one has been inserted
It is important to keep track how long the insertion process
is taking.

♦ Insert the thumb of non-dominant hand deep into the This will allow easy access to the oral cavity for insertion.
patient’s mouth, grasping the tongue and lower jaw Be careful in performing this maneuver if the patient has
between thumb and index finger. facial trauma.

♦ Lift the tongue and lower jaw anteriorly, away from

the posterior pharynx

♦ Hold the Combitube so that it curves the same as the ƒ Trauma to the upper airway could be caused by forceful
natural curvature of the pharynx. insertion of the Combitube.

ƒ Insertion to the black rings is the point for the Combitube to

♦ Insert the tip of the tube into the mouth along the have proper positioning in the patient’s airway.
midline and advance it carefully along the tongue

Gently guide the Combitube along the base of

the tongue.

Do not force the Combitube if resistance is met.

16
KCEMT
EMT 1Model Curriculum
Esophageal-Tracheal Combitube Skill: Instructor Resource
 Skill Component Teaching Points

♦ Insert the Combitube until the teeth or gums are

between airway’s black rings

♦ Inflate cuff #1 (blue) with large syringe of 100 ml of Inflate balloon and hold tube in place. The ensures that the
air and detach syringe, hold tube in place Combitube is in the correct anatomical location.

♦ Inflate cuff #2 (clear) with smaller syringe of 15 ml of

air and detach syringe

♦ Attach BVM to tube #1 (blue) and ventilate, assess ƒ It is important to assess for placement of tube because it is
patient. blindly inserted.

ƒ Assessment is important to determine the correct tube to

♦ If breath sounds are present bilaterally, and chest
ventilate, prolong ventilations into the stomach can cause
rises and falls with ventilation and epigastric sounds
gastric distention and put pressure on the diaphragm and
are absent – the Combitube is in the esophagus and
make ventilations difficult.
continue to ventilate through blue tube
ƒ Consider hyperventilation for 2 minutes then resume normal
♦ If breath sounds are absent, the chest does not rise ventilations. Your patient may become hypoxic during the
and fall, - the Combitube is in the trachea, ventilate procedure.
through tube #2 (clear) tube

♦ If breath sounds are absent, there is no chest rise, Assessment is important to determine correct placement.
and epigastric sounds are not auscultated – deflate Ventilating a patient through the wrong tube can result in
both cuffs, recess the tube 1-3 cm, re-inflate both death or severe disability. Reassess your placement, to
cuffs, ventilate tube #1 and reassess breath sounds. make adjustments or remove tube if unsure of placement.

1 cm equals approximately ½ inch.

♦ If unable to verify placement, there is no chest rise,

and breath sounds are absent – deflate both cuffs,
remove tube and resume BVM ventilation with NP or
OP airway.

♦ Secure tube and continue ventilating with 100%

oxygen.

♦ Dispose of equipment using approved technique.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes: ƒ The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
ƒ Initial assessment priority patients.

ƒ Relevant portion of the focused assessment ƒ Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
ƒ Respiratory assessment changes in the patient’s condition are anticipated sooner.

ƒ Assessment of placement of device ƒ Priority patients are patients who have abnormal vital signs,
signs/symptoms of poor perfusion or if there is a suspicion that

17
KCEMT
EMT 1Model Curriculum
Esophageal-Tracheal Combitube Skill: Instructor Resource
 Skill Component Teaching Points

ƒ Evaluate response to treatment the patient’s condition may deteriorate.

ƒ Compare results to baseline condition and vital ƒ Assessment of placement of device should be
signs continuously monitored and after each movement of the
patient.

ƒ Assess for any balloon cuff leaks or tears.

DOCUMENTATION

§ Verbalize/Document ƒ Documentation must be on prehospital care report form

per local policies and procedures.
ƒ Assessment findings before and after treatment
ƒ Documenting reassessment information provides a
ƒ Patient’s response to treatment comprehensive picture of patient’s response to treatment.

ƒ Respiratory status ƒ Last reassessment information (before patient care

is transferred) should be documented.
ƒ Cardiovascular status

ƒ Mental status

ƒ Vital signs

18
KCEMT
EMT 1Model Curriculum
Esophageal-Tracheal Combitube Skill: Instructor Resource
 EMT 1SKILL

AIRWAY MANAGEMENT
ESOPHAGEAL TRACHEAL COMBITUBE

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in the insertion of an esophageal tracheal combitube.
CONDITION
The examinee will be requested to insert an esophageal tracheal combitube in a manikin. Necessary equipment will be adjacent
to the simulated patient.
EQUIPMENT
Manikin, oxygen tank with a flow meter, oxygen mask, BVM and reservoir, combitube, water-soluble lubricant, 100 cc syringe, 20
cc syringe, blood pressure cuff, stethoscope, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Verbalize the indications for insertion of a

Combitube

Patient is unconscious

Patient has no gag reflex

♦ Verbalize contraindications for insertion of a

Combitube

Patients younger than 16 years of age

Patients less than 5 feet tall or over 7 feet tall

Patients are conscious or has a gag reflex

Suspected hydrocarbon or caustic ingestion

Suspected esophageal disease

19
KCEMT
EMT 1Model Curriculum
Esophageal-Tracheal Combitube Skill: Student
 Skill Component Yes No Comments

♦ Place patient in supine position

♦ Open patient’s airway

♦ Suction if needed

♦ Preoxygenate with bag-valve-mask device supplied

with 100% oxygen.

PROCEDURE

♦ Position yourself at the patient’s head

♦ Select the appropriate equipment, check and

assemble components

Inflate cuff#1 (blue) with 100 ml of air and

remove syringe

ƒ Check integrity of cuff then remove air,

leave syringe attached with 100 ml of air

ƒ Inflate cuff#2 (white) with 15 ml of air and remove

syringe

ƒ Check for integrity of cuff then remove air,

leave syringe attached with 15 ml of air

ƒ Lubricate tube distal to the air holes

♦ Position patient’s head

No trauma – neutral position

Trauma – neutral position with in-line stabilization

♦ Hyperventilate the patient for a few minutes

♦ Remove OPA if one has been inserted

♦ Insert the thumb of non-dominant hand deep into the

patient’s mouth, grasping the tongue and lower jaw
between thumb and index finger.

♦ Lift the tongue and lower jaw anteriorly, away from

the posterior pharynx

♦ Hold the Combitube so that it curves the same as the

natural curvature of the pharynx.

♦ Insert the tip of the tube into the mouth along the
midline and advance it carefully along the tongue

Gently guide the Combitube along the base of the

20
KCEMT
EMT 1Model Curriculum
Esophageal-Tracheal Combitube Skill: Student
 Skill Component Yes No Comments
tongue.

Do not force the Combitube if resistance is met.

Insert the Combitube until the teeth or gums

are between airway’s black rings

♦ Inflate cuff #1 (blue) with large syringe of 100 ml of

air and detach syringe, hold tube in place

♦ Inflate cuff #2 (clear) with smaller syringe of 15 ml of

air and detach syringe

♦ Attach BVM to tube #1 (blue) and ventilate, assess

patient.

♦ If breath sounds are present bilaterally, and chest

rises and falls with ventilation and epigastric sounds
are absent –the Combitube is in the esophagus and
continue to ventilate through blue tube

♦ If breath sounds are absent, the chest does not rise

and fall, - the Combitube is in the trachea, ventilate
through tube #1 (clear) tube

♦ If breath sounds are absent, there is no chest rise,

and epigastric sounds are not auscultated – deflate
both cuffs, recess the tube 1-3 cm, re-inflate both
cuffs, ventilate tube #1 and reassess breath
sounds.

♦ If unable to verify placement, there is no chest rise,

and breath sounds are absent – deflate both cuffs,
remove tube and resume BVM ventilation with NP or
OP airway.

♦ Secure tube and continue ventilating with 100%

oxygen.

Dispose of equipment using approved technique.

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

ƒ Initial assessment

21
KCEMT
EMT 1Model Curriculum
Esophageal-Tracheal Combitube Skill: Student
 Skill Component Yes No Comments

ƒ Relevant portion of the focused assessment

ƒ Respiratory assessment

ƒ Assessment of placement of device

ƒ Evaluate response to treatment

ƒ Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

ƒ Assessment findings before and after treatment

ƒ Patient’s response to treatment

ƒ Respiratory status

ƒ Cardiovascular status

ƒ Mental status

22
KCEMT
EMT 1Model Curriculum
Esophageal-Tracheal Combitube Skill: Student
Module 3
 MODULE 3:
PATIENT ASSESSMENT

Number of Lecture Hours: 4 Hours

Topics:

1. History Taking / Patient Assessment 2 Hours

2. Communications 1 Hour
3. Documentation 1 Hour

Labs/Workshops: Number of Hours: 4 Hours

1. History Taking / Patient Assessment 2 Hours

2. Communications 1 Hour
3. Documentation 1 Hour

Testing Number of Hours: 2 Hours

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 1
 MODULE 3:
PATIENT ASSESSMENT

MODULE TERMINAL OBJECTIVES:

At the completion of this module the EMT 1student as an active participant will be able to
successfully:

1. Describe the techniques and components of a physical exam.

2. Use the appropriate techniques to obtain a medical history from a patient.

3. Integrate the principals of history taking and techniques of the physical exam to perform
a patient assessment on an emergency patient.

4. Apply a process of clinical decision making to use the assessment findings to help form
a field impression.

5. Use an accepted format for the dissemination of patient information in verbal form,
either in person or over the radio.

6. Document the essential elements of patient assessment, care, and transport.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 2
MODULE 3: PATIENT ASSESSMEMT

Topic: HISTORY TAKING / PATIENT ASSESSMENT

Purpose:

This topic will give the EMT 1student a review of the techniques of physical exam
and integrate the principals of history taking and physical exam to perform a patient
assessment and apply a process of decision making to form a field impression.

Suggested Time Frame: 2 Hours

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Describe factors than may influence the EMT 1’s ability to collect a medical history.

2. List the components of a history on a patient.

3. Describe the techniques of history taking.

4. Discuss strategies to overcome situations that may represent special challenges in

obtaining a medical history.

5. Defend the importance of empathy when obtaining a patient history

6. Practice the importance of confidentiality when obtaining a patient history.

7. Review the importance of scene size-up and scene safety.

8. Discuss the common mechanisms of injury /nature of illness for medical and trauma
patients.

9. Discuss the components of the initial assessment.

10. Describe the steps of the focused history and physical exam.

11. State the areas of the body evaluated in the focused history and physical exam.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 3
HISTORY TAKING / PATIENT ASSESSMENT
continued

12. Discuss the reason and importance of performing the focused history and physical

13. Apply the techniques of physical examination to the medical patient.

14. Differentiate between the assessment that is performed for a patient who has an
altered mental status and other medical patients.

15. Apply the techniques of physical examination to the trauma patient.

16. Describe when to perform a rapid trauma assessment and the areas included in the
rapid trauma assessment.

17. Discuss the components of the detailed physical and when it is performed.

18. State the areas of the body that is evaluated during the detailed physical exam.

19. Distinguish between the detailed physical exam that is performed on the trauma
patient and that of the medical patient.

20. Describe the components of the on-going assessment.

21. Discuss the reasons for repeating the initial assessment as part of the on-going
assessment.

22. Discuss special considerations to take when performing physical examinations on a

pediatric patient.

23. Differentiate between critical life-threatening, potentially life-threatening, and non-life

threatening patient presentations.

24. Define the components, stages, and sequences of critical thinking in performing
patient assessment.

25. Develop strategies for effective thinking under pressure.

26. Discuss the “six R’s” of putting it all together

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 4
HISTORY TAKING / PATIENT ASSESSMENT
Continued

27. Value the need for maintaining a professional caring attitude when performing a
patient assessment.

28. Demonstrate a caring attitude when performing a patient assessment.

29. Demonstrate an appropriate physical exam on a medical patient to include the

following:

A. An initial assessment
B. A focus history and physical exam
C. Detailed physical exam
D. On-going assessment

30. Demonstrate the techniques for assessing a patient with an altered mental status.

31. Demonstrate the assessment of a trauma patient.

32. Demonstrate a rapid trauma assessment used to assess a patient based on

mechanism of injury.

33. Perform a focused history and physical exam on a non-critically injured patient and a
patient with life-threatening injuries.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 5
DECLARATIVE
MODULE 3: PATIENT ASSESSMENT
HISTORY TAKING

I. Influences on collecting a history

A. Source of history
1. Patient
2. Family
3. Friends
4. Police
5. Others
B. Reliability
1. Variable
a. Memory
b. Trust
c. Motivation
2. Made at the end of the evaluation, not the beginning
C. Contents of history
1. Date
a. Always important
b. Time may be a consideration
2. Identifying data
a. Age
b. Sex
c. Race
D. Chief Complaint
1. Main part of the health history
2. The one or more symptoms for which the patient is seeking medical care
E. History of present illness
1. Detailed evaluation of the chief complaint
2. Provides a full, clear, chronological account of symptoms
F. Past Medical History
1. Pertinent information to the current condition
G. Current Health Status
1. Focuses on present state of health
2. Environmental conditions
3. Individual factors
a. Current medications
b. Allergies
c. Tobacco use
d. Alcohol, drugs, and related substances

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 6
HISTORY TAKING
continued

e. Diet
f. Environmental hazards
g. Use of safety measures
h. Family history
i. Home situation
II. Techniques of history taking
A. Setting the stage
1. Environment
a. Proper environment enhances communication
b. Be cautious of power relationship
c. Personal space
2. Your demeanor and appearance
a. Patient will be watching you
b. Messages of body language
c. Clean, neat, professional appearance
3. Note taking
a. Difficult to remember all details
b. Most patients are comfortable with note taking
1. Do not divert your attention from patient to take notes
4. Refer to patient by name
a. Avoid using unfamiliar or demeaning terms, such as “Granny” or “Hon”
B. Questioning
1. Types of questions
a. Open-ended
b. Direct
2. Determine chief complaint
a. Use general, open-ended questions
b. Follow the patient’s lead
3. History of present illness
a. Location
i. Where is it
ii. Does it radiate
b. Quality
i. What is it like
c. Quantity or severity
i. How bad is it
ii. Attempt to quantify the pain
1. 1-10 scale

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 7
HISTORY TAKING
continued

2. Other scales
d. Duration/timing
i. When did it start
ii. How long does it last
e. Onset/setting
i. Emotional response
ii. Environmental factors
f. Aggravation/alleviation
g. Associated complaints
4. Assess past medical history
a. Pre-existing medical problems or surgeries
b. Medication
c. Allergies
d. Physician
e. Family history
f. Social history
i. Housing environment
ii. Economic status
iii. Occupation
iv. High risk behavior
v. Travel history
g. Current health status
i. Tobacco use
ii. Use of alcohol, drugs
iii. Diet
C. Standardized approach to history taking
1. SAMPLE
a. Signs
b. Allergies
c. Medications
d. Past medical history
e. Last meal
f. Events leading to complaint
2. OPQRST
a. Onset
b. Provoking
c. Quality
d. Radiation/Region

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 8
HISTORY TAKING
continued

e. Severity
f. Time
IV. Special challenges
A. Silent patient
1. Silence is often uncomfortable
2. Silence has meaning and many uses
a. Patients may use this to collect their thoughts, remember details, or
decide whether or not they trust you
b. Be alert for non-verbal clues of sensitivity
3. Silence may be a result of the interviewer’s lack of sensitivity
B. Overly talkative patient
1. Faced with a limited amount of time, interviewers may become impatient
a. Lower your goals, accept a less comprehensive history
b. Give the patient free reign only for the first several minutes
c. Summarize frequently
C. Patient with multiple symptoms
D. Anxious patient
1. Be sensitive to non-verbal clues
E. Reassurance
1. It’s tempting to be overly reassuring
2. Premature reassurance blocks communication
F. Angry and hostile patient
1. Understand anger and hostility are natural
2. Do not get angry in return
G. Intoxicated patient
1. Be accepting, not challenging
H. Crying patient
1. Crying can provide valuable insight
I. Depressed patient
J. Patient with confusing behavior or history
1. Be prepared for the confusion and frustration of varying behaviors and
histories
2. Be alert for mental illness, delirium, or dementia
a. Do not overlook the ability of these patients to provide you with adequate
information
b. Be alert for omissions
c. May require you to get information from family or friends
K. Patients with language barriers

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 9
HISTORY TAKING
continued

1. Make an effort to find a translator

2. A few broken words are not an acceptable substitute
L. Patients with a hearing problem
1. Make an effort to find a translator
M. Blind patients
1. Be careful to announce yourself and explain who you are and why you are
there

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EMT 1Model Curriculum
Module 3: Patient Assessment 10
MODULE 3: PATIENT ASSESSMEMT

Topic: PATIENT ASSESSMENT

Purpose:

This topic will give the EMT 1student a review of the techniques of physical exam
and integrate the principals of history taking and physical exam to perform a patient
assessment and apply a process of decision making to form a field impression.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Review the importance of scene size-up and scene safety.

2. Discuss the common mechanisms of injury /nature of illness for medical and trauma
patients.

3. Discuss the components of the initial assessment.

4. Describe the steps of the focused history and physical exam.

5. State the areas of the body evaluated in the focused history and physical exam.

6. Discuss the reason and importance of performing the focused history and physical
exam.

7. Apply the techniques of physical examination to the medical patient.

8. Differentiate between the assessment that is performed for a patient who has an
altered mental status and other medical patients.

9. Apply the techniques of physical examination to the trauma patient.

10. Describe when to perform a rapid trauma assessment and the areas included in the
rapid trauma assessment.

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EMT 1Model Curriculum
Module 3: Patient Assessment 11
PATIENT ASSESSMENT
continued

11. Discuss the components of the detailed physical and when it is performed.

12. State the areas of the body that is evaluated during the detailed physical exam.

13. Distinguish between the detailed physical exam that is performed on the trauma
patient and that of the medical patient.

14. Describe the components of the on-going assessment.

15. Discuss the reasons for repeating the initial assessment as part of the on-going
assessment.

16. Discuss special considerations to take when performing physical examinations on a

pediatric patient.

17. Differentiate between critical life-threatening, potentially life-threatening, and non-life

threatening patient presentations.

18. Define the components, stages, and sequences of critical thinking in performing
patient assessment.

19. Develop strategies for effective thinking under pressure.

20. Discuss the “six R’s” of putting it all together

21. Value the need for maintaining a professional caring attitude when performing a
patient assessment.

22. Demonstrate a caring attitude when performing a patient assessment.

23. Demonstrate an appropriate physical exam on a medical patient to include the

following:

A. An initial assessment
B. A focus history and physical exam
C. Detailed physical exam
D. On-going assessment

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EMT 1Model Curriculum
Module 3: Patient Assessment 12
PATIENT ASSESSMENT
continued

24. Demonstrate the techniques for assessing a patient with an altered mental status.

25. Demonstrate the assessment of a trauma patient.

26. Demonstrate a rapid trauma assessment used to assess a patient based on

mechanism of injury.

27. Perform a focused history and physical exam on a non-critically injured patient and a
patient with life-threatening injuries.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 13
DECLARATIVE
MODULE 3: PATIENT ASSESSMENT
PATIENT ASSESSMENT

I. Scene size-up / assessment

A. Body substance isolation review
1. Eye protection if necessary
2. Gloves if necessary
3. Gown if necessary
4. Mask if necessary
B. Scene safety
1. Definition -an assessment to assure the well-being of the EMT 1
2. Personal protection - is it safe to approach the patient?
a. Crash rescue scenes
b. Toxic substances - low oxygen areas
c. Crime scenes - potential for violence
d. Unstable surfaces -slope, ice, water
3. Protection of the patient - environmental considerations
4. Protection of bystanders - if necessary, help the bystander avoid becoming a
patient
5. Do not enter unsafe scenes
6. Scenes may be dangerous even if they appear to be safe
C. Definition -an assessment of the scene and surroundings that will provide valuable
information to the EMT 1
D. Mechanism of injury / nature of illness
1. Medical
a. Nature of illness - determine from the patient, family, or bystanders why EMS
was activated
b. Determine the total number of patients
c. If there are more patients than the responding unit can effectively handle,
initiate a mass casualty plan
(1) EMT-II is less likely to call for help if involved in patient care
(2) Prior to contact with patients, obtain additional help: law enforcement,
fire, rescue, ALS, and utilities
(3) Begin triage
2. Trauma
a. Mechanism of injury
(1) determine from the patient, family, or bystanders and inspection of the
scene
(2) Immobilize the cervical spine
b. Determine the total number of patients

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 14
PATIENT ASSESSMENT
continued

c. If there are more patients than the responding unit can effectively handle,
initiate a mass casualty plan
(1) EMT 1is less likely to call for help if involved in patient care
(2) Prior to contact with patients, obtain additional help: law enforcement,
fire, rescue, ALS, and utilities
(3) Begin triage
(4) If the responding crew can manage the situation, consider spinal
precautions and continue care

II. Initial assessment

A. General impression of the patient
1. Formed to determine priority of care and is based on the EMT 1’s
immediate assessment of the environment and the patient's chief complaint
2. Determine if ill, i.e., medical or injured (trauma)
a. If injured, identify mechanism of injury
b. If ill, identify nature of illness
B. Assess the patient and determine if the patient has a life-threatening condition
1. If a life threatening condition is found, treat immediately
2. Assess nature of illness or mechanism of injury
C. Assess patient's mental status (maintain spinal immobilization if needed)
1. Levels of mental status (AVPU)
a. Alert
b. Responds to verbal stimuli
c. Responds to painful stimuli
d. Unresponsive -no gag or cough
D. Assess the patient's airway status
1. Patent
2. Obstructed
a. Suction
b. Position
c. Airway adjuncts
d. Invasive techniques
(1) Multi-lumen airways
E. Assess the patient's breathing
1. Adequate
2. Inadequate
F. Assess the patient's circulation
1. Pulse

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EMT 1Model Curriculum
Module 3: Patient Assessment 15
PATIENT ASSESSMENT
continued

2. If major bleeding is present -if bleeding is present, control bleeding

3. Perfusion by evaluating skin color, temperature, capillary refill, and condition
G. Identify priority patient
1. Consider
a. Poor general impression
b. Altered mental status
c. Responsive, not following commands
d. Difficulty breathing
e. Inadequate minute volume
f. Shock (hypoperfusion)
g. Complicated childbirth
h. Chest pain with suspected cardiac origin
i. Uncontrolled bleeding
j. Severe pain anywhere
k. Multiple injuries
2. Expedite transport of the patient
H. Proceed to the appropriate focused history and physical examination

III. Focused history and physical exam - medical patient

A. Responsive medical patient
1. Assess patient history
a. Chief complaint
b. History of present illness
(1) Attributes of a symptom
(a) Location
i) Where is it
ii) Does it radiate
(b) Quality
i) What is it like
(c) Quantity or severity
i) How bad is it
(d) Timing
i) When did it start
ii) How long does it last
(e) Setting in which it occurs
i) Emotional response
ii) Environmental factors
(f) Factors that make it better or worse

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EMT 1Model Curriculum
Module 3: Patient Assessment 16
PATIENT ASSESSMENT
continued

(g) Associated manifestations

c. Past medical history
d. Current health status
2. Perform physical examination
a. Utilize the techniques of physical examination to
(1) Assess the head as necessary
(2) Assess the neck as necessary
(3) Assess the chest as necessary
(4) Assess the abdomen as necessary
(5) Assess the pelvis as necessary
(6) Assess the extremities as necessary
(7) Assess the posterior body as necessary
3. Assess baseline vital signs
a. Consider orthostatic vital signs
4. Provide emergency medical care based on signs and symptoms in consultation
with medical direction
B. Unresponsive medical patient
1. Perform rapid assessment
2. Utilize the techniques of patient assessment
a. Position patient to protect airway
b. Assess the head
c. Assess the neck
d. Assess the chest
e. Assess the abdomen
f. Assess the pelvis
g. Assess the extremities
h. Assess the posterior aspect of the body
3. Assess baseline vital signs
4. Obtain patient history from bystander, family, friends, and/ or medical
identification devices/ services
a. Chief complaint
b. History of present illness
c. Past medical history
d. Current health status

IV. Focused history and physical exam - trauma patient

A. Re-consider mechanism of injury
1. Helps to identify priority patients

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 17
PATIENT ASSESSMENT
continued

2. Helps to guide the assessment

3. Significant mechanism of injury
a. Ejection from vehicle
b. Death in same passenger compartment
c. Falls> 20 feet
d. Roll-over of vehicle
e. High speed vehicle crash
f. Vehicle-pedestrian crash
g. Motorcycle crash
h. Unresponsive or altered mental status
i. Penetrations of the head, chest, or abdomen
j. Hidden injuries
(1) Seat belts
(a) If buckled, may have produced injuries
(b) If patient had seat belt on, it does not mean they do not have injuries
(2) Airbags
(a) May not be effective without seat belt
(b) Patient can hit steering wheel after deflation
(c) Lift the deployed airbag and look at the steering wheel for deformation
i) Lift and look under the bag after the patient has been removed
ii) Any visible deformation of the steering wheel should be regarded
as an indicator of potentially serious internal injury, and appropriate
action should be taken
iii) Child safety seats
a) Injury patterns with airbags
b) Proper use in vehicles with airbags
4. Infant and child considerations
a. Falls >10 feet
b. Bicycle collision
c. Vehicle in medium speed collision
B. Perform rapid trauma physical examination on patients with significant mechanism
of injury to determine life-threatening injuries
1. In the responsive patient, symptoms should be sought before and during the
trauma assessment
2. Continue spinal stabilization
3. Reconsider transport decision
4. Assess mental status
5. As you inspect and palpate, look and feel for injuries or signs of injury

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 18
PATIENT ASSESSMENT
continued

6. Examination
a. Assess the head, inspect and palpate for injuries or signs of injury
b. Assess the neck, inspect and palpate for injuries or signs of injury
c. Apply cervical spinal immobilization collar (CSIC)
d. Assess the chest, inspect and palpate for injuries or signs of injury
e. Assess the abdomen, inspect and palpate for injuries or signs of injury
f. Assess the pelvis, inspect and palpate for injuries or signs of injury
g. Assess all four extremities, inspect and palpate for injuries or signs of injury
h. Roll patient with spinal precautions and assess posterior body, inspect and
palpate for injuries or signs of injury
i. Look for medical identification devices
j. Assess baseline vital signs
k. Assess patient history
(1) Chief complaint
(2) History of present illness
(3) Past medical history
(4) Current health status
C. For patients with no significant mechanism of injury, e.g., cut finger
1. Perform focused history and physical exam of injuries based on the techniques of
examination
2. The focused assessment is performed on the specific injury site
3. Assess baseline vital signs
4. Assess patient history
a. Chief complaint
b. History of present illness
c. Past medical history
d. Current health status

V. Detailed physical exam

A. Patient and injury specific, e.g., cut finger would not require the detailed physical
exam
B. Perform a detailed physical examination on the patient to gather additional
information
C. General approach
1. Assess patient history
a. Chief complaint
b. History of present illness
c. Past medical history

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 19
PATIENT ASSESSMENT
continued

d. Current health status

2. Examine the patient systematically
3. Place special emphasis on areas suggested by the present illness and chief
complaint
4. Keep in mind that most patients view a physical exam with apprehension and
anxiety - they feel vulnerable and exposed
D. Overview of the detailed physical exam
1. Mental status
a. Appearance and behavior
b. Posture and motor behavior
c. Speech and language
d. Mood
e. Thought and perceptions
f. Thought content
g. Perceptions
h. Insight and judgement
i. Memory and attention
j. Remote memory (i.e., birthdays)
k. Recent memory (i.e., events of the day)
l. New learning ability
2. General survey
a. Level of consciousness
b. Signs of distress
c. Apparent state of health
d. Skin color and obvious lesions
e. Height and build
f. Sexual development
g. Weight
h. Posture, gait, and motor activity
i. Dress, grooming and personal hygiene
j. Odors of breath or body
k. Facial expression
3. Skin
4. Head
5. Eyes
6. Ears
7. Nose and sinuses
8. Mouth and pharynx

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 20
PATIENT ASSESSMENT
continued

9. Neck
10. Thorax and lungs
11. Cardiovascular system
12. Abdomen
13. External genitalia
14. Peripheral vascular system
15. Musculoskeletal system
16. Nervous system
E. Recording examination findings
F. Assess baseline vital signs

VI. On-going assessment

A. Repeat initial assessment
1. For a stable patient, repeat and record every 15 minutes
2. For an unstable patient, repeat and record at a minimum of every 5 minutes
3. Reassess mental status
4. Reassess airway
5. Monitor breathing for rate and quality
6. Reassess circulation
7. Re-establish patient priorities
B. Reassess and record vital signs
C. Repeat focused assessment regarding patient complaint or injuries
D. Assess interventions
1. Assess response to management
2. Maintain or modify management plan

VII. Pediatric Considerations

A. Assessment
1. General considerations
2. Physical exam
a. Scene survey
b. Initial assessment
c. Vital functions
3. Focused history
4. Detailed physical exam
5. Ongoing Exam

VIII. Key Concepts in differentiating critical life-threatening, potentially life-threatening, and

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 21
PATIENT ASSESSMENT
continued

non-life threatening presentations.

A. The cornerstone of effective decision making
1. Gathering, evaluating, and synthesizing information
2. Developing and implementing appropriate patient management plans
3. Applying judgment and exercising independent decision making
4. Thinking and working effectively under pressure
B. Spectrum of patient care in the prehospital setting
1. Critical life-threats
a. Major, multi-system trauma
b. Devastating single system trauma
c. End-stage disease presentations
d. Acute presentations of chronic conditions
2. Potential life-threats
a. Serious, multi-system trauma
b. Multiple disease etiologies
3. Non-life threatening presentations
C. Providing guidance and authority for EMT 1treatment
1. Protocols, standing orders, and patient care algorithms
a. Can clearly define and outline performance parameters
b. Promote a standardized approach
2. Limitations of protocols, standing orders, and patient care algorithms
a. Only address “classic” patient presentations
b. May not address multiple disease etiologies
c. May not address multiple treatment modalities
XIV. Components, stages, and sequence of critical thinking process
A. Concept formation
1. MOI / scene assessment
2. Initial assessment and physical examination
3. Chief complaint
4. Patient history
5. Patient affect
6. Technical tools
B. Data interpretation
1. Data gathered
2. Knowledge of anatomy and physiology
3. Attitude
4. Previous experience
C. Application of principle

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 22
PATIENT ASSESSMENT
continued

1. Field impression
2. Protocols, standing orders
3. Treatment/intervention
D. Evaluation
1. Reassessment of patient
2. Reflection in action
3. Revision in impression
4. Protocols/standing orders
5. Revision of treatment/intervention
E. Review on action
1. Run critique
2. Addition to/modification of experience base for the EMT 1F.
Thinking under pressure
1. “Fight or flight” response impacts the EMT 1both positively and
negatively
a. Enhanced visual and auditory acuity
b. Improved reflexes and muscle strength
c. Impaired critical thinking skills
d. Diminished concentration and assessment ability
2. Mental conditioning is the key to effective performance under pressure
a. Skills learned at a pseudo-instinctive performance level
b. Automatic response for technical treatment requirements
1 Mental checklist for thinking under pressure
1. Stop and think
2. Scan the situation
3. Decide and Act
4. Maintain clear, concise control
5. Regularly and continually reevaluate the patient
6. Stay calm, don’t panic
7. Assume and plan for the worse
8. Maintain a systematic assessment pattern
9. Situation awareness
a. Reading the scene
b. Reading the patient
2 Putting it all together – “the six R’s”
1. Read the patient
a. Observe the patient
i. Level of responsiveness/conciousness

KCEMT
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Module 3: Patient Assessment 23
PATIENT ASSESSMENT
continued

ii. Skin color

iii. Position and location of patient – obvious deformity or asymmetry
b. Talk to the patient
i. Determine chief complaint
ii. New problem or worsening of preexisting condition
c. Touch the patient
i. Skin temperature and moisture

ii.Pulse rate, strength, and regularity

d. Auscultate the patient
i. Identify problems with the lower airway
ii. Identify problems with the upper airway
e. Status of ABC’s – identifying life-threats
f. Complete and accurate set of vital signs
i.Use as triage tool to estimate severity
ii.Can assist in identifying the majority of life-threatening conditions
iii.Influenced by patient age, underlying physical and medical
conditions and current medications
2. Read the scene
a. General environment conditions
b. Evaluate immediate surroundings
c. Mechanism of injury
3. React
a. Address life-threats in the order they are found
b. Determine the most common and statistically probable cause that fits
the patient’s initial presentation
c. Consider the most serious condition that fits the patient’s initial
presentation
d. Treat based on presenting signs and symptoms
4. Reevaluate
a. Focused and detailed assessment
b. Response to initial management/interventions
c. Discovery of less obvious problems
5. Revise treatment plan
6. Review performance

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 24
MODULE 3: PATIENT ASSESSMENT

Topic: COMMUNICATIONS

Purpose:

This topic will give the EMT 1student an understanding of appropriate formats for
giving patient information over the radio.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Identify the importance of communications when providing EMS.

2. Identify the role of verbal, written, and electronic communications in providing

EMS.

3. Describe the phases of communications necessary to complete a typical

EMS event.

4. Identify the importance of proper terminology when communicating during an

EMS event.

5. Identify the importance of proper verbal and written communication during

and EMS event.

6. List factors that impede and enhance verbal / written communications.

7. Identify and differentiate the following communication systems:

A. Simplex
B. Multiplex
C. Duplex
D. Trunked
E. Digital communications
F. Cellular telephone
G. Facsimile

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 25
COMMUNICATIONS
continued

H. Computer

8. Identify the components of the local dispatch communications system and

describe their function and use.

9. Describe the functions and responsibilities to the Federal Communications

Commission.

10. Describe the role of the EMS Dispatcher as part of the EMS team.

11. Describe the procedure of verbal communication of patient information to the

hospital.

12. Describe the information that should be included in patient information

verbally reported to medical direction.

13. Discuss the local policy/procedure addressing:

A. Indications for radio contact with a base hospital

B. Appropriate radio call-in format
C. Communications failure policy
D. Overview of local communications system

14. Demonstrate an appropriate call-in to the base hospital, giving all pertinent
information that constitutes a complete radio report.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 26
DECLARATIVE
MODULE 3: PATIENT ASSESSMENT
COMMUNICATIONS

I. General
A. Importance of communications when providing EMS
1. Functions as one part of a team
2. Need to effectively communicate patient information and scene assessment
3. Medical direction
4. System control and administration
5. Scene control
B. Role of verbal, written, and electronic communications in the provision of EMS
1. Communications between party requesting help and the dispatcher
2. Communications between the dispatcher and the EMT 1
3. Communications between the field and receiving hospital and / or medical
direction physician (on-line)
4. Communication with receiving hospital personnel (on-arrival)
C. Phases of communications necessary to complete a typical EMS event
1. Occurrence
2. Detection
3. Notification and response
4. Treatment and preparation for transport
5. Preparation for next event
a. Pre-arrival instructions
b. Communication on scene among other providers and with patient
D. Diagram of a basic model of communications
1. Idea
2. Encoder
3. Sender
4. Media or channel
5. Receiver
6. Decoder
7. Feedback
E. Role of proper terminology when communicating during an EMS event
1. Can shorten transmissions / narratives
2. Unambiguous
3. Common means of communications with other medical professionals
F. Role of proper verbal communications during an EMS event
1. Exchange of system information
2. Exchange of patient information
3. Medical control

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 27
COMMUNICATIONS
continued

4. Professionalism
G. Factors that impede effective verbal communications
1. Semantic
2. Technical
H. Factors which enhance verbal communications
1. Semantic
2. Technical
I. Importance of proper written communications during an EMS event
1. Written record of incident
2. Legal record of incident
3. Professionalism
4. Other
a. Medical audit
b. Quality improvement
c. Billing
d. Data collection
J. Factors which impede effective written communications
1. Semantic
2. Technical
K. Factors which enhance written communications
1. Semantic
2. Technical
L. Legal status of written communications related to an EMS event
1. Record of incident
2. Part of medical record
3. Confidentiality / disclosure
M. Importance of data collection during an EMS event
1. System administration
2. Research
3. Quality management -often results in policy change
N. New technology used to collect and exchange patient and / or scene information
electronically
1. Technology-based
2. Real-time capture of events / information
3. Integrated with diagnostic technology
4. Reduces dependence on traditional means of documentation, i.e., written
5. Influences role of medical direction
a. Provides for advanced notification

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 28
COMMUNICATIONS
continued

b. Potential for reduced time to in-hospital diagnosis and therapy

O. Legal status of patient medical information collected and exchanged electronically
1. Same status as traditional written documentation
2. May not have a "paper record" of incident

II. Systems
A. Methodology used for EMS communication
1. Simplex
a. Advantages
(1) Allows speaker to get message out without interruption
b. Disadvantages
(1) Slows process
(2) More formal
(3) Takes away ability to discuss case
2. Multiplex
a. Advantages
(1) Either party can interrupt as necessary
(2) Facilitates discussion
b. Disadvantages
(1) Each end has tendency to interrupt the other
(2) Voice interferes with data transmission
3. Duplex
a. Advantages
(1) Either party can interrupt as necessary
(2) Facilitates discussion
b. Disadvantages
(1) Each end has tendency to interrupt the other
4. Trunked
a. Advantages
b. Disadvantages
5. Digital
a. Advantages
b. Disadvantages
6. Cellular telephone
a. Advantages
(1) Less formal
(2) Promotes discussion
(3) Can reduce on-line times

KCEMT
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Module 3: Patient Assessment 29
COMMUNICATIONS
continued

(4) Physician can speak directly with patient

b. Disadvantages
(1) Geography can interfere with signal
(2) Cell site may be unavailable
(3) External antenna necessary
(4) Problems with denied access to cell (PIN numbers unknown or forgotten)
7. Facsimile
a. Advantages
(1) Provides earlier notification
(2) Produces another piece of medical documentation
b. Disadvantages
(1) Must have access to a fax machine (at each end)
8. Computer
a. Advantages
(1) Potential to save retrospective data entry step
(2) Can document in real-time
(3) Sort on many categories
(4) Create multiple reporting formats
(5) Provide system data quickly
b. Disadvantages
(1) Subject to limitation of the computer and the operator
(2) Lose flexibility
B. Components of the local dispatch communications system and function
1. Define 9-1-1 AND E 9-1-1
2. Public safety access point
3. Emergency medical dispatcher
4. Pre-arrival instructions

III. Regulation -The Federal Communications Commission (FCC)

A. Federal agency established to regulate telecommunications in the U.S.
B. Functions
1. Licensing
2. Frequency allocation
3. Technical standards
4. Rule making and enforcement
C. Responsibilities

IV. Dispatch

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 30
COMMUNICATIONS
continued

A. The functions of an Emergency Medical Dispatcher

1. Call taking
2. Alerting and directing response
3. Monitoring and coordinating communications
4. Pre-arrival instructions
5. Maintaining incident record
B. Appropriate information to be gathered by the Emergency Medical Dispatcher
1. Caller's name and call-back number
a. Enhanced 9-1-1 system
2. Address of event
3. Nature of event
4. Specific event information
a. Call screening
b. Pre-arrival instructions
C. Role of emergency medical dispatch in a typical EMS event
1. Part of the EMS system team
2. First contact with the EMS system
3. Coordination of response
4. Coordination of communications
5. Provision of pre-arrival instructions to mitigate event prior to arrival of units
6. Incident data collection
D. Importance of pre-arrival instructions in a typical EMS event
1. Provides immediate assistance
2. Complements call screening
3. Provides updated information to responding unit(s)
4. May be life sustaining in critical incidents
5. Emotional support for caller / bystanders / victim

V. Procedures
A. Information that should be verbally reported to medical direction
1. Depends on technology used for transmission
2. May vary with local protocol
3. Based on patient priority
4. Standard format
a. Efficient use of communications system
b. Assists medical direction
c. Assures no significant information is omitted
5. Information

KCEMT
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Module 3: Patient Assessment 31
COMMUNICATIONS
continued

a. Unit identification / provider identification

b. Description of scene
c. Patient's age, sex, and approximate weight (for drug orders)
d. Patient's chief complaint
e. Associated symptoms
f. Brief, pertinent history of the present illness / injury
g. Pertinent past medical history, medications, and allergies
h. Pertinent physical exam findings
i. Treatment given so far
j. Estimated time of arrival at hospital
k. Other pertinent information
B. General procedures for exchange of information
1 .Protect privacy of the patient
2. Use proper unit numbers, hospital numbers, proper names, and titles
3. Do not use slang or profanity
4. Use standard formats for transmission
5. Utilize the "echo" procedure when receiving directions from the dispatcher or
physician orders
6. Obtain confirmation that message was received

VI. Orientation to local public safety communication system

A. Local public safety communication system overview
1. Infrastructure
2. Public Safety Answering Points (PSAPs)
B. Local communication protocols
1. EMS Medical Communications (MedComm)
2. Interoperability (Law/Fire/EMS)
3. Mutual Aid/ Disaster communications
C. Radio equipment
1. Portable radios
2. Mobile radios

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 32
MODULE 3: PATIENT ASSESSMENT

Topic: DOCUMENTATION

Purpose:

This topic will give the EMT 1student the understanding to be able to effectively
document the essential elements of patient assessment, care, and transport.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Identify the general principals regarding the importance of EMS documentation and
ways in which documentation is used.

2. Discuss the importance of using appropriate and accurate medical abbreviations and
acronyms.

3. Explain the pertinent information needed for documentation.

4. Describe the elements of a properly written report.

5. Describe what information is required in each section of the patient care report.

6. Discuss the potential consequences of illegible, incomplete, or inaccurate

documentation.

7. Explain the special considerations concerning patient refusal of transport.

8. Describe special considerations concerning mass casualty incident documentation.

9. Discuss state and/or local record and reporting requirements.

10. Demonstrate proper completion of a patient care report used locally.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 33
DECLARATIVE
MODULE 3: PATIENT ASSESSMENT
DOCUMENTATION

I. Introduction
A. Importance of documentation
B. Written record of incident
1. May be the only source of information for persons subsequently interested in the
event
2. Provides a source for identifying pertinent reportable clinical data from each
patient interaction
3. Legal record of incident
a. May be used in court proceedings
b. May be the EMT 1’s sole source of reference to a case
4. Professionalism
a. As a link to subsequent care, documentation may be the only means for EMT-
IIs to represent themselves as professionals to certain other health
professionals
C. Other uses of documentation
1. Medical audit
a. Run review conferences
b. Other educational forums
2. Quality improvement
a. Tally the individual's performance of patient care procedures and to review
individual performance
b. Identify systems issues regarding quality improvement
3. Billing and administration
a. Acquire the necessary billing and administrative data
4. Data collection
a. Research purposes

II. General considerations

A. Be familiar with common medical terms, their meaning and correct spelling
B. Be familiar with commonly-accepted medical abbreviations and their correct spelling
C. Be familiar with common industry acronyms
D. Incident times
1. Understand the legal purposes of accurate recording of the following incident times
a. Time of call
b. Time of dispatch
c. Time of arrival at the scene

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EMT 1Model Curriculum
Module 3: Patient Assessment 34
DOCUMENTATION
continued

d. Time(s) of medication administration and certain medical procedures as

defined by local protocol
e. Time of departure from the scene
f. Time of arrival at the medical facility (when transporting a patient)
g. Time back in service
E. Accurately note in the document narrative (and elsewhere, when applicable) medical
direction's advice and orders, and the results of implementing that advice and those
orders
F. "Pertinent findings"
1. Findings that are relevant to the clinical situation
G. "Pertinent negatives"
1. Findings that warrant no medical care or intervention, but which, by seeking them,
show evidence of the thoroughness of the EMT 1’s examination and history of the
event
2. Record all "pertinent negative" findings
H. Pertinent oral statements made by patients and other on-scene people
1. Record statements made which may have an impact on subsequent patient care
or resolution of the situation, including reports of
a. Mechanism of injury
b. Patient's behavior
c. First aid interventions attempted prior to the arrival of EMS personnel
d. Safety-related information, including disposition of weapons
e. Information of interest to crime scene investigators
f. Disposition of valuable personal property (e.g., watches, wallets)
2. Use of quotations
a. The EMT 1should put into quotation marks any statements by patients or
others, which relate to possible criminal activity or admissions of suicidal
intention
I. Record support services used (e.g., helicopter, coroner, rescue/ extrication)
J. Record use of mutual aid services

III. Elements of a properly written EMS document

A. Accurate
1. Document accuracy depends on all information provided, both narrative and
checkbox, being
a. Precise
b. Comprehensive

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 35
DOCUMENTATION
continued

2. All checkbox sections of a document must show that the EMT 1attended to them,
even if a given section was unused on a call
3. Medical terms, abbreviations, and acronyms are properly used and correctly
spelled
B. Legible
1. Legibility means that handwriting, especially in the narrative portion of the
document, can be read by others without difficulty
2. Checkbox marking should be clear and consistent from the top page of the
document to all underlying pages
C. Timely
1. Documentation should be completed ideally before the EMT 1handles tasks
subsequent to the patient interaction
D. Unaltered
1. While writing the document, should the EMT 1make an error, a single line
should be drawn through the error, initialed, and dated
2. Should alterations to a document be required after the document has been
submitted, see "document revision/ correction" (below)
E. Free of non-professional/ extraneous information
1. Jargon
2. Slang
3. Bias
4. Libel / slander
5. Irrelevant opinion / impression
6. Unacceptable abbreviations / acronyms

IV. Systems of narrative writing

A. Head to toe approach
1. The narrative uses a comprehensive, consistent physical approach from head to
toe
B. Body systems approach
1. The narrative uses a comprehensive review of the primary body systems
C. Call incident approach
D. Patient management approach
E. Other formats
F. Know how to differentiate subjective from objective elements of documentation

V. Special considerations of documentation

A. Documentation of patient's refusal of care and / or transport

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EMT 1Model Curriculum
Module 3: Patient Assessment 36
DOCUMENTATION
continued

1. When a patient refuses medical care, the EMT 1must show in the report the
process undergone to reach that conclusion, including
a. The EMT 1’s advice to the patient
b. The advice rendered by medical direction by telephone or radio
c. Signatures of witness (es) to the event, according to local protocol
d. Complete narrative, including quotations or statements by others
B. Document decisions / events where care and transportation were not needed
1. If canceled en route, note canceling authority and the time
2. If canceled at scene, note canceling authority and special circumstances (e.g.,
"On scene officer reported no injuries and asked us to leave the scene - no
patient contacts made")
C. Documentation in mass casualty situations
1. In unusual circumstances, comprehensive documentation has to wait until after
mass casualties are triaged and transported
2. The EMT 1should know and follow local procedures for documentation of mass
casualty situations

VI. Document revision / correction

A. Procedure
1. Write revisions to documents on separate report forms
2. Note the purpose of the revision, and why the information did not appear on the
original document
3. Note the date and time
4. Revisions should be made by the original author of a document
5. When the need for revision is realized, it should be done as soon as possible
B. Acceptable method(s)
1. Corrections
a. Written narrative is appropriate, on a new report form which is then attached to
the original
2. Deletions and additions
a. Should only be done on a new report form, not the original
3. Supplemental narratives
a. If more information comes to the EMT 1’s attention, a supplemental narrative
can be written on a separate report form and attached to the original

VII. Consequences of errors, omissions, and inappropriate documentation

A. Implications to medical care

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 37
DOCUMENTATION
continued

1. An incomplete, inaccurate, or illegible report may cause subsequent care givers

to provide inappropriate care to a patient
B. Legal implications
1. A lawyer considering the merits of an impending lawsuit can be dissuaded from a
case when the documentation is done correctly
2. The converse is true if documentation is anything less
C. Timeliness

VIII. Patient Care Reports – local policies, procedures, protocols

A. Paper PCR
1. Completion
2. Distribution
B. Electronic / Web-based PCR
1. Completion
2. Distribution

IX. Closing
A. The EMT 1shall assume responsibility for self-assessment of all
documentation
B. Peer advocacy for good documentation
1. Documentation is a maligned task in EMS, but one of utmost importance for a
variety of reasons
2. A professional EMS provider appreciates this and strives to set a good example
to others regarding the completion of the documentation tasks
C. Respect the confidential nature of an EMS report
D. Principals of documentation are to remain valid regarding computer charting, as that
technology becomes available

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 38
MODULE 3: PATIENT ASSESSMENT

Topic: HISTORY TAKING AND PATIENT ASSESSMENT LAB

Purpose:

This lab will give the EMT 1student the techniques to take an appropriate patient
history and complete a patient assessment.

Suggested Time Frame: 2 Hours

Objectives:

At the conclusion of this lab, the EMT 1student as an active participant will be able to
successfully:

1. Given a medical and trauma scenario, obtain a complete patient history.

2. Demonstrate an appropriate physical exam on a medical patient to include the

following:

A. An initial assessment
B. A focus history and physical exam
C. Detailed physical exam
D. On-going assessment

3. Demonstrate the techniques for assessing a patient with an altered mental status.

4. Demonstrate the assessment of a trauma patient.

5. Demonstrate a rapid trauma assessment used to assess a patient based on

mechanism of injury.

6. Perform a focused history and physical exam on a non-critically injured patient and a
patient with life-threatening injuries.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 39
MODULE 3: PATIENT ASSESSMENT
HISTORY TAKING AND PATIENT ASSESSMENT LAB

The EMT 1student in a lab setting with an instructor will demonstrate the following skills
either as a single skill or in a scenario based demonstration. Once the students
have mastered performing the skill, the instructor should incorporate all the skill in this unit
together in scenarios to test the application of the knowledge from this unit.

I. Obtaining a patient history – Given various scenarios, including medical and trauma,
the student will demonstrate obtaining a complete patient history
A. Establishes patient rapport and trust
B. Performs proper introductions
C. Obtains essential components of the patient’s history
1. Date, timing of event
2. Identifying data – age, gender
3. Chief complaint
4. History of present illness
a. OPQRST
b. SAMPLE
5. Past medical history
6. Current health status
a. Medications
b. Allergies
c. Alcohol, drugs, tobacco, related substances
d. Diet
e. Exercise
f. Environmental hazards
g. Use of safety measures
h. Daily life
D. Demonstrates active listening
E. Asks appropriate open-ended and closed-ended questions
F. Performs a review of body systems
G. Handles special challenges appropriately

II. Patient Assessment - Given various scenarios, including medical and trauma, the
student will perform an appropriate patient assessment including all the components of
the patient assessment.
A. Proper BSI
B. Scene Size-up
1. Scene safety – personnel and patient
2. Environmental hazards

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EMT 1Model Curriculum
Module 3: Patient Assessment 40
HISTORY TAKING / PATIENT ASSESSMENT LAB
continued

3. Number of patients
4. Nature of illness or mechanism of injury
5. Determine needs for additional resources, specialized equipment, extrication
needs
C. Initial Assessment
1. General impression
a. Priority of care
2. Provide spinal stabilization if indicated
3. Assess patient’s mental status
a. Establish rapport
b. AVPU
4. Assess / Manage airway
5. Assess / Manage breathing
6. Assess / Manage circulation
7. Assess major disability and deformities
a. Altered mental status
b. Neurological deficits
8. Determine chief complaint / problem, transport priority
9. Documentation
D. Rapid trauma Assessment – if indicated by mechanism of injury with life-threatening
injuries
1. Reassess mental status
2. Inspect, palpate, look and feel for signs of injury for rapid head to toe
examination using DCAP-BTLS and crepitation
a. D – Deformity
b. C – Contusions
c. A – Abrasions
d. P – Punctures / penetrations
e. B – Burns
f. T – Tenderness
g. L – Lacerations
h. S – Swelling
3. Using above acronym assess the following:
a. Inspect and palpate the head
b. Inspect and palpate the neck. Place cervical collar if indication and if it
hasn’t already been done.
i. Jugular vein distention
ii. Tracheal deviation

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 41
HISTORY TAKING / PATIENT ASSESSMENT LAB
continued

iii. Subcutaneous emphysema

iv. Crepitation of cervical spinal bones
c. Inspect and palpate chest
i. Crepitation
ii. Paradoxical motion
iii. Breath sounds
d. Inspect and palpate abdomen
i. Firmness
ii. Distention
e. Inspect and palpate the pelvis
f. Inspect and palpate all four extremities
i. Distal pulse
ii. Motor function and sensory
g. Roll patient to side, using spinal precautions, inspect and palpate posterior
chest, buttocks, and legs
h. Treat injuries identified by the rapid trauma assessment
i. Document
E. Focused history and physical exam – second stage of patient assessment, and is a
problem-oriented process based on the initial assessment and patient’s chief
complaint
1. Assess current problem
a. Signs and symptoms
2. Assess pain or current problem
a. OPQRST
b. Events leading to illness / mechanism of injury
3. Obtain personal and past medical history
a. SAMPLE
4. Assess vital signs
5. Examine neurological status
6. Examine injured or affected area
F. Detailed Physical Exam – is a more detailed exam than the focused history and
physical exam. This is an organized subjective and objective exam. This exam is
patient and injury specific. The patient’s injury or illness will determine whether this
part of the patient assessment is necessary. For “priority” patients this exam may
be done enroute to the hospital.

Refer to skill sheet for details

1. Mental status

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 42
HISTORY TAKING / PATIENT ASSESSMENT LAB
continued

2. General survey
3. Skin
4. Head, eyes, ears, nose and sinuses
5. Mouth and pharynx
6. Neck
7. Thorax and lungs
8. Cardiovascular system
9. Abdomen
10. External genitalia
11. Peripheral vascular system
12. Musculoskeletal system
13. Nervous system
14. Documentation
G. Ongoing Assessment – patient condition can change suddenly. Patient
assessment is an ongoing process. Reassessment in the stable patient is
repeated every 15 minutes, reassessment in the unstable patient is repeated every
5 minutes.
1. Reassess the patient’s mental status
2. Monitor the airway
3. Monitor the breathing rate and quality
4. Reassess the pulse rate and quality
5. Monitor the skin for color, temperature, and condition
6. Realign patient priorities and treatment
7. Reassess vital signs
8. Repeat focused examination regarding the complaints or injuries
9. Reassess the results of treatment

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 43
MODULE 3: PATIENT ASSESSMENT

Topic: COMMUNICATIONS LAB

Purpose:

This lab will give the EMT 1student the techniques to give an appropriate radio
report according to local protocol and policy.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this lab, the EMT 1student as an active participant will be able to
successfully:

1. Demonstrate an appropriate call-in to the base hospital, giving all pertinent

information that constitutes a complete radio report.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 44
MODULE 3: PATIENT ASSESSMENT
COMMUNICATIONS LAB

The EMT 1student in a lab setting with an instructor will demonstrate the following skills
either as a single skill or in a scenario based demonstration. The student when
given various simulated medical and trauma scenarios will give an appropriate radio call
per local protocol and policy.

I. Radio Report
A. Verifies open channel before speaking
B. Transmits correctly
C. Speaks slowly and clearly
D. Speaks in normal pitch, avoiding emotion
E. Is brief, knows what to say before transmitting
F. Does not waste air time
G. Protects privacy of patient
H. Repeats back orders if indicated
I. Confirms message is received
J. Documents orders and information given
K. Follows correct radio call format per local protocol
H. Demonstrates ability to troubleshoot basic equipment malfunction

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 45
MODULE 3: PATIENT ASSESSMENT

Topic: DOCUMENTATION LAB

Purpose:

This lab will give the EMT 1student the techniques to accurately complete a
patient care report per local protocol.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this lab, the EMT 1student as an active participant will be able to
successfully:

1. Demonstrate proper completion of a patient care report used locally.

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 46
MODULE 3: PATIENT ASSESSMENT
DOCUMENTATION LAB

The EMT 1student in a lab setting with an instructor will demonstrate the following skills
either as a single skill or in a scenario based demonstration. The student when
given various simulated medical and trauma scenarios will correctly document the patient
information, history, physical examination, treatment, and transport priorities on a patient
care record per local protocol.

I. Documentation of patient information, history, physical examination, treatment, and

transport priorities on a patient care record.
A. Records all pertinent administrative information using a consistent format
B. Identifies and records all pertinent, reportable clinical data for each patient,
including pertinent negatives
C. Uses appropriate medical terminology, abbreviations, and acronyms
D. Records accurate, consistent times
E. Includes relevant history given by witnesses, bystanders, and patients
F. Uses correct spelling and grammar
G. Writes legibly
H. Uses appropriate narrative format
I. Properly corrects errors and omissions
J. Includes all personnel and resources
K. Completes report completely and as soon as possible after the call

KCEMT
EMT 1Model Curriculum
Module 3: Patient Assessment 47
 EMT 1

INSTRUCTOR RESOURCE

PATIENT ASSESSMENT & MANAGEMENT

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in performing a complete medical or trauma assessment involving scene size-up,initial
assessment, focused history, physical examination, ongoing assessment, and perform initial interventions as necessary.
CONDITION
The examinee will be requested to perform a complete medical or trauma assessment on a simulated patient and perform initial
interventions as necessary. Required equipment will be either next to the patient or brought to the scene by the prehospital
provider.
EQUIPMENT
Live model or manikin, oxygen tank with flow meter, oxygen tubing, BVM device, oxygen mask, nasal cannula, stethoscope, blood
pressure cuff, pen light, timing device, clipboard, pen, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond ( ) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation must be taught and practiced, but is not a requirement for passing the skill.
Appropriate body substance isolation precautions must be instituted as required for scenario given.

Skill Component Teaching Points

PREPARATION

Take body substance isolation precautions · Mandatory personal protective equipment - gloves

· Situational - long sleeves, goggles, masks, gown

SCENE SIZE-UP

CRITICAL DECISIONS

Assess: · Discourage blind reciting of elements.

· Personnel/patient safety · Have student verbalize what is actually seen.

· Environmental hazards · Instructors should write on tape or provide assessment

information on body for more realistic assessment to reinforce
· Number of patients observation skills.

· Mechanism of injury

48
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

Determine: · Manual spinal stabilization begins here – C-collar is applied after

initial assessment is completed.
· Additional resources

· Specialized equipment

· Need for extrication/spinal immobilization

INITIAL ASSESSMENT

CRITICAL MANAGEMENT AND TRANSPORT DECISIONS

Consider: · Continue to reinforce observation skills.

· General impression · Demonstrate how chief complaint can often be deduced

by overall appearance, patient position, sounds, and smell.
· Life-threatening condition

Establish patient rapport: · Situation and patient condition determines the level of rapport
that is possible.
· Ask the right questions
· Pertinent questions assess chief complaint and
· Respond with empathy patient symptoms, assist in deciding which areas need more
in-depth information and what systems to focus on.

· Responding with empathy develops trust and encourages

essential patient communication.

Assess mental status/stimulus response (AVPU): · Emphasize that this is NOT the time to obtain a complete
orientation level, but to assess how the patient responds to
· Awake/not awake and orientation to environment environmental stimuli.

· Verbal stimulus response · Observe orientation to environment and then assess by using
the lowest level of stimuli.
· Painful stimulus response

· Unresponsive

** Consider blood glucose level - if unresponsive

Assess/Manage airway: · Reinforce that noisy respirations indicate an obstructed

airway and airway positioning or maneuvers must be
· Patent instituted to provide a patent airway.

· Obstructed · Assess for foreign body such as food, gum, etc.

** Open and clear/suction airway - if indicated · Use an NP airway for responsive or unresponsive patients.

** Consider basic airway adjuncts - if indicated · Use an OP airway for the unresponsive patient.

49
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

Assess/Manage breathing: · Determine if tidal volume and rate are adequate to assure
effective ventilation - use BVM to increase tidal volume or rate if
· Rate necessary.

· Effort · Administer O2 therapy if vital organs are at risk for

hypoperfusion.
· Tidal volume
· Breath sounds are assessed in 2 spaces only , for presence and
th th
· Breath s ounds (rapid chest auscultation) - if equality, at the 5 -6 intercostal space, mid-axillary line.
difficulty breathing or shortness of breath
· Respiratory rate > 40 or < 10 may not provide adequate tidal
** Consider O2 therapy volume. Be prepared to assist with bag-valve-mask ventilation if
level of consciousness is decreased.
** Consider BVM - if inadequate ventilation

Assess/Manage circulation: · Check radial and carotid pulses at same time in critical
situations. Radial pulse may be absent due to decreased blood
· Pulse - rate, rhythm, quality pressure.

· Skin - color, temperature, moisture · An irregular pulse is an indicator for ECG monitoring.

· Bleeding · Capillary refill is most appropriate in pediatric patients. NOT

always accurate in adults due to chronically poor peripheral
· Capillary refill - if appropriate circulation. NOT ACCURATE in cold environments.

** Control severe bleeding · Capillary refill can be taken at any skin area such as:
fingernail bed, palm, chest, forehead, etc. (If using the ball of
** Consider shock position - if hypotensive the foot in pediatric patients, child must be in a supine
position.)
** Consider cardiac monitor/AED - if indicated

** Consider venous access - if indicated

Assess major disability & deformities: · Neurological deficits include: facial droop, slurred speech,
drooling, paresthesia, paralysis, agitation, headache, blurred
· Altered mental status vision, etc.

· Neurological deficits · Note abnormal presentation such as tripod position, decerebrate

or decorticate posturing, contractures, etc.
· Abnormal body presentation (posture)

Determine: · Determine which specific focused history and physical

examination is indicated:
· Chief complaint/problem
- responsive medical/minor trauma patient
· Specific focused history and physical examination
- unresponsive medical/major trauma patient.
· Transport decision

Expose specific body area for detailed examination - · Maintain patient modesty and dignity as much as possible.
if pertinent

50
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

FOCUSED HISTORY AND PHYSICAL EXAMINATION

“RESPONSIVE MEDICAL / MINOR TRAUMA PATIENT”

Assess current problem: · Current problem reflects the chief complaint.

· Signs and symptoms · Assess pediatric patients from feet to head.

· Assess pain - if pertinent: · Current pain history:

- onset - Severity of pain is the patient’s perception.

- provoking/relieving factor - Quality refers to the type of pain such as: burning,
squeezing, ache, sharp, stabbing, etc.
- quality

- region/radiation/recurrence

- severity (mild-severe or 1 -10 scale)

- time

Assess current problem (continued): · Current respiratory history:

· Assess difficulty breathing - if pertinent: - Severity is the EMS provider’s perception and is rated as
mild, moderate or severe - this is obtained from a complete
- onset respiratory assessment.

- provoking factor - Quality assesses if the patient is having difficulty getting air
in or out, use of accessory muscles, tripod position,
- quality speaking in one word sentences, etc.

- recurrence and what treatment provides relief - Recurrence helps determine severity as to frequency of
problem and treatment needed to obtain relief.
- severity

- time

· Events leading to illness/mechanism of injury

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KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

Obtain personal and past medical history: · Use the pediatric emergency resuscitation tape to obtain an
infant’s or small child’s weight.
· Age
· Obtain information: under physician care, name of PMD,
· Weight or health plan - assists in eliciting medical history and
transport destination.
· Under physician’s care/private medical doctor
· Pertinent history refers to past medical history that is pertinent
· Pertinent history to the chief complaint/problem such as: a heart condition and
pulmonary problems, hypertension, diabetes, CVA, or recent
· Allergies surgery.

· Medications · Last oral intake is important when there is a possibility

the patient may require surgery or if there is a potential
· Last oral intake - if pertinent for aspiration.

Assess vital signs:
Pulse and respirations are actually counted at this time.

· Cardiac status
Both systolic and diastolic B/P should be auscultated. Palpate
B/P only if unable to hear when auscultated.
- pulse - rate, rhythm, quality

Palpating blood pressure for convenience or saving time does
- ECG reading - if indicated and available NOT provide needed cardiovascular information or evaluate
changes in patients with cerebral edema, CHF or other serious
· Respiratory status conditions.

- respirations - rate, effort, tidal volume
Temperature reading is important in suspected febrile seizures
or environmental emergencies.
- breath sounds

· Blood pressure

· Temperature - if indicated

Examine neurological status
Comprehensive orientation level involves 4 parameters of

person, place, time, purpose/event.
· Comprehensive orientation level

Assess each extremity individually then compare findings.
· Glasgow Coma Scale (GCS) - eyes, motor, verbal

Determine from patient’s family what is the patient’s normal
· Pupils - size, equality, reactivity, movement - if status
indicated

· Extremities-circulation, movement, strength,

sensation

Examine injured or affected area
Maintain patient modesty and dignity as much as possible.

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KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

FOCUSED HISTORY AND PHYSICAL EXAMINATION

“UNRESPONSIVE MEDICAL / MAJOR TRAUMA PATIENT”

Perform detailed physical examination · A detailed physical examination entails a complete body
check on scene if patient is stable or if possible during
** Manage specific problem or injury transport if the patient is critical (priority patient).

· A rapid trauma examination reveals life-threatening injuries

which m ust be treated immediately and require rapid
transport.

A rapid trauma assessment consists of a brief inspection and

palpation of the:

- head - abdomen

- neck - pelvis

- chest - extremities

Assess: · Obtain information from patient, family, or bystanders if patient

is unable to provide.
· Current medical history
· Medical history includes: signs/symptoms, medications,
· Past medical history medical problems, last seen by PMD, name of PMD, health plan,
etc.
· OPQRST for pain/respiratory - if indicated
· Personal history includes: age, sex, weight, etc.
· Personal history

· Vital signs

· Neurological status

ONGOING ASSESSMENT

“STABLE PATIENTS / PRIORITY (CRITICAL) PATIENTS”

Repeat (every 5 minutes for priority patients and every · Repeat initial and focused examination every 15 minutes for
15 minutes for stable patients): stable patients and every 5 minutes for prior ity patients.

· Priority patients are patients who have abnormal vital signs, S/S
of poor perfusion or if there is a suspicion that the patient’s
· Initial assessment
condition may deteriorate.
· Relevant portion of the focused examination

53
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

Evaluate response to treatment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
changes in the patient’s condition are anticipated sooner.

Compare results to baseline condition and vital signs

ELEMENTS FOR A DETAILED PHYSICAL EXAMINATION OR EXAMINATION OF A SPECIFIC BODY PART

MANAGEMENT OF SPECIFIC PROBLEM OR INJURY

HEAD - Skull, Eyes, Ears, Nose, Mouth, Face · Adults – head-to-toe examination works best.

Examine for: · Children – toe-to-head examination works best to gain

the child’s confidence.
- drainage
· Battle’s sign – bruising over the mastoid process indicates a
- deformity basilar skull fracture or fracture of the temporal bone.

- contusion (raccoon eyes, Battle’s sign) · Racoon eyes – bruising of one or both orbits indicates
fracture of the sphenoid sinus.
- punctures/penetrations
· Battle’s sign and racoon’s eyes develop some time after the
- burns/soot injury and generally are not seen upon EMS arrival, if noted, this
may be due to a previous injury.
- lacerations
· Fluid from the ear or nose also may indicate leakage of spinal
- swelling fluid resulting from a basilar skull fracture.

- scars

Palpate for:

- tenderness

- instability

- crepitus

** Maintain patent airway

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EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

NECK/CERVICAL SPINE · DO NOT simultaneously press on both carotid arteries.

Examine for: · Paramedics should consider spinal immobilization indications

and EMTs shall perform spinal immobilization based on
- deformity mechanism of injury.

- contusions · Full face helmets should be removed to allow access to the

patient’s airway and provide in-line immobilization of the head
- abrasions and neck.

- punctures/penetrations · Custom fitted helmets such as football or hockey helmets

SHOULD NOT BE REMOVED unless respiratory distress is
- burns coupled with inability to access the airway. Remove face guard
with rescue scissors or a screwdriver.
- lacerations
· An athlete wearing shoulder pads who has a helmet on - will
- swelling maintain his neck in a neutral position when placed on a
backboard.
- scars
· Pad patients to maintain a neutral position on backboard:
- jugular vein distention (JVD)
- Adults – head and neck for comfort and to prevent
- tracheal deviation hyper- extension

- accessory muscle use - Infant or child – immobilize in child safety seat, if possible, or
pad neck and shoulder area to maintain alignment
- medical alert tags
- Elderly – head and neck to maintain comfort and
prevent hyper-extension, airway obstruction, and skin
Palpate for:
breakdown
- tenderness
- Athletes – head and neck to prevent hyper-extension, if
shoulder pads are in place, and helmet removed
- instability

- crepitus

- subcutaneous emphysema

- carotid pulses

** Maintain spinal immobilization - if indicated

** Apply occlusive dressing - if puncture wound to neck

55
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

CHEST - Clavicles Sternum, Ribs · Maintain patient modesty and perform chest palpation in
a manner as to avoid any inference of impropriety.
Examine for:
· Complete either anterior or posterior auscultation for 2
- deformity breaths in all 3 fields.

- contusions · Chest percussion assists in providing information if there is a

hemothorax or a pneumothorax. Percussion on scene may be
- abrasions difficult due to environmental noise and patient condition –
transport should not be delayed for this assessment element.
- punctures/penetrations
- Hemothorax – dull sound
- paradoxical movement
- Pneumothorax – hyperresonant sound
- burns
· Paramedics must perform chest decompression once
- lacerations tension pneumothorax is confirmed to prevent irreversible
shock.
- swelling
· Percussion is a paramedic skill and not an EMT-I skill.
- scars

- accessory muscle use

- sucking chest wound

Palpate for:

- tenderness

- instability

- crepitus

- subcutaneous emphysema

Auscultate:

- breath sounds

Percuss - if breath sounds unequal

** Apply occlusive dressing to sucking chest wound - if

indicated

** Splint flail segment - if paradoxical motion

** Decompress chest - if tension pneumothorax

56
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

ABDOMEN/PELVIS · EMS providers should palpate each of the 4 quadrants one time
only to assess for rigidity and guarding. Further palpation does
Examine for: not add to examination findings and results in unnecessary pain.

- deformity · Rebound tenderness is a diagnostic test for peritoneal irritation

and causes severe pain and SHOULD NOT be evaluated in the
- contusions field by EMS providers.

- abrasions · Guarding is a reflexive tightening of abdominal muscles as

depth of palpation is increased.
- punctures/penetrations
· Palpating femoral pulses is useful in the elderly if circulation
- burns to extremities is diminished. Maintain modesty and dignity
and palpate in a manner as to avoid inference of impropriety.
- lacerations
· DO NOT palpate pulsating masses -- this may rupture
- swelling an aneurysm.

- scars · Use finger pads of the first 3 fingers to palpate, DO NOT use
finger tips to palpate.
- distention

- pulsating mass

- incontinence

- priapism

Palpate for:

- rigidity/guarding

- tenderness

- femoral pulses

- crepitus

57
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

LOWER EXTREMITIES · Compare bilateral pulses, motor movement and sensation.

Examine for: · Midline calf tenderness may indicate deep vein thrombosis and
should be assessed for in patients complaining of shortness of
- deformity breath, chest pain, or signs of a stroke. Deep vein thrombosis
may indicate migration of a clot to the lungs, coronary arteries or
- contusions brain.

- abrasions

- punctures/penetrations

- burns

- lacerations

- swelling

- scars

- medical alert tags

Palpate for:

- pedal pulses

- tenderness

- instability

- crepitus

58
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

UPPER EXTREMITIES · Compare bilateral pulses, motor movement and sensation.

Examine for:

- deformity

- contusions

- abrasions

- punctures/penetrations

- burns

- lacerations

- swelling

- scars

- medical alert tags

Palpate for:

- brachial/radial pulses

- tenderness

- instability

- crepitus

59
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 Skill Component Teaching Points

BACK - Posterior Thorax, Lumbar, Buttocks · Log roll patient if suspected spinal injury.

Examine for: · Roll patient directly onto backboard once examination is

complete.
- deformity

- contusions

- abrasions

- punctures/penetrations

- burns

- lacerations

- swelling

- scars

Palpate for:

- tenderness

- instability

- crepitus

- sacral edema

INSTRUCTOR NOTES:

Assessment should be guided by mechanism of injury or complaint. DO NOT reinforce mindless recitation of assessment
elements that are not appropriate for given scenario. Physical examination CANNOT be performed without visualization.
Examination through clothing represents an incomplete examination. Actual palpation of body parts must be done with
appropriate findings provided to the student.

60
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Instructor Resource
 EMT 1Skill

PATIENT ASSESSMENT & MANAGEMENT

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in performing a complete medical or trauma assessment involving scene size-up,initial
assessment, focused history, physical examination, ongoing assessment, and perform initial interventions as necessary.
CONDITION
The examinee will be requested to perform a complete medical or trauma assessment on a simulated patient and perform initial
interventions as necessary. Required equipment will be either next to the patient or brought to the scene by the prehospital
provider.
EQUIPMENT
Live model or manikin, oxygen tank with flow meter, oxygen tubing, BVM device, oxygen mask, nasal cannula, stethoscope, blood
pressure cuff, pen light, timing device, clipboard, pen, long sleeves, goggles, masks, gown, gloves.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond ( ) for skills testing and must manage successfully all items
indicated by double asterisks (**).
Appropriate body substance isolation precautions must be instituted as required for scenario given.

NAME DATE / /_ EXAMINER(S)

1st 2nd 3rd (Final)

PASS FAIL

Skill Component Yes No Comments

PREPARATION

Take body substance isolation precautions

SCENE SIZE-UP

CRITICAL DECISIONS

Assess:

· Personnel/patient safety

· Environmental hazards

· Number of patients

· Mechanism of injury

Determine:

· Additional resources

· Specialized equipment

· Need for extrication/spinal immobilization

61
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

INITIAL ASSESSMENT

CRITICAL MANAGEMENT AND TRANSPORT DECISIONS

Consider:

· General impression

· Life-threatening condition

Establish patient rapport:

· Ask the right questions

· Respond with empathy

Assess mental status/stimulus response (AVPU):

· Awake/not awake and orientation to environment

· Verbal stimulus response

· Painful stimulus response

· Unresponsive

** Consider blood glucose level - if unresponsive

Assess/Manage airway:

· Patent

· Obstructed

** Open and clear/suction airway - if indicated

** Consider basic airway adjuncts - if indicated

Assess/Manage breathing:

· Rate

· Effort

· Tidal volume

· Breath sounds (rapid chest auscultation)

if difficulty breathing/shortness of breath

** Consider O2 therapy

** Consider BVM - if inadequate ventilation

62
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

Assess/Manage circula tion:

· Pulse - rate, rhythm, quality

· Skin - color, temperature, moisture

· Bleeding

· Capillary refill - if appropriate

** Control severe bleeding

** Consider shock position - if hypotensive

** Consider monitor/AED - if indicated

** Consider venous access - if indicated

Assess major disability & deformities:

· Altered mental status

· Neurological deficits

· Abnormal body presentation (posture)

Determine:

· Chief complaint/problem

· Focused history and physical examination

· Transport decision

Expose specific body area for detailed examination -

if pertinent

63
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

FOCUSED HISTORY AND PHYSICAL EXAMINATION

“RESPONSIVE MEDICAL / MINOR TRAUMA PATIENT”

Assess current problem:

· Signs and symptoms

· Assess pain - if pertinent:

- onset

- provoking factor/relieving factor

- quality

- region/r/radiation/recurrence

- severity (mild-severe or 1 -10 scale)

- time

Assess current problem (Continued)

· Assess difficulty breathing - if pertinent:

- onset

- provoking factor

- quality

- recurrence and what treatment provides relief

- severity

- time

· Events leading to illness/mechanism of injury

64
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

Obtain personal and past medical history:

· Age

· Weight

· Under physician’s care/Private medical doctor

· Pertinent history

· Allergies

· Medications

· Last oral intake - if pertinent

Assess vital signs:

· Cardiac status

- Pulse - rate, rhythm, quality

- ECG reading - if indicated and available

· Respiratory status

- Respirations - rate, effort, tidal volume

- Breath sounds

· Blood pressure

· Temperature - if indicated

Assess neurological status:

· Comprehensive orientation level

· Glasgow Coma Scale (GCS) - eyes, motor, verbal

· Pupils - size, equality, reactivity, movement - if

indicated

· Extremities-circulation, movement, strength,

sensation

Examine injured or affected area

65
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

FOCUSED HISTORY AND PHYSICAL EXAMINATION

“UNRESPONSIVE MEDICAL / MAJOR TRAUMA PATIENT”

Perform detailed physical examination

** Manage specific problem or injury

Assess:

· Current medical history

· Past medical history

· OPQRST for pain/respiratory - if indicated

· Personal history

· Vital signs

· Neurological status

ONGOING ASSESSMENT

STABLE PATIENTS AND PRIORITY (CRITICAL) PATIENTS

Repeat (every 5 minutes for priority patients and every

15 minutes for stable patients):

· Initial assessment

· Relevant portion of the focused examination

Evaluate response to treatment

Compare results to baseline condition and vital signs

66
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

ELEMENTS FOR A DETAILED PHYSICAL EXAMINATION OR EXAMINATION OF A SPECIFIC BODY PART

MANAGEMENT OF SPECIFIC PROBLEM OR INJURY

HEAD - Skull, Eyes, Ears, Nose, Mouth, Face

Examine for:

- drainage

- deformity

- contusions (raccoon eyes, Battle’s sign)

- abrasions

- punctures/penetrations

- burns/soot

- lacerations

- swelling

- scars

- eye movement

Palpate for:

- tenderness

- instability

- crepitus

** Maintain patent airway

67
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

NECK/CERVICAL SPINE

Examine for:

- deformity

- contusions

- abrasions

- punctures/penetrations

- burns

- lacerations

- swelling

- scars

- jugular vein distention (JVD)

- tracheal deviation

- accessory muscle use

- medical alert tags

Palpate for:

- tenderness

- instability

- crepitus

- subcutaneous emphysema

- carotid pulses

** Maintain spinal immobilization - if indicated

** Apply occlusive dressing - if puncture wound to

neck

68
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

CHEST - Clavicles Sternum, Ribs

Examine for:

- deformity

- contusions

- abrasions

- punctures/penetrations

- paradoxical movement

- burns

- lacerations

- swelling

- scars

- accessory muscle use

- sucking chest wound

Palpate for:

- tenderness

- instability

- crepitus

- subcutaneous emphysema

Auscultate:

- breath sounds

Percuss - if breath sounds unequal

** Apply occlusive dressing to sucking chest wound - if

indicated

** Splint flail segment - if paradoxical motion

69
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

ABDOMEN/PELVIS

Examine for:

- deformity

- contusions

- abrasions

- punctures/penetrations

- burns

- lacerations

- swelling

- scars

- distention

- pulsating mass

- incontinence

- priapism

Palpate for:

- rigidity/guarding

- tenderness

- femoral pulses

- crepitus

70
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

LOWER EXTREMITIES

Examine for:

- deformity

- contusions

- abrasions

- punctures/penetrations

- burns

- lacerations

- swelling

- scars

- medical alert tags

Palpate for:

- pedal pulses

- tenderness

- instability

- crepitus

71
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

UPPER EXTREMITIES

Examine for:

- deformity

- contusions

- abrasions

- punctures/penetrations

- burns

- lacerations

- swelling

- medical alert tags

Palpate for:

- brachial/radial pulses

- tenderness

- instability

- crepitus

72
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
 Skill Component Yes No Comments

BACK - posterior thorax, lumbar, buttocks

Examine for:

- deformity

- contusions

- abrasions

- punctures/penetrations

- burns

- lacerations

- swelling

- scars

Palpate for:

- tenderness

- instability

- crepitus

- sacral edema

73
KCEMT
EMT 1Model Curriculum
Patient Assessment Skill: Student
Module 4
 MODULE 4:
TRAUMA

Number of Lecture Hours: 2 Hours

Topics:

1. Trauma 1 Hour
2. Hemorrhage and Shock 1 Hour

Labs/Workshops: Number of Hours: 2 Hours

1. Assessment and management of the trauma patient

Testing Number of Hours: 2 Hours

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 1
 MODULE 4:
TRAUMA

MODULE TERMINAL OBJECTIVES:

At the completion of this module the EMT 1student will be able to successfully:

1. Apply the principals of kinematics to enhance the patient assessment and predict the
likelihood of injuries based on the patient’s mechanism of injury.

2. Interpret assessment findings to formulate a field impression and implement the

treatment plan for the patient with hemorrhage or shock.

3. Demonstrate the practical skills of managing trauma patients.

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 2
MODULE 4: TRAUMA

Topic: TRAUMA

Purpose:

This topic will give the EMT 1student an understanding of the principals of
kinematics to enhance patient assessment.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this topic, the EMT 1student will be able to successfully:

1. List and describe the components of a comprehensive trauma system.

2. Describe the role and differences between levels of trauma centers.

3. Discuss the criteria for transport to the trauma center per local protocol.

4. Describe the kinematics of blunt, penetrating, and blast injuries.

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 3
DECLARATIVE
MODULE 4: TRAUMA
TRAUMA

I. Introduction
A. Epidemiology of Trauma
1. A leading cause of death for people 1 - 44 years of age
2. 140,000 unexpected deaths per year
3. Automobile related deaths are greater than 40,000

II. Trauma Systems

A. Components
1. Injury prevention
2. Prehospital Care
a. Treatment
b. Transport
c. Trauma triage guidelines
3. Emergency Department care
4. Interfacility transportation as necessary
5. Definitive care
6. Rehabilitation
7. Data collection / trauma registry
B. Trauma Centers
1. Levels
2. Qualifications
3. Roles
C. Transport Considerations
1. Level of receiving facility
2. Mode of transport
a. Ground transport
(1) If appropriate facility can be reached within reasonable time
(2) To a more accessible landing zone for air medical transport
b. Air medical transport
(1) Indications
(2) Contraindications
(3) Procedure (refer to local protocol)

III. Blunt Trauma

A. Mechanism
1. Vehicle crashes
2. Vehicle vs pedestrian
3. Falls
4. Other

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 4
TRAUMA
continued

IV. Penetrating Trauma

A. Mechanism
1. Stab wounds
2. Gun shot wounds
3. Other

V. Blast Injuries
A. Three phases
1. Primary
a. Pressure wave (ruptured organs)
b. Heat wave (burns)
2. Secondary
a. Flying debris / shrapnel
b. Compression / lacerations
3. Tertiary
a. Patient becomes flying object
(1) Impact on other objects
(2) Similar to falls

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 5
MODULE 4: TRAUMA

Topic: HEMORRHAGE AND SHOCK

Purpose:

This topic will give the EMT 1student an opportunity to utilize their assessment
findings to formulate a field impression and implement the treatment plan for the patient
with hemorrhage shock.

Suggested Time Frame: 2 Hours

Objectives:

At the conclusion of this topic, the EMT 1student will be able to successfully:

1. Discuss the various types and degrees of hemorrhage and shock.

2. Discuss the assessment findings associated with hemorrhage and shock.

3. Describe the body’s physiological response to changes in perfusion.

4. Discuss the indications, contraindications, complications, and techniques of

intervention for shock.

5. Discuss fluid resuscitation for the trauma patient.

6. Discuss local protocols for the management of shock in trauma patients.

7. Demonstrate the assessment of a patient with signs and symptoms of shock.

8. Demonstrate the management of a patient with signs and symptoms of shock.

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 6
DECLARATIVE MODULE 4:
TRAUMA HEMORRHAGE
AND SHOCK

I. Pathophysiology, assessment, and management of hemorrhage

A. Hemorrhage
1. Pathophysiology
a. Location
(1) External
(a) Controlled
(b) Uncontrolled
(2) Internal
(a) Trauma
(b) Non-trauma
(c) Controlled
(d) Uncontrolled
b. Anatomical type
(1) Arterial
(2) Venous
(3) Capillary
2. Assessment
a. Bright red blood from wound, mouth, rectum, or other orifice
b. Coffee ground appearance of vomitus
c. Dizziness or syncope on sitting or standing
d. Signs and symptoms of hypovolemic shock
3. Management
a. Airway and ventilatory support
b. Circulatory support
(1) Bleeding from nose or ears after head trauma
(a) Refrain from applying pressure
(b) Apply loose sterile dressing to protect from infection
(2) Bleeding from other areas
(a) Control bleeding
i) Direct pressure
ii) Elevation if appropriate
iii) Pressure points
iv) Apply sterile dressing and pressure bandage
v) Tourniquet

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 7
HEMORRHAGE AND SHOCK
continued

II. Pathophysiology, assessment, and management of shock

A. Shock
1. Pathophysiology
a. Perfusion depends on cardiac output (CO), systemic vascular resistance
(SVR), and transport of oxygen
(1) CO = HR X SV
(a) HR -heart rate
(b) SV -stroke volume
(2) BP = CO X SVR
(3) Shock (hypoperfusion) can result from
(a) Inadequate cardiac output (↓ HR and/or ↓ SV)
(b) Inadequate systemic vascular resistance (peripheral vasodilation)
(c) Inability of red blood cells to deliver oxygen to tissues
b. Compensation for decreased perfusion
(1) Sympathetic nervous system stimulated
(a) Decrease in systolic pressure less than 80 mmHg stimulates vasomotor
center to increase arterial pressure
(b) Adrenal medulla glands secrete epinephrine and norepinephrine
i) Vasoconstriction
ii) Increase in peripheral vascular resistance
iii) Bronchodilation
c. Stages of shock
(1) Compensated
(a) Characterized by signs and symptoms of early shock
(b) Arterial blood pressure is normal or high
(c) Treatment at this stage will typically result in recovery
(2) Decompensated
(a) Characterized by signs and symptoms of late shock
(b) Arterial blood pressure is abnormally low
(c) Treatment at this stage will sometimes result in recovery
(3) Irreversible
(a) Characterized by signs and symptoms of late shock
(b) Arterial blood pressure is abnormally low
(c) Even aggressive treatment at this stage does not result in
recovery
2. Assessment
a. Early or compensated
(1) Tachycardia
(2) Pale, cool skin

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 8
HEMORRHAGE AND SHOCK
continued

(3) Diaphoresis
(4) Level of consciousness
(a) Normal
(b) Anxious or apprehensive
(5) Blood pressure maintained
(6) Complaints of thirst
(7) Weakness
b. Late or progressive
(1) Extreme tachycardia
(2) Extreme pale, cool skin
(3) Diaphoresis
(4) Significant decrease in level of consciousness
(5) Hypotension
3. Management
a. Airway and ventilatory support
(1) Ventilate and suction as necessary
(2) Administer high concentration oxygen
b. Circulatory support
(1) Hemorrhage control
(2) Intravenous fluids (refer to local protocol)
(a) Hypotension in the non-traumatic patient
(b) Trauma (other than head trauma)
(c) Head trauma
c. Transport considerations
(1) Indications for rapid transport
(2) Indications for transport to a trauma center
(3) Considerations for air medical transportation

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 9
MODULE 4: TRAUMA

Topic: TRAUMA ASSESSMENT LAB

Purpose:

This lab will give the EMT 1student an opportunity to demonstrate assessment
skills to formulate treatment and transport plans for trauma emergencies.

Suggested Time Frame: 2 Hours

Objectives:

At the conclusion of this lab, the EMT 1student will be able to successfully:

1. Demonstrate the assessment and management of a patient with signs and symptoms
of shock.

2. Demonstrate the appropriate assessment, treatment, and transport of a patient with

non life-threatening injuries and a patient with life-threatening injuries.

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 10
MODULE 4: TRAUMA
TRAUMA ASSESSMENT LAB

The EMT 1student in a lab setting with an instructor will demonstrate the
appropriateassessment and management of various trauma scenarios to include life-
threatening and non-life threatening trauma patients. These scenarios will include review
of the basic skills for splinting, bandaging, and immobilization.

I. Demonstrate the appropriate patient assessment with a trauma patient without life-
threatening injuries or without significant mechanism of injuries.
A. Proper BSI
B. Scene size up
1. Use clues on scene to determine mechanism of injury
2. Determine scene is safe
C. Manual C-spine stabilization until chief complaint is established
D. General impression of patient
E. Determine level of consciousness
1. AVPU
F. Ensure airway patency
1. Open airway if needed
G. Determine chief complaint or any apparent life threats
H. Assess rate and quality of breathing
1. Apply oxygen
I. Assess pulses and skin color
1. Control external bleeding
2. Initiate management of shock
J. Determine patient priority and transport decision
K. Perform a focused trauma assessment
L. Obtain baseline vital signs
M. Obtain a past medical history
1. SAMPLE
N. Treat patient for injuries per local protocol
O. Prepare patient for transport
P. Detailed physical examination
Q. Ongoing assessment
R. Documentation

II. Demonstrate the appropriate patient assessment with a trauma patient with life-
threatening injuries or with significant mechanism of injuries.
A. Proper BSI
B. Scene size up
1. Use clues on scene to determine mechanism of injury
2. Determine scene is safe

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 11
TRAUMA ASSESSMENT LAB
continued

C. Manual C-spine stabilization until chief complaint is established

D. General impression of patient
E. Determine level of consciousness
1. AVPU
F. Ensure airway patency
1. Open airway if needed
2. Airway adjuncts , suction if needed
G. Determine chief complaint or any apparent life threats
H. Assess rate and quality of breathing
1. Apply oxygen
I. Assess pulses and skin color
1. Control external bleeding
2. Initiate management of shock
J. Determine patient priority and transport decision
K. Reassess mechanism of injury
L. Continue spinal immobilization. Apply cervical collar after assessing neck.
M. Reassess mental status
N. Perform a rapid trauma assessment
O. Provide treatment for injuries per local protocol
P. Obtain baseline vital signs
Q. Obtain a past medical history
1. SAMPLE
R. Transport if transport wasn’t started earlier
S. Perform a detail examination if time permits
T. Ongoing Assessment
U. Documentation

III. Demonstrate the appropriate management and treatment of trauma patients per
local protocols.
A. Extremity trauma
1. Bandaging and splinting
2. Hemorrhage control
3. HARE or Sager
B. Head and spinal trauma
1. Spinal immobilization
2. Long board
3. KED
4. Helmet removal

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 12
TRAUMA ASSESSMENT LAB
continued

C. Burns
D. Thoracic Trauma and abdominal trauma
E. Management of shock
1. IV Management
D. Transport priorities and destinations per local protocol

KCEMT
EMT 1Model Curriculum
Module 4: Trauma 13
Module 5
 MODULE 5:
MEDICAL

Number of Lecture Hours: 13 Hours

Topics:

1. Respiratory Emergencies 4 Hours

2. Cardiovascular Emergencies 3 Hours
3. Diabetic Emergencies 2 Hours
4. Allergic Reactions 1 Hour
5. Poisoning / Overdose Emergencies 1 Hour
6. Environmental Emergencies 2 Hours

Labs/Workshops: Number of Hours: 6 Hours

Assessment and treatment scenarios for medical emergencies:

1. Respiratory Emergencies
2. Cardiovascular Emergencies
3. Diabetic Emergencies
4. Allergic Reactions
5. Poisoning / Overdose Emergencies
6. Environmental Emergencies

Testing: Number of Hours: 2 Hours

KCEMT
EMT 1Model Curriculum
Module 5: Medical 1
 MODULE 5:
MEDICAL

MODULE TERMINAL OBJECTIVES:

At the completion of this module the EMT 1student as an active participant will be able to
successfully:

1. Interpret assessment findings to formulate a field impression and implement the

treatment plan for the patient with respiratory emergencies.

2. Interpret assessment findings to formulate a field impression and implement the

treatment plan for the patient experiencing a cardiac emergency.

3. Interpret assessment findings to formulate a field impression and implement the

treatment plan for the patient with a diabetic emergency.

4. Interpret assessment findings to formulate a field impression and implement the

treatment plan for the patient with an allergic or anaphylactic reaction.

5. Interpret assessment findings to formulate a field impression and implement the

treatment plan for the patient with a poisoning or overdose respiratory emergency.

6. Interpret assessment findings to formulate a field impression and implement the

treatment plan for the patient with an environmentally-induced or exacerbated
emergency.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 2
MODULE 5: MEDICAL

Topic: RESPIRATORY EMERGENCIES

Purpose:

This topic will give the EMT 1student an understanding of respiratory

emergencies and to utilize assessment findings to formulate a treatment plan.

Suggested Time Frame: 4 Hours

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Review the structures of the upper and lower airway.

2. Identify common pathological events that affect the pulmonary system.

3. Discuss abnormal assessment findings associated with pulmonary diseases and

conditions.

4. Discuss the pharmacological characteristics for inhaled beta-2 agonists and

epinephrine.

5. Describe the causes, pathophysiology, assessment findings, and management of

the following respiratory conditions:

a. Bronchial asthma
b. Chronic bronchitis
c. Emphysema / COPD
d. Pneumonia
e. Pulmonary edema
f. Spontaneous pneumothorax
g. Hyperventilation syndrome

6. Appreciate the importance of the accurate field impressions of patients with

respiratory diseases and conditions.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 3
7. Demonstrate an appropriate assessment and field management of a patient with
respiratory diseases and conditions.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 4
DECLARATIVE MODULE 5:
MEDICAL RESPIRTORY
EMERGENCIES

I. Introduction

II. General system pathophysiology, assessment, and management

A. Pathophysiology
1. A variety of problems can impact the pulmonary system's ability to achieve its goal
of gas exchange to provide for cellular needs and excretion of wastes
2. Specific pathophysiologies
a. Ventilation
(1) Foreign body obstruction
(a) Trauma
(b) Epiglottitis
(2) Lower airway obstruction
(a) Trauma
(b) Obstructive lung disease
(c) Mucous accumulation
(d) Smooth muscle spasm
(e) Airway edema
B. Assessment Findings
1. Scene size up - a safe environment for all EMS personnel before initiating patient
contact
2. Initial assessment
a. A major focus of the initial assessment is the recognition of life-threat;
(1) Alterations in mental status
(2) Severe cyanosis
(3) Absent breath sounds
(4) Audible stridor
(5) 1-2 word dyspnea
(6) Tachycardia>130 beats / minute
(7) Pallor and diaphoresis
(8) The presence of retractions / use of the accessory muscles
b. Recognition of life-threat and the initiation of resuscitation take priority over
detailed assessment
3. Focused history and physical examination
a. Chief complaint
(1) Dyspnea
(2) Chest pain

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EMT 1Model Curriculum
Module 5: Medical 5
RESPIRATORY EMERGENCIES
continued

(3) Cough
(a) Productive
(b) Non-productive
(c) Hemoptysis
(4) Wheezing
(5) Signs of infection
(a) Fever / chills
(b) Increased sputum production
b. History
(1) Known pulmonary disease
(2) Medication history
(a) Current medications
(b) Medication allergies
(c) Pulmonary medications
(d) Cardiac-related drugs
(3) History of the present episode
(4) Exposure / smoking history
c. Physical exam
(1) General impression
(a) Position
i) Sitting
ii) "Tripod" position
(b) Mentation
i) Confusion is a sign of hypoxemia
ii) Restlessness and irritability may be signs of fear and hypoxemia
iii) Severe lethargy or coma
(c) Ability to speak
i) 1-2 word dyspnea versus ability to speak freely
ii) Rapid, rambling speech is a sign of anxiety and fear
(d) Respiratory effort
i) Hard work indicates obstruction
ii) Retractions
iii) Use of accessory muscles
(e) Color
i) Pallor
ii) Diaphoresis
iii) Cyanosis

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RESPIRATORY EMERGENCIES
continued

a) Central
b) Peripheral
(2) Vital signs
(a) Pulse
i) Tachycardia is a sign of hypoxemia and the use of sympathomimetic
medications
(b) Blood pressure
i) Hypertension may be associated with sympathomimetic medication
use
(c) Respiratory rate
(3) Head / neck
(a) Pursed lip breathing
(b) Use of accessory muscles
(c) Sputum
i) Increasing amounts suggest infection and/or pneumonia
ii) Pink, frothy sputum is associated with severe, late stages of
pulmonary edema
(d) Jugular venous distention may accompany right-sided heart failure,
which may be caused by severe pulmonary obstruction
(4) Chest
(a) Signs of trauma
(b) Barrel chest demonstrates the presence of long-standing chronic "
obstructive lung disease
(c) Retractions
(d) Symmetry
(e) Breath sounds
i) Normal
ii) Abnormal
a) Stridor
b) Wheezing
c) Rhonchi (low wheezes)
d) Rales (crackles)
(5) Extremities
(a) Peripheral cyanosis
(b) Carpopedal spasm may be associated with hypocapnia resulting from
periods of rapid, deep respiration
C. Management

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EMT 1Model Curriculum
Module 5: Medical 7
RESPIRATORY EMERGENCIES
continued

1. Airway and ventilatory support

a. Manual airway opening maneuvers
b. Oropharyngeal airway
c. Nasopharyngeal airway
d. Nasal cannula
e. Simple oxygen mask
f. Non-rebreather mask
g. Multi-lumen airway
h. Bag-valve-mask
i. Suctioning
2. Circulatory support
3. Pharmacological interventions
a. Oxygen
b. Sympathomimetic
(1) Beta 2 agonists (e.g., albuterol- Proventil, Ventolin)
(2) Epinephrine
4. Non-pharmacological interventions
a. Positioning -sitting up
5. Transport considerations
a. Appropriate mode
b. Appropriate facility

IV. Specific illness

A. Obstructive airway disease
1. A spectrum of diseases which affect a substantial number of individuals
worldwide
2. Diseases include asthma, COPD (which includes emphysema and chronic
bronchitis)
3. Epidemiology
a. Morbidity / mortality
(1) Overall
(2) Asthma -4-5% of US population
(3) 20% of adult males have chronic bronchitis
b. Causative factors
(1) Cigarette smoking
(2) Exposure to environmental toxins
(3) Genetic predisposition

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EMT 1Model Curriculum
Module 5: Medical 8
RESPIRATORY EMERGENCIES
continued

c. Factors which may exacerbate underlying conditions

(1) Intrinsic
(a) Stress is a significant exacerbating factor, particularly in adults
(b) Upper respiratory infection
(c) Exercise
(2) Extrinsic
(a) Tobacco smoke
(b) Allergens (including foods, animal danders, dusts, molds, pollens)
(c) Drugs
(d) Occupational hazards
4. Pathophysiology overview
a. Obstruction occurs in the bronchioles, and may be the result of
(1) Smooth muscle spasm
(2) Mucous
(3) Inflammation
b. Obstruction may be reversible or irreversible
c. Obstruction causes air trapping through the following mechanism
(1) Bronchioles dilate naturally on inspiration
(2) Dilation enables air to enter the alveoli despite the presence of
obstruction
(3) Bronchioles naturally constrict on expiration
(4) Air becomes trapped distal to obstruction on exhalation
5. Specific pathophysiology
a. Asthma
(1) Reversible obstruction
(2) Obstruction caused by a combination of smooth muscle spasm, mucous,
and edema
(3) Exacerbating factors tend to be extrinsic in children, intrinsic in adults
(4) Status asthmaticus - prolonged exacerbation which does not respond to
therapy
b. Chronic bronchitis
(1) Reversible and irreversible obstruction
(2) Characterized by hyperplasia and hypertrophy of mucous-producing
glands
(3) Clinical definition - productive cough for at least 3 months per year for 2
or more consecutive years

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EMT 1Model Curriculum
Module 5: Medical 9
RESPIRATORY EMERGENCIES
continued

(4) Typically associated with cigarette smoking, but may also occur in non-
smokers
c. Emphysema
(1) Irreversible airway obstruction
(2) Diffusion defect also exists because of the presence of blebs
(3) Because blebs have extremely thin walls, they are prone to collapse
(4) To prevent collapse, the patient often exhales through pursed lips,
effectively maintaining a positive airway pressure
(5) Almost always associated with cigarette smoking or significant exposure
to environmental toxins
6. Assessment findings
a. Signs of severe respiratory impairment
(1) Altered mentation
(2) 1-2 word dyspnea
(3) Absent breath sounds
b. Chief complaint
(1) Dyspnea
(2) Cough
(3) Nocturnal awakening with dyspnea and wheezing
c. History
(1) Personal or family history of asthma and/ or allergies
(2) History of acute exposure to pulmonary irritant
(3) History of prior similar episodes
d. Physical findings
(1) Wheezing may be present in ALL types of obstructive lung disease
(2) Retractions and/or use of accessory muscles
7. Management
a. Airway and ventilatory support
(1) Intubation as required
(2) Assisted ventilation may be necessary
(3) High flow oxygen
b. Pharmacological interventions
(1 ) Beta 2 agonists
c. Transport considerations
(1) Appropriate mode
(2) Appropriate facility
(3) Continue monitoring

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EMT 1Model Curriculum
Module 5: Medical 10
RESPIRATORY EMERGENCIES
continued

(4) Contact medical direction

d. Psychological support / communication strategies
B. Pneumonia
1. Epidemiology
a. Incidence
(1) Fifth leading cause of death in the US
(2) Not a single disease, but a group of specific infections
b. Risk factors
(1) Cigarette smoking
(2) Alcoholism
(3) Exposure to cold
(4) Extremes of age (old or young)
2. Anatomy and physiology review
a. Cilia
b. Causes and process of mucous production
3. Pathophysiology
a. Ventilation disorder
b. Infection of lung parenchyma
c. May cause alveolar collapse (atelectasis)
d. Localized inflammation / infection may become systemic, leading to sepsis
and septic shock
4. Assessment findings
a. Typical pneumonia
(1) Acute onset of fever and chills
(2) Cough productive of purulent sputum
(3) Location of bronchial breath sounds
(4) Rales
5. Management
a. Airway and ventilatory support
(1) Intubation may be required
(2) Assisted ventilation as necessary
(3) High flow oxygen
b. Pharmacological interventions
(1) Beta 2 agonists may be required if airway obstruction is severe or if the
patient has accompanying obstructive lung disease
c. Non-pharmacological interventions
(1) Cool if high fever

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EMT 1Model Curriculum
Module 5: Medical 11
RESPIRATORY EMERGENCIES
continued

d. Transport considerations
(1) Appropriate mode
(2) Appropriate facility
e. Psychological support / communication strategies
C. Pulmonary edema
1. Not a disease, but a pathophysiological condition
2. Epidemiology
a. Risk factors vary based on type
(1) High pressure (cardiogenic)
(a) Acute myocardial infarction
(b) Chronic hypertension
(c) Myocarditis
(2) High permeability (non-cardiogenic)
(a) Acute hypoxemia
(b) Near-drowning
(c) Post cardiac arrest
(d) Post shock
(e) High altitude exposure
(f) Inhalation of pulmonary irritants
(g) Adult Respiratory Distress Syndrome (ARDS)
3. Anatomy and physiology review
4. Pathophysiology
a. High pressure (cardiogenic)
(1) Left-sided heart failure
(2) Increase pulmonary venous pressure
(3) In severe cases, fluid may accumulate in the alveoli
b. High permeability (non-cardiogenic)
(1) Disruption of the alveolar-capillary membranes caused by
(a) Severe hypotension
(b) Severe hypoxemia (post drowning, post cardiac arrest, severe
seizure, prolonged hypoventilation)
(c) High altitude
(d) Environmental toxins
(e) Septic shock
5. Assessment findings
a. High pressure (cardiogenic)
(1) Refer to Cardiac Emergencies unit

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EMT 1Model Curriculum
Module 5: Medical 12
RESPIRATORY EMERGENCIES
continued

b. High permeability (non-cardiogenic)

(1) History of associated factors
(a) Hypoxic episode
(b) Shock (hypovolemic, septic, or neurogenic)
(c) Chest trauma
(d) Recent acute inhalation of toxic gases or particles
(e) Recent ascent to high altitude without acclimatizing
(2) Dyspnea
(3) Orthopnea
(4) Fatigue
(5) Pulmonary rales, particularly in severe cases
c. Diagnostic testing
6. Management
a. High pressure (cardiogenic)
(1) Airway and ventilatory support
(a) Intubation as necessary
(b) Assisted ventilation as necessary
(c) High flow oxygen
(2) Circulatory support
(a) Avoid fluid excess; monitor IV flow rates carefully
(3) Pharmacological interventions
(a) Nitroglycerine
(4) Non-pharmacological interventions
(a) Position the patient in an upright position with legs dangling
(5) Transport decisions
(a) Appropriate mode
(b) Appropriate facility
(6) Psychological support / communication strategies
b. High permeability (non-cardiogenic)
(1) Airway and ventilatory support
(a) Intubation as necessary
(b) Assisted ventilation as necessary
(c) High flow oxygen
(2) Circulatory support
(a) Avoid fluid excess; monitor IV flow rates carefully
(3) Non-pharmacological interventions
(a) Position the patient in an upright position with legs dangling

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EMT 1Model Curriculum
Module 5: Medical 13
RESPIRATORY EMERGENCIES
continued

(b) Rapid removal from any environmental toxins

(c) Rapid descent in altitude if high altitude pulmonary edema (HAPE) is
suspected
(4) Transport considerations
(a) Appropriate mode
(b) Appropriate facility
(5) Psychological support / communication strategies
E. Hyperventilation syndrome
1. Epidemiology
a. Incidence is unknown
2. Pathophysiology
a. Tachypnea without physiologic demand for increased oxygen causes
respiratory alkalosis
b. Tachypnea caused by anxiety resulting in respiratory alkalosis
3. Assessment findings
a. Chief complaint
(1) Dyspnea
(2) Chest pain
b. Physical findings
(1) Rapid breathing with high minute volume
(2) Carpopedal spasms
c. Caution there are multiple causes of tachypnea that are not hyperventilation
syndrome but cause increased oxygen demand
(1) Hypoxia
(2) High altitude
(3) Pulmonary disorders
(4) Pneumonia
(5) Pulmonary emboli, vascular disease
(6) Bronchial asthma
(7) Cardiovascular disorders
(8) Congestive heart failure
(9) Hypotension/ shock
(10) Metabolic disorders
(11) Acidosis
(12) Hepatic failure
(13) Neurologic disorders
(14) Central nervous system infection, tumors

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EMT 1Model Curriculum
Module 5: Medical 14
RESPIRATORY EMERGENCIES
continued

(15) Drugs
(16) Fever, sepsis
(17) Pain
(18) Pregnancy
4. Management
a. Depends on cause of syndrome
b. Airway and ventilatory support
(1) Oxygen, rate of administration based on symptoms
(2) If anxiety hyperventilation is confirmed (especially based on patient's prior
history) coached ventilation / rebreathing techniques might be considered
c. Circulatory support
(1) Intervention rarely required
d. Pharmacological interventions
(1) Intervention rarely required
e. Non-pharmacological interventions
(1) Intervention rarely required
(2) Patients with anxiety hyperventilation will require psychological
approaches to calm them
(3) Have them mimic your respiratory rate and volume
(4) Do not place bag over mouth and nose
f. Transport considerations
(1) Appropriate mode
(2) Appropriate facility
g. Psychological support / communication strategies
(1) Depend on cause of hyperventilation

KCEMT
EMT 1Model Curriculum
Module 5: Medical 15
MODULE 5: MEDICAL

Topic: CARDIOVASCULAR EMERGENCIES

Purpose:

This topic will give the EMT 1student an understanding of cardiovascular

emergencies and to utilize assessment findings to formulate a treatment plan.

Suggested Time Frame: 3 Hours

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Review cardiovascular anatomy and physiology.

2. Identify and describe the components of the patient assessment as it relates to the
cardiovascular patient.

3. Discuss the pathophysiology of angina pectoris and acute myocardial infarction.

4. List the pertinent special questions (OPQRST) and physical exam for a chief complaint
of chest pain.

5. List the clinical presentation of a patient with angina and acute myocardial infarction.

6. Describe the initial assessment parameters to be evaluated in a patient with angina

pectoris and myocardial infarction.

7. Describe the pharmacological characteristics and actions of nitroglycerin and aspirin.

8. Develop a treatment plan for a patient with chest pain that may be angina pectoris or
myocardial infarction.

9. Discuss the pathophysiology of congestive heart failure / pulmonary edema.

10. List the clinical presentation of a patient with pulmonary edema.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 16
CARDIOVASCULAR EMERGENCIES
continued

11. Identify the general drug actions for nitroglycerine as they apply to pulmonary edema.

12. Develop a treatment plan for a patient with pulmonary edema.

13. Discuss the assessment and field management of a patient in cardiac arrest.

14. Identify other non-cardiac causes of chest pain:

a. Cholecystitis
b. Aneurysm
c. Hiatal hernia
d. Pleurisy
e. Esophageal and gastrointestinal diseases
f. Pulmonary embolism
g. Pancreatitis
h. Respiratory infections
i. Aortic dissection
j. Pneumothorax
k. Herpes zoster
l. Chest wall tumors
m. Blunt trauma

15. Value the sense of urgency for initial assessment and intervention as it contributes to
the treatment plan for the patient with a cardiac emergency.

16. Demonstrate an appropriate patient assessment and field management of a patient

with a cardiac emergency.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 17
DECLARATIVE MODULE 5:
MEDICAL CARDIOIVASCULAR
EMERGENCIES

I. Initial cardiovascular assessment

A. Level of consciousness
1. Alert and responsive
2. Dizziness
3. Unresponsive
B. Airway
1. Patent
2. Debris, blood
3. Frothy sputum
C. Breathing
1. Absent
2. Present
a. Rate and depth
(1) Effort
(2) Breath sounds
(a) Characteristics
(b) Significance
D. Circulation
1. Pulse
a. Absent
b. Present
(1) Rate and quality
(2) Pulse deficit
(3) Apical
(4) Peripheral
2. Skin
a. Color
b. Temperature
c. Moisture
d. Edema
3. Blood pressure

II. Focused history

A. SAMPLE format
B. Chief complaint
1. Pain

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EMT 1Model Curriculum
Module 5: Medical 18
CARDIOVASCULAR EMERGENCIES
continued

a. OPQRST
(1) Onset / origin
(a) Pertinent past history
(b) Time of onset
(2) Provocation
(a) Exertional
(b) Non-exertional
(3) Quality
(a) Patient's narrative description
i) For example -sharp, tearing, pressure, heaviness
(4) Region / radiation
(a) For example: substernal, radiates to arms, neck, back
(5) Severity
(a) "1-10" scale
(6) Timing
(a) Duration
(b) Worsening or improving
(c) Continuous or intermittent
(d) At rest or with activity
2. Dyspnea
a. Continuous or intermittent
b. Exertional
c. Non-exertional
d. Orthopneic
e. Paroxysmal Nocturnal Dyspnea (PND)
f. Cough
(1) Dry
(2) Productive
(3) Frothy
(4) Bloody
3. Related signs and symptoms
a. Level of consciousness (LOC)
b. Diaphoresis
c. Restlessness, anxiety
d. Feeling of impending doom
e. Nausea / vomiting
f. Fatigue

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EMT 1Model Curriculum
Module 5: Medical 19
CARDIOVASCULAR EMERGENCIES
continued

g. Palpitations
h. Edema
(1) Extremities
(2) Sacral
i. Headache
j. Syncope
k. Behavioral change
l. Anguished facial expression
m. Activity limitations
n. Trauma
C. Past medical history
1. Coronary artery disease (CAD)
2. Atherosclerotic heart disease
a. Angina
b. Previous MI
c. Hypertension
d. Congestive heart failure (CHF)
3. Valvular disease
4. Aneurysm
5. Pulmonary disease
6. Diabetes
7. Renal disease
8. Vascular disease
9. Inflammatory cardiac disease
10. Previous cardiac surgery
11. Congenital anomalies
12. Current / past medications
a. Prescribed
(1) Compliance
(2) Non-compliance
b. Borrowed
c. Over-the-counter
d. Recreational
(1) Cocaine
13. Allergies
14. Family history
a. Stroke, heart disease, diabetes, hypertension

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EMT 1Model Curriculum
Module 5: Medical 20
CARDIOVASCULAR EMERGENCIES
continued

III. Physical examination

A. Inspection
1. Neck veins
a. Appearance
b. Clinical significance

2. Chest
a. Surgical scars
b. Clinical significance
B. Auscultation
1. Breath sounds
a. Depth
b. Equality
c. Adventitious sounds
(1) Crackles
(2) Wheezes
(a) Gurgling
(b) Frothing (mouth and nose)
i) Blood tinged
ii) Foamy
C. Palpation
1. Areas of crepitus or tenderness
2. Thorax
3. Epigastrium
a. Pulsation
b. Distention

IV. Chest pain that may be myocardial in origin

A. Define angina pectoris and myocardial infarction
1. Epidemiology
2. Precipitating causes
B. Morbidity/ mortality
1. Not a self-limiting disease
2. Chest pain may dissipate, but myocardial ischemia and injury can continue
3. A single anginal episode may be a precursor to myocardial infarction
4. May not be cardiac in origin

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EMT 1Model Curriculum
Module 5: Medical 21
CARDIOVASCULAR EMERGENCIES
continued

5. Must be diagnosed by a physician

6. Related terminology
a. Defined as a brief discomfort, has predictable characteristics, and is relieved
promptly - no change in this pattern
b. Stable
(1) Occurs at a relative fixed frequency
(2) Usually relieved by rest and/ or medication
c. Unstable
(1) Occurs without fixed frequency
(2) Mayor may not be relieved by rest and/ or medication
d. Initial -first episode
e. Progressive -accelerating in frequency and duration
f. Preinfarction angina
(1) Pain at rest
(2) Sitting or lying down
7. Other possible causes of chest pain
a. Cholecystitis
b. Aneurysm
c. Hiatal hernia
d. Pleurisy
e. Esophageal and gastrointestinal diseases
f. Pulmonary embolism
g. Pancreatitis
h. Respiratory infections
i. Aortic dissection
j. Pneumothorax
k. Herpes zoster (shingles)
l. Chest wall tumors
m. Blunt trauma
C. Initial assessment findings
1. Level of consciousness
a. Anxiety and restlessness
b. Near syncopal episodes
2. Airway/ breathing
a. labored breathing may or may not be present
3. Circulation
a. Peripheral pulses

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EMT 1Model Curriculum
Module 5: Medical 22
CARDIOVASCULAR EMERGENCIES
continued

(1) Quality
(2) Rhythm
b. Changes in skin
(1) Color
(2) Temperature
(3) Moisture
D. Focused history
1. Chief complaint
a. Angina -typically sudden onset of discomfort, usually of brief duration, lasting
three to five minutes, maybe five to 15 minutes; usually relieved by rest and/ or
medication
b. Myocardial infarction -may be sudden onset, lasting more than five minutes,
unrelieved by rest and/ or medications
c. May be referred to as chest pressure
d. Epigastric pain or discomfort
e. Atypical
2. Denial
3. Contributing history
a. Onset
(1) Exertional
(2) Non-exertional
b. Initial recognized event
c. Recurrent event
d. Increasing frequency and/ or duration of event
e. Prior use of nitroglycerin
f. Prior use of aspirin
g. Other medications
(1) Prescribed
(2) Borrowed
(3) Over-the-counter
h. Allergy to medications
E. Detailed physical exam
1. Airway
2. Breathing
a. May or may not be labored
(1) Sounds
(a) May be clear to auscultation

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Module 5: Medical 23
CARDIOVASCULAR EMERGENCIES
continued

(b) May be congested in the bases

3. Circulation
a. Alterations in heart rate and rhythm may occur
b. Peripheral pulses are usually not affected
c. Blood pressure may be elevated during the episode and normalize afterwards
F. Management
1. Position of comfort
2. Pharmacological interventions (for example)
a. Oxygen
b. Aspirin
c. Nitroglycerin
G. Transport considerations
1. Sense of urgency for reperfusion
a. No relief with medications
b. Hypotension / hypoperfusion
H. Psychological support / communications strategies
1. Explanation for patient, family, significant others
2. Communication and transfer of data to the physician

V. Complications of cardiovascular compromise

A. Define pulmonary edema
B. Epidemiology
1. Precipitating causes
a. Left-sided failure
b. Right-sided failure
c. Myocardial infarction
d. Pulmonary embolism
e. Hypertension
f. Cardiomegaly
2. Related terminology
a. Preload
b. Afterload
c. Congestive heart failure
(1) Loss of contractile ability which results in fluid overload
d. Chronic versus acute
(1) First time event
(2) Multiple events

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EMT 1Model Curriculum
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CARDIOVASCULAR EMERGENCIES
continued

C. Morbidity/ mortality
1. Pulmonary edema
2. Respiratory failure
3. Death
D. Initial assessment
1. Airway / breathing
a. Labored breathing mayor may not be present
2. Circulation
a. Peripheral pulses
(1) Quality
(2) Rhythm
b. Changes in skin
(1) Color
(2) Temperature
(3) Moisture
E. Focused history
1. Chief complaint
a. Progressive or acute SOB
b. Progressive accumulation of edema
c. Weight gain over short period of time
d. Episodes of paroxysmal nocturnal dyspnea
e. Medication history
(1) Prescribed
(a) Compliance
(b) Non-compliance
(2) Borrowed
(3) Over-the-counter
f. Home oxygen use
F. Detailed physical exam
1. Level of consciousness
a. Unconscious
b. Altered level of consciousness
2. Airway / breathing
a. Dyspnea
b. Productive cough
c. Labored breathing
(1) Most common, often with activity

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EMT 1Model Curriculum
Module 5: Medical 25
CARDIOVASCULAR EMERGENCIES
continued

(2) Paroxysmal nocturnal dyspnea (PND)

(3) Tripod position
(4) Adventitious sounds
(a) Wheezing
(b) Rales
(5) Frothy sputum
(6) Retraction
(7) Cyanosis in advanced stages
3. Circulation
a. Peripheral pulses
(1) Quality
(2) Rhythm
b. Changes in skin
(1) Color
(2) Temperature
(3) Moisture
c. Edema
(1) Pitting versus non-pitting
(2) Extremities
(3) Ascites
(4) Sacral
G. Management
1. Position of comfort
2. Pharmacological interventions (for example)
a. Oxygen
b. Nitroglycerin
H. Transport considerations
I. Psychological support / communications strategies
1. Explanation for patient, family, significant others
2. Communication and transfer of data to the physician

VI. Cardiac arrest

A. Precipitating causes
1. Trauma
2. Medical conditions (for example)
a. End stage renal disease
b. Hyperkalemia with renal disease

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EMT 1Model Curriculum
Module 5: Medical 26
CARDIOVASCULAR EMERGENCIES
continued

c. Hypothermia
3. Pediatric / neonatal
4. Geriatric
B. Morbidity and mortality
C. Initial assessment
1. Critical findings
a. Unresponsive
b. Apneic
c. Pulseless
D. Focused history
1 .Witnessed event
2. Witnessed by EMS personnel
3. Bystander cardiopulmonary resuscitation (CPR)
4. Time from discovery to activation of CPR
5. Time from discovery to activation of EMS
6. Past medical history
E. Management
1. Resuscitative measures (refer to local protocol)
2. Indications for NOT initiating or terminating resuscitative techniques
a. Signs of obvious death
(1) Rigor, fixed lividity, decapitation
b. Refer to local protocol
(1) Out-of-hospital advance directives
3. Airway and ventilatory support
a. High flow oxygen
(1) Bag-valve system
(2) Intubation (Combitube)
4. Circulatory support
a. CPR in conjunction with defibrillation (AED)
b. IV therapy
5. Pharmacological interventions (for example)
a. Oxygen
6. Transport considerations
7. Psychological support / communications strategies
a. Explanation for patient, family, significant others
b. Communication and transfer of data to the physician

KCEMT
EMT 1Model Curriculum
Module 5: Medical 27
MODULE 5: MEDICAL

Topic: DIABETIC EMERGENCIES

Purpose:

This topic will give the EMT 1student an understanding of diabetic emergencies
and to utilize assessment findings to formulate a treatment plan.

Suggested Time Frame: 2 Hours

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Discuss the pathophysiology of diabetes mellitus.

2. Describe the assessment findings and the management of a patient with diabetic
emergency.

3. Discuss the pathophysiology, signs and symptoms, field assessment, and

management for a patient with hypoglycemia.

4. Discuss the pathophysiology, signs and symptoms, field assessment, and

management for a patient with hyperglycemia.

5. Differentiate between diabetic emergencies based on assessment and history.

6. Describe the pharmacological characteristics and actions of 50% Dextrose and

Glucagon.

7. Demonstrate an appropriate patient assessment and field management of a patient

with a diabetic emergency.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 28
DECLARATIVE MODULE
5: MEDICAL DIABETIC
EMERGENCIES

I. Introduction
A. Define
1. Diabetes mellitus
2. Hypoglycemia
3. Hyperglycemia

II. Specific illnesses

A. Diabetes mellitus
1. Epidemiology
a. Incidence
b. Morbidity / mortality
c. Long term complications
d. Risk factors
2. Pathophysiology
a. Types
(1) Type I-insulin dependent
(2) Type II-non insulin dependent
b. A chronic system syndrome characterized by hyperglycemia caused by a
decrease in the secretion or activity of insulin
c. Normal insulin metabolism
d. Abnormal metabolism / ketone formation
(1) When insulin supply is insufficient, glucose cannot be used for cellular energy
(2) Response to cellular starvation
(3) Body releases and breaks down stored fats and protein to provide energy
(4) Fatty acids produce ketones
(5) Excess ketones upset pH balance and acidosis develops (DKA)
3. Assessment findings
a. History
(1) Has insulin dosage changed recently?
(2) Has the patient had a recent infection?
(3) Has the patient suffered any psychologic stress?
b. Signs and symptoms
(1) Altered mental status
(2) Abnormal respiratory pattern (Kussmaul's breathing)
(3) Tachycardia
(4) Hypotension

KCEMT
EMT 1Model Curriculum
Module 5: Medical 29
DIABETIC EMERGENCIES
continued

(5) Breath has a distinct fruity odor

(6) Abnormal increase in urination
(7) Warm dry skin
(8) Weight loss
(9) Weakness
(10) Dehydration
c. Blood glucose analysis
4. Management
a. Airway and ventilation
b. Circulation
c. Pharmacological interventions
d. Non-pharmacological interventions
e. Transport considerations
(1) Appropriate mode
(2) Appropriate facility
f. Psychological support / communication strategies
B. Hypoglycemia
1. Epidemiology
a. Morbidity / mortality
b. Risk factors
2. Pathophysiology
a. Blood glucose levels fall below that required for normal body functioning
b. Cellular/ organ death can occur
3. Assessment
a. History
(1) Diabetes
(2) Prolonged fasting
(3) Alcoholism
(4) Activity
b. Signs and symptoms
(1) Weakness
(2) Irritability
(3) Hunger
(4) Confusion
(5) Anxiety
(6) Bizarre behavior
(7) Tachycardia

KCEMT
EMT 1Model Curriculum
Module 5: Medical 30
DIABETIC EMERGENCIES
continued

(8) Normal respiratory pattern

(9) Cool, pale skin
(10) Diaphoresis
c. Blood glucose analysis
4. Management
a. Airway and ventilation
b. Circulation
c. Pharmacological interventions
(1) Oral glucose
(2) D50
(3) Glucagon
d. Non-pharmacological interventions
e. Transport considerations
(1) Appropriate mode
(2) Appropriate facility
f. Psychological support, communication strategies
C. Hyperglycemia / DKA
1. Epidemiology
a. Mortality / morbidity
b. Risk factors
2. Pathophysiology
a. Hyperglycemia
b. Ketonemia
c. Relative insulin insufficiency
3. Assessment
a. History
(1) General health
(2) Previous medical conditions
(3) Medications
(4) Previous experience with complaint
(5) Time of onset
b. Signs and symptoms
(1) Neurologic abnormalities
(a) Altered level of consciousness
(b) Coma
(c) Seizures
(d) Hemiparesis

KCEMT
EMT 1Model Curriculum
Module 5: Medical 31
DIABETIC EMERGENCIES
continued

(e) Aphasia
(2) Dehydration
(3) Hypotension
(4) Acetone (fruity) odor on breath
(5) Nausea/vomiting
(6) Abdominal pain
(7) Kussmall's respiration
4. Management
a. Airway and ventilation
(1) Oxygen
(2) Positioning
(3) Suction
(4) Assisted ventilation
(5) Advanced airway devices
b. Circulation
c. Pharmacological interventions
d. Non-pharmacological interventions
e. Transport considerations
(1) Appropriate mode
(2) Appropriate facility
f. Psychological support / communication strategies

KCEMT
EMT 1Model Curriculum
Module 5: Medical 32
MODULE 5: MEDICAL

Topic: ALLERGIC REACTIONS

Purpose:

This topic will give the EMT 1student an understanding of allergic reactions and to
utilize assessment findings to formulate a treatment plan.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Discuss the pathophysiology of allergic reactions and anaphylaxis.

2. Describe the common methods of entry of substances into the body.

3. List common antigens associated with anaphylaxis.

4. List the signs and symptoms of an allergic reaction, including localized and systemic.

5. Discuss the signs and symptoms of anaphylaxis.

6. Discuss the drug characteristics and actions of epinephrine and inhaled beta-2
agonists.

7. List the pertinent history and physical exam to be elicited from a patient with an allergic
reaction / anaphylaxis.

8. Explain the importance of prompt treatment in anaphylaxis.

9. Develop a treatment plan for a patient with an allergic reaction and anaphylaxis.

10. Given a scenario, demonstrate an appropriate patient history and assessment and
implement a treatment plan for a patient with an allergic reaction and anaphylaxis.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 33
DECLARATIVE
MODULE 5: MEDICAL
ALLERIC REACTIONS/ANAPHYLAXIS

I. Introduction
A. Anatomy
1. Review of cardiovascular system
2. Review of respiratory system
B. Terminology
1. Allergic reaction
2. Anaphylaxis
3. Allergen

II. Pathophysiology
A. Routes of entry
1. Oral ingestion
2. Injected / envenomation
3. Inhaled
4. Topical
B. Common allergens
1. Drugs
2. Insects
3. Foods
4. Animals
5. Other
C. Allergic response
1. Histamine or histamine-like substance release
2. Biphasic response
a. Acute reaction
b. Delayed reaction
3. Immunity
4. Sensitivity
5. Hypersensitivity
6. Redness of skin
7. Swelling / edema of the skin
8. Anaphylactic shock
a. Cardiovascular system
b. Respiratory system

III. Assessment findings

KCEMT
EMT 1Model Curriculum
Module 5: Medical 34
ALLERIC REACTIONS/ANAPHYLAXIS
continued

A. Not all signs and symptoms are present in every case

B. History
1. Previous exposure
2. Previous experience to exposure
3. Onset of symptoms
4. Dyspnea
C. Level of consciousness
1. Unable to speak
2. Restless
3. Decreased level of consciousness
4. Unresponsive
D. Upper airway
1. Hoarseness
2. Stridor
3. Pharyngeal edema / spasm
E. Lower airway
1. Tachypnea
2. Hypoventilation
3. Labored -accessory muscle use
4. Abnormal retractions
5. Prolonged expirations
6. Wheezes
7. Diminished lung sounds
F. Skin
1. Redness
2. Rashes
3. Edema
4. Moisture
5. Itching
6. Pallor
7. Cyanotic
G. Vital signs
1. Tachycardia
2. Hypotension
3. Assessment tools

IV. Management of anaphylaxis

KCEMT
EMT 1Model Curriculum
Module 5: Medical 35
ALLERIC REACTIONS/ANAPHYLAXIS
continued

A. Remove offending agent (i.e., stinger)

B. Airway and ventilation
1. Positioning
2. Oxygen
3. Assist ventilation
4. Advanced airway
C. Circulation
1. Venous access
2. Fluid resuscitation
D. Pharmacological interventions
1. Oxygen
2. Epinephrine - mainstay of treatment
a. Bronchodilator
b. Decreases vascular permeability
c. Vasoconstriction
3. Bronchodilator
E. Transport considerations
F. Psychological support / communications strategies

V. Management of acute allergic reaction without dyspnea or hypotension

A. Remove offending agent (i.e., stinger)
B. Airway and ventilation
C. Circulation
D. Transport considerations

KCEMT
EMT 1Model Curriculum
Module 5: Medical 36
MODULE 5: MEDICAL

Topic: POISONING/OVERDOSE EMERGENCIES

Purpose:

This topic will give the EMT 1student an understanding of poisoning/overdose

emergencies and to utilize assessment findings to formulate a treatment plan.

Suggested Time Frame: 1 Hour

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Identify appropriate personal protective equipment and scene safety awareness in

dealing with toxicology emergencies.

2. Discuss the different types of toxicological emergencies.

3. List four methods by which poisons can enter the body.

4. Discuss the pathophysiology, sign and symptoms, and field treatment for a toxic
ingestion.

5. Discuss the pathophysiology, sign and symptoms, and field treatment for a narcotic
overdose.

6. Discuss the drug characteristics and actions of activated charcoal and naloxone.

7. Utilize assessment findings to formulate a field impression and implement a treatment

plan for a patient with the most common types of poisonings/overdoses.

8. Appreciate the psychological needs of victims of drug abuse or overdose.

9. Demonstrate an appropriate patient assessment and field management of a patient

with a toxic ingestion or overdose.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 37
DECLARATIVE MODULE 5: MEDICAL
POISONING/OVERDOSE EMERGENCIES

I. General toxicology, assessment and management

A. Types of toxicological emergencies
1. Unintentional poisoning
a. Dosage errors
b. Childhood poisoning
c. Environmental exposure
d. Occupational exposures
e. Neglect / abuse
2. Drug/ alcohol abuse
3. Intentional poisoning / overdose
a. Chemical warfare
b. Assault / homicide
c. Suicide attempts
B. Provider safety and resources identification
1. Need for appropriate personal protective equipment and scene safety awareness
a. Airway protection
b. Body surface absorption isolation
c. Specialized equipment
2. Need for additional resources
a. Hazardous Materials Teams
b. Police
c. Fire
d. Rescue
3. Equipment and environmental decontamination
C. Use of Poison Control Centers
D. Routes of absorption
1. Ingestion
2. Inhalation
3. Injection
4. Absorption
E. Poisoning by ingestion, inhalation, injection, and absorption
1. Examples
2. Anatomy and physiology review
a. Absorption
b. Distribution

KCEMT
EMT 1Model Curriculum
Module 5: Medical 38
POISONING/OVERDOSE EMERGENCIES
continued

3. General management considerations – Narcotics / opiates

a. Common causative agents -heroin, morphine, codeine, meperidine,
propoxyphene, fentanyl
b. Assessment findings
(1) Euphoria
(2) Hypotension
(3) Respiratory depression/ arrest
(4) Nausea
(5) Pinpoint pupils
(6) Seizures
(7) Coma
c. Management
(1) Airway and ventilation
(2) Circulation
(3) Pharmacological
(a) Naloxone - opiate specific antidotal therapy
(4) Non-pharmacological
(5) Transport considerations
(a) Appropriate mode
(b) Appropriate facility
(6) Psychological support / communication strategies

KCEMT
EMT 1Model Curriculum
Module 5: Medical 39
MODULE 5: MEDICAL

Topic: ENVIRONMENTAL EMERGENCIES

Purpose:

This topic will give the EMT 1student an understanding of environmental

emergencies and to utilize assessment findings to formulate a treatment plan.

Suggested Time Frame: 2 Hours

Objectives:

At the conclusion of this topic, the EMT 1student as an active participant will be able to
successfully:

1. Define “environmental emergency.”

2. Identify risk factors predisposing to environmental emergencies.

3. Discuss the pathophysiology, predisposing factors, causes, and sign and symptoms of
heat illness.

4. Define and discuss how to differentiate between heat cramps, heat exhaustion, and
heat stroke.

5. Differentiate between the various treatments and interventions of heat disorders,

develop a treatment plan based on assessment findings.

6. Discuss the pathophysiology, predisposing factors, causes, and sign and symptoms of
hypothermia.

7. List measures to prevent hypothermia.

8. Identify differences between mild and severe hypothermia.

9. Discuss the differences between chronic and acute hypothermia.

10. Utilize assessment findings to formulate a field impression and implement a treatment
plan for a patient with mild or severe hypothermia.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 40
ENVIRONMENTAL EMERGENCIES
continued

11. Discuss the pathophysiology, signs and symptoms, and the field treatment for near
drowning.

12. Discuss trauma considerations to be taken with a near-drowning episode.

13. Describe post-resuscitation complications associated with a near-drowning episode.

14. Demonstrate an appropriate patient assessment and treatment plan for a patient with a
heat-related illness, a hypothermia patient, and a near-drowning patient.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 41
DECLARATIVE MODULE 5:
MEDICAL ENVIRONMENTAL
EMERGENCIES

I. Environmental emergency
A. A medical condition caused or exacerbated by the weather, terrain, atmospheric
pressure, or other local factors
1. Instances of environmental emergencies
2. Environmental impact on morbidity and mortality
a. Environmental stressors that induce or exacerbate other medical or traumatic
conditions
B. Risk factors
1. Age
2. General health
3. Fatigue
4. Predisposing medical conditions
5. Medications
a. Prescription
b. Over the counter (OTC)
C. Environmental factors
1. Climate
2. Season
3. Weather
D. Types of environmental emergencies
1. Heat illness
2. Near Drowning
E. Thermolysis (Methods of heat loss)
1 .Conduction
2. Convection
3. Radiation
4. Evaporation
5. Respiration

II. Specific pathology, assessment, and management -heat disorders

A. Heat illness
1. Definition
a. Increased core body temperature (CBT) due to inadequate thermolysis
2. General signs and symptoms
a. Signs of thermolysis
(1) Diaphoresis

KCEMT
EMT 1Model Curriculum
Module 5: Medical 42
ENVIRONMENTAL EMERGENCIES
continued

(2) Posture
(3) Increased skin temperature
(4) Flushing
b. Signs of thermolytic inadequacy
(1) Altered mentation
(2) Altered level of consciousness
3. Predisposing factors
a. Age
(1) Pediatric
(2) Geriatric
b. General health and medications
(1) Diabetes
(a) Autonomic neuropathy interferes with vasodilation and perspiration
(b) Autonomic neuropathy may interfere with thermoregulatory input
(2) Various medications
(3) Acclimatization
c. Length of exposure
d. Intensity of exposure
e. Environmental
(1) Humidity
(2) Wind
4. Preventative measures
a. Maintain adequate fluid intake
(1) Thirst is an inadequate indicator of dehydration
b. Acclimatize
(1) Acclimatization results in more perspiration with lower salt concentration
(2) Increases fluid volume in body
c. Limit exposure
5. Heat cramps
a. Muscle cramps due to dehydration and overexertion
b. Not specifically related to heat illness
6. Heat exhaustion (mild heat illness)
a. Ill-defined term referring to milder forms of heat illness
b. Increased CBT with some neurologic deficit
c. Signs of active thermolysis usually present
d. Symptoms may be due solely to simple dehydration, combined with overexertion
(1) Result is orthostatic hypotension

KCEMT
EMT 1Model Curriculum
Module 5: Medical 43
ENVIRONMENTAL EMERGENCIES
continued

(2) Symptoms resolve with rest and supine positioning

(a) Fluids and elevation of knees beneficial
e. Symptoms that do not resolve with rest and supine positioning may be due to
increased CBT, are predictive of impending heat stroke and must be treated
aggressively
7. Heat stroke
a. Increased CBT with significant neurologic deficit
b. Organ damage
(1) Brain
(2) Liver
(3) Kidneys
c. Signs of active thermolysis may be present or absent
(1) Classic
(a) Commonly presents in those with chronic illnesses
(b) Increased CBT due to deficient thermoregulatory function
(c) Predisposing conditions include age, diabetes, and other medical
conditions
(d) "Hot, red, dry" skin is common
(2) Exertional
(a) Commonly presents in those who are in good general health
(b) Increased CBT due to overwhelming heat stress
(c) Excessive ambient temperature
(d) Excessive exertion
(e) Prolonged exposure
(f) Poor acclimatization
(g) "Moist, pale" skin is common
B. Treatment
1. Remove from environment
2. Active cooling
a. Misting and fanning
b. Moist wraps
c. Risks of over-cooling
(1) Reflex hypothermia
d. Use of tepid water for cooling
(1) Ice packs and cold water immersion may produce reflex vasoconstriction and
shivering due to effect on peripheral thermoreceptors
3. Fluid therapy

KCEMT
EMT 1Model Curriculum
Module 5: Medical 44
ENVIRONMENTAL EMERGENCIES
continued

a. Oral
(1) Some salt additive is beneficial
(2) Limited need for other electrolytes in oral rehydration
(3) Salt tablets
(a) May cause GI irritation and ulceration
(b) May cause hypernatremia
(c) Should be avoided
b. Intravenous
(1) Normal saline solution preferred

III. Specific pathology, assessment, and management – cold disorders

A. Hypothermia
1. Definition
a. Decreased CBT due to
(1) Inadequate thermogensis
(2) Excess cold stress
(3) A combination of both
B. Mechanisms of heat loss
1. Physiological
2. Environmental
C. Predisposing factors
1. Age
a. Pediatric
b. Geriatric
2. General health and medications
a. Hypothyroidism
b. Malnutrition
c. Hypoglycemia
d. Medication may interfere with thermogenesis
3. Fatigue and exhaustion
4. Length of exposure
5. Intensity of exposure
6. Environmental
a. Humidity
b. Wind
c. Temperature
B. Preventive measures

KCEMT
EMT 1Model Curriculum
Module 5: Medical 45
ENVIRONMENTAL EMERGENCIES
Continued

1. Dress
2. Rest
3. Food
4. Limit exposure
C. Categories of hypothermia
1. Severity
a. Mild
(1) Presence of signs and symptoms with a CBT that is greater than 90
degrees F
b. Severe
(1) Presence of signs and symptoms with a CBT that is less than 90 degrees F
c. Compensated
(1) Presence of signs and symptoms with a normal CBT
(2) CBT being maintained by thermogenesis
(3) As energy stores (liver and muscle glycogen) are exhausted, CBT will drop
2. Onset
a. Acute (immersion)
b. Subacute (exposure)
c. Chronic (urban)
3. Primacy
a. Primary cause of symptoms
b. Secondary presentation of other etiology
D. Principal signs and symptoms
1. No reliable correlation between signs or symptoms and specific CBT
2. Signs of thermogenesis
3. Diminished coordination and psychomotor function
4. Altered mutation
5. Altered level of consiousnsess
6. Cardiac irritability
E. Specific treatment
1. Stop heat loss
a. Remove from environment
b. Dry
c. Wind/vapor/moisture barrier
d. Insulate
2. Rewarming
a. Passive external

KCEMT
EMT 1Model Curriculum
Module 5: Medical 46
ENVIRONMENTAL EMERGENCIES
continued

(1) Insulation
(2) Wind/vapor/moisture barrier
b. Active external
(1) Heat packs
(a) Placed over areas of high heat transfer with core
(i) Base of neck
(ii) Axilla
(iii) Groin
(2) Heat guns
(3) Lights
(4) Warm water immersion
(a) 102 degrees F to 104 degrees F
(b) Can induce rewarming shock
(c) Little application in out-of-hospital setting
c. Active internal
(1) Warmed (102 degrees F to 104 degrees F) humidified oxygen
(2) Warmed (102 degrees F to 104 degrees F) intravenous administration
(3) Role of warmed administration
(a) Crucial, to prevent further heat loss
(b) Limited contribution to rewarming
3. Rewarming shock
a. Active external rewarming causes reflex vasodilation
b. Requires more heat transference than is possible with methods available in out-
of –hospital setting
c. Easily prevented by IV fluid administration during rewarming
4. Cold diuresis and the need for fluid resuscitation
a. Oral
b. Intravenous
5. Resuscitation considerations
a. BCLS considerations
(1) Increased time to evaluate vital signs
(2) Use of normal chest compression and ventilation rates
(3) Use of oxygen
(4) AED recommendations
b. ACLS considerations
(1) Effects of cold on cardiac medications
(2) Considerations for airway management

KCEMT
EMT 1Model Curriculum
Module 5: Medical 47
ENVIRONMENTAL EMERGENCIES
continued

(a) No increased risk of inducing ventricular fibrillation (V-fib) from

orotradcheal intrubation
(3) AHA recommendations
(4) Risks and management of V-fib
(a) Risk of V-fib related both to depth and duration of hypothermia
(b) Rough handling can induce V-fib
(c) It is generally impossible to electrically defibrillate a hypothermic heart
that is colder than 86 degrees F
6. Transportation considerations
a. Gentle transportation necessary due to myocardial irritability
b. Transport with patient level or head slightly down
c. General rewarming options of destination
d. Availability of cardiac bypass rewarming preferable in destination
consideration

IV. Specific pathology, assessment, and management of near-drowning

A. Definition
1. Drowning
a. Suffocation due to submersion in water or other fluids
2. Near-drowning
a. Near suffocation due to submersion in water or other fluids with a recovery event
that last at least 24 hours
B. Pathophysiology
1. Hypothermic considerations in near-drownings
a. Common concomitant syndrome
b. May be organ protective in cold water near-drownings
c. Always treat hypoxia first
d. Treat all near-drowning patients for hypothermia
C. Treatment
1. Establish airway
a. Conflicting recommendations regarding prophylactic abdominal thrusts
b. Questionable scientific data to support prophylactic abdominal thrusts
c. Combitube
2. Ventilation
3. Oxygen
D. Trauma considerations
1. Immersion episode of unknown etiology warrants trauma management

KCEMT
EMT 1Model Curriculum
Module 5: Medical 48
 E. Post-resuscitation complications
1. Adult respiratory distress syndrome (ARDS) or renal failure otten occur post-
resuscitation
2. Symptoms may not appear for 24 hours or more, post-resuscitation
3. All near-drowning patients should be transported for evaluation

KCEMT
EMT 1Model Curriculum
Module 5: Medical 49
MODULE 5: MEDICAL

Topic: MEDICAL EMERGENCIES LAB

Purpose:

This lab will give the EMT 1student an opportunity to demonstrate assessment
skills to formulate treatment and transport plans for medical emergencies.

Suggested Time Frame: 6 Hours

Objectives:

At the conclusion of this lab, the EMT 1student as an active participant will be able to
successfully:

1. Given scenarios, demonstrate an appropriate assessment and field management and

transport of a patient with respiratory diseases and conditions.

2. Demonstrate the proper technique of the application and operation of an automatic

external defibrillator.

3. Given scenarios, demonstrate an appropriate patient assessment and field

management of a patient with a cardiac emergency, including cardiac arrest and use
of an automatic defibrillator.

4. Given scenarios, demonstrate an appropriate patient assessment and field

management of a patient with a diabetic emergency.

5. Given a scenario, demonstrate an appropriate patient history and assessment and

implement a treatment plan for a patient with an allergic reaction and anaphylaxis.

6. Demonstrate an appropriate patient assessment and field management of a patient

with a toxic ingestion or overdose.

7. Demonstrate an appropriate patient assessment and treatment plan for a patient with
a heat-related illness, a hypothermia patient, and a near-drowning patient.

KCEMT
EMT 1Model Curriculum
Module 5: Medical 50
MODULE 5: MEDICAL
MEDICAL ASSESSMENT LAB

The EMT 1student in a lab setting with an instructor will demonstrate the appropriate
assessment and management of various medical scenarios to include life- threatening and
non-life threatening medical patients. The students will be given scenarios to include skills
and medications to allow the student to apply the knowledge and skills taught in earlier
modules.

I. Demonstrate the appropriate patient assessment with a responsive medical patient.

A. Proper BSI
B. Scene size up
1. Determine scene is safe
2. Nature of illness
C. General impression of patient
D. Determine level of consciousness
1. AVPU
E. Determine chief complaint or any apparent life threats
F. Ensure airway patency
1. Open airway if needed
2. Airway adjuncts if needed
G. Assess rate and quality of breathing
1. Apply oxygen
H. Assess pulses and skin color
1. Control external bleeding
2. Initiate management of shock
I. Determine patient priority and transport decision per local protocol
J. Perform a focused history
1. OPQRST
2. SAMPLE
K. Focused physical examination
L. Obtain baseline vital signs, any diagnostic test
M. Determine field impression
N. Treat patient per local protocol
O. Re-evaluate transport decision prepare patient for transport if not transported
earlier
P. Detailed physical examination
Q. Ongoing assessment
R. Documentation

KCEMT
EMT 1Model Curriculum
Module 5: Medical 51
MEDICAL ASSESSMENT LAB
continued

II. Demonstrate the appropriate patient assessment of an unresponsive medical patient.

A. Proper BSI
B. Scene size up
1. Determine scene is safe
2. Nature of illness
C. General impression of patient
D. Determine level of consciousness
1. AVPU
E. Determine chief complaint or any apparent life threats
F. Ensure airway patency
1. Open airway if needed
2. Airway adjuncts if needed
G. Assess rate and quality of breathing
1. Apply oxygen
H. Assess pulses and skin color
1. Control external bleeding
2. Initiate management of shock
I. Determine patient priority and transport decision per local protocol
J. Perform a rapid assessment
K. Obtain baseline vital signs
L. Obtain history from family or bystanders if possible
1. SAMPLE
M. Determine field impression
N. Treat patient per local protocol
O. Detailed physical examination if time permits
P. Ongoing assessment
Q. Documentation

III. Given various scenarios, demonstrate the appropriate assessment, management and
treatment of medical patients per local protocols.
A. Respiratory emergencies
1. Asthma
2. COPD
3. Pulmonary edema
4. Pnemonia
5. Hyperventilation syndrome

KCEMT
EMT 1Model Curriculum
Module 5: Medical 52
MEDICAL ASSESSMENT LAB
continued

B. Cardiovascular emergencies
1. Chest pain
2. Congestive heart failure / pulmonary edema
3. Non-cardiac chest pain
4. Cardiac arrest
a. Application and use of the AED
b. Insertion of a dual lumen airway
c. IV / medication therapy
C. Diabetic emergencies
1. IV and medication therapy
D. Allergic Reactions
1. IV and medication therapy
E. Poisoning / overdose emergencies
1. IV and medication therapy
F. Environmental emergencies
1. Treatment for heat-related, hypothermia, and near-drowning emergencies

KCEMT
EMT 1Model Curriculum
Module 5: Medical 53
 EMT 1SKILL

INSTRUCTOR RESOURCE

CARDIAC ARREST MANAGEMENT

AUTOMATED EXTERNAL DEFIBRILLATION (AED)
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in performing external defibrillation using a semi-automated external defibrillator.
CONDITION
The examinee will be requested to manage an adult patient who is found unresponsive, pulseless, apneic with no signs of trauma.
CPR may or may not be in progress. The manikin will be placed supine on the floor. The examinee will be required to bring the
necessary equipment to the scene.
EQUIPMENT
Adult CPR manikin, AED trainer, defibrillator pads, cables, towel, safety razor, bag-valve-mask device, O2 connecting tubing,
oxygen source with flow regulator, 1-2 assistants (optional), goggles, masks, gown, gloves, timing device.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions · Only gloves are required.

♦ Perform BLS assessment: · Immediate Defibrillation for sudden witnessed collapse with
· CPR in progress an AED immediately available.
- stop CPR · Provide 5 cycles of CPR (2 minutes) before attempting AED if
- establish unresponsiveness arrival is > 4-5 minutes
- verify apnea
- verify pulselessness - ** apply AED – if · Defibrillation stops all chaotic electrical impulses in the heart
indicated and allows for the normal pacemaker to re-establish a viable
heart beat.
· No CPR in progress
- establish unresponsiveness · Follow local policies and procedures for use of the AED.
- open the airway · The AED should not be applied to any patient who has a
- assess breathing - ** give 2 breaths - if pulse or is breathing, meets obviously dead criteria, or is in
indicated traumatic full arrest unless the arrest is due to a medical
- assess pulse – provide 5 cycles of CPR (2 problem.
minutes - ** apply AED - if indicated

PROCEDURE

♦ Position AED next to patient · The AED should be placed near the patient’s left side if
possible to allow for easier control by the provider due to
cable length and pad placement.

♦ Turn on AED
♦ Bare chest · Metal surfaces do not pose a hazard to either the patient or
the provider.
** Prepare pad sites for secure pad contact · Water conducts electricity and may provide a pathway for
energy from the AED to the provider or bystanders or from
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EMT 1Model Curriculum
AED Skill: Instructor Resource
 Skill Component Teaching Points
one electrode pad to another.
· Medication patches may block energy delivery to the heart
and cause minor burns due to arcing. Gloves should be
worn to protect provider from exposure to medications which
may be absorbed through the skin.
· Pacemakers and ICDs may reduce energy delivery to the
heart if pads are placed over them.
· Excessive chest hair may interfere with electrode pad
placement. Use safety razor or apply initial pads and remove
to epilate hair, then reapply a second set of pads.

· Electrical devices may create wave forms that could be

misinterpreted by the AED (electric blanket, TV, radio,
wireless phones, pagers, etc.).

♦ Apply defibrillator pads: · Some manufactures recommend that pads are placed on
· Upper - right sternal border directly below the specific sides. Always follow manufacturer’s directions.
clavicle
Place pads at least 2 inches apart. For patients with
smaller chest diameter and pads are too large, may apply
· Lower - left midaxillary line, 5th - 6th intercostal
pads anterior and posterior
space with top margin below the axilla

♦ Analyze rhythm
· The AED is unable to analyze the rhythm when there is
artifact from chest compressions
** Insure no one touches patient
♦ Follow AED voice prompt, deliver 1 shock if · Touching the patient during defibrillation may also shock the
indicated provider. Therefore, it is the responsibility of the AED
operator to make sure everyone is clear.
** Insure no one touches patient- if shocks are to be
delivered

♦ Immediately resume CPR · If no pulse and AED indicates “shock”, stand clear and follow
♦ Reassess patient for: voice prompt.
· Unresponsiveness · If no pulse and AED indicates “no shock”, start CPR and
· Breathing ready for transport.
· Pulse
· If a pulse is present and not breathing, start BVM
** Start/Resume CPR - if indicated ventilations.
** Provide rescue breathing at 10-12 breaths/min - if · If a pulse is present and the patient is breathing, place in
indicated recovery position.
** Place in recovery position - if indicated
· The 3 main considerations post-resuscitation are:
♦ Reassess patient after 1 minute/follow AED voice - Perform pulse check every 30-60 seconds
prompt - Perform a focused assessment and reassessment every 5
minutes.
- Keep AED on patient enroute

ONGOING ASSESSMENT
§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment
priority patients.
· Relevant portion of the focused assessment

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EMT 1Model Curriculum
AED Skill: Instructor Resource
 Skill Component Teaching Points
· Evaluate response to treatment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Compare results to baseline condition and vital
changes in the patient’s condition are anticipated sooner.
signs
· Priority patients are patients who have abnormal vital signs,
signs/symptoms of poor perfusion or if there is a suspicion
that the patient’s condition may deteriorate.

DOCUMENTATION
§ Verbalize/Document: · Documentation must be on an approved prehospital care
report form
· Patient assessment
· Analysis result - shock vs no shock advised
· Time and number of shocks - if applicable
· Patient response to shocks - if applicable

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KCEMT
EMT 1Model Curriculum
AED Skill: Instructor Resource
 EMT 1SKILL

CARDIAC ARREST MANAGEMENT

AUTOMATED EXTERNAL DEFIBRILLATION (AED)
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in performing external defibrillation using a semi-automated external defibrillator.
CONDITION
The examinee will be requested to manage an adult patient who is found unresponsive, pulseless, apneic with no signs of trauma.
CPR may or may not be in progress. The manikin will be placed supine on the floor. The examinee will be required to bring the
necessary equipment to the scene.
EQUIPMENT
Adult CPR manikin, AED trainer, defibrillator pads, cables, towel, safety razor, bag-valve-mask device, O2 connecting tubing,
oxygen source with flow regulator, 1-2 assistants (optional), goggles, masks, gown, gloves, timing device.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.
Assessment, analysis and first shock must be completed within 90 seconds.
Appropriate body substance isolation precautions must be instituted.

NAME EXAMINER(S) DATE / /

PASS FAIL
1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Perform BLS assessment:

· CPR in progress

- stop CPR

- establish unresponsiveness

- verify apnea

- verify pulselessness - ** apply AED - if

indicated

· No CPR in progress

- establish unresponsiveness

- open the airway

- assess breathing - ** give 2 breaths - if

indicated

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EMT 1Model Curriculum
AED Skill: Student
 Skill Component Yes No Comments

- assess pulse - provide 5 cycles of CPR (2

minutes) ** apply AED - if indicated

PROCEDURE

♦ Position AED next to patient

♦ Turn on AED

♦ Bare chest

** Prepare pad sites for secure pad contact

♦ Apply defibrillator pads:

· Upper - right sternal border directly below the

clavicle

· Lower - left midaxillary line, 5th - 6th intercostal

space with top margin below the axilla

♦ Analyze rhythm

** Insure no one touches patient

♦ Follow AED voice prompt until “no shock advised” is

given

** Insure no one touches patient- if shocks are to be

delivered

♦ Reassess patient for:

· Unresponsiveness

· Breathing

· Pulse

** Start/Resume CPR - if indicated

** Provide rescue breathing at 10-12 breaths/min - if

indicated

** Place in recovery position - if indicated

♦ Reassess patient after 1 minute/follow AED voice

prompt

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

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EMT 1Model Curriculum
AED Skill: Student
 Skill Component Yes No Comments

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Verbalize/Document:

· Patient assessment

· Analysis result - shock vs no shock advised

· Time and number of shocks - if applicable

· Patient response to shocks - if applicable

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EMT 1Model Curriculum
AED Skill: Student
 EMT 1SKILL INSTRUCTOR

RESOURCE
BLOOD GLUCOSE TEST (CHEMSTRIP)

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in performing a blood glucose test with a Chemstrip.
CONDITION
The examinee will be requested to appropriately perform a blood glucose test with a Chemstrip.
EQUIPMENT
Gloves, glucose testing chemstrips, syringes (various sizes), sterile gauze, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions

♦ Assemble equipment (color chart, test strip, gauze)

♦ Explain procedure to patient Reassure patient and explain the reason for the procedure.
This will help calm the patient and improve cooperation.

PROCEDURE

♦ Obtain blood sample.

♦ Place large drop of blood on test pads, covering

both test zones completely.

♦ Wait 60 seconds and wipe off all blood with dry

gauze. Wait an additional 60 seconds.

♦ Compare test zone colors with the vial color chart (2

minute value)

· Report results if color chart reads 10-180mg/dl

· Wait an additional 60 seconds if color chart reads

240 mg/dl. Report results on color chart (3
minute value)

♦ Dispose of equipment using approved techniques.

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Blood Glucose Test Skill: Instructor Resource
 Skill Component Teaching Points

DOCUMENTATION

§ Document: Documentation must be on an approved prehospital care report

form. Follow local policies and protocols.
· Time and date

· Record results

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EMT 1Model Curriculum
Blood Glucose Test Skill: Instructor Resource
 EMT 1SKILL

BLOOD GLUCOSE TEST (CHEMSTRIP)

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in performing a blood glucose test with a Chemstrip.
CONDITION
The examinee will be requested to appropriately perform a blood glucose test with a Chemstrip.
EQUIPMENT
Gloves, glucose testing chemstrips, syringes (various sizes), sterile gauze, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL
1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Assemble equipment (color chart, test strip, gauze)

♦ Explain procedure to patient

PROCEDURE

♦ Obtain blood sample.

♦ Place large drop of blood on test pads, covering

both test zones completely.

♦ Wait 60-seconds and wipe off all blood with dry

gauze. Wait an additional 60-seconds

♦ Compare test zone colors with the vial color chart

(2 minute value)

· Report results if color chart reads 10-180mg/dl

· Wait an additional 60 seconds if color chart

reads 240 mg/dl. Report results on color chart (3
minute value)

♦ Dispose of equipment using approved techniques

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KCEMT
EMT 1Model Curriculum
Blood Glucose Test Skill: Student
 Skill Component Yes No Comments

DOCUMENTATION

§ Document:

· Time and date

. Record results

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KCEMT
EMT 1Model Curriculum
Blood Glucose Test Skill: Student
 EMT 1SKILL INSTRUCTOR

RESOURCE
BLOOD SAMPLE FROM CAPILLARY FINGER STICK

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in obtaining a blood sample from a capillary finger stick.
CONDITION
The examinee will be requested to appropriately perform a finger stick to obtain a blood sample from a finger stick.
EQUIPMENT
Gloves, lancets, chemstrips, sterile gauze, alcohol wipes, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions

♦ Explain procedure to patient · Reassure patient and explain the reason for the procedure.
This will help calm the patient and improve cooperation.

♦ Prepare site:

Middle or ring finger of non-dominant hand

Place hand in dependent position for 10-

15 seconds

Cleanse site with alcohol wipe

Dry site with sterile dry wipe

PROCEDURE

♦ Puncture site with retractable lancet (side or tip of

finger). Squeeze finger for approximately 3 seconds.

♦ Wipe first drop of blood with sterile dry wipe.

♦ Maintain firm pressure on surrounding tissue.

nd
Lightly touch 2 drop of blood to reagent test
pad, completely covering test zones.

♦ Wipe blood from finger with sterile dry wipe.

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Blood Sample / Finger Stick Skill: Instructor Resource
 Skill Component Teaching Points

Apply pressure until bleeding stops. Apply sterile

adhesive dressing.

♦ Dispose of equipment using approved techniques.

DOCUMENTATION

§ Document: · Documentation must be on an approved prehospital care

report form. Follow local policies and protocols.
· Time and date

· Procedure

· Record results

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EMT 1Model Curriculum
Blood Sample / Finger Stick Skill: Instructor Resource
 EMT 1SKILL

BLOOD SAMPLE FROM CAPILLARY FINGER STICK

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in obtaining a blood sample from a capillary finger stick.
CONDITION
The examinee will be requested to appropriately perform a finger stick to obtain a blood sample from a finger stick.

EQUIPMENT
Gloves, lancets, chemstrips, sterile gauze, alcohol wipes, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

1st 2nd 3rd (final)

PASS FAIL

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Explain procedure to patient

♦ Prepare site:

Middle or ring finger of non-dominant hand

Place hand in dependent position for 10-

15 seconds

Cleanse site with alcohol wipe

Dry site with sterile dry wipe

PROCEDURE

♦ Puncture site with retractable lancet (side or tip of

finger). Squeeze finger for approximately 3 seconds.

♦ Wipe first drop of blood with sterile dry wipe.

♦ Maintain firm pressure on surrounding tissue.

nd
Lightly touch 2 drop of blood to reagent test
pad, completely covering test zones.

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Blood Sample / Finger Stick Skill: Student
 Skill Component Yes No Comments

♦ Wipe blood from finger with sterile dry wipe.

♦ Apply pressure until bleeding stops. Apply sterile

adhesive dressing.

♦ Dispose of equipment using approved techniques.

DOCUMENTATION

§ Document:

· Time and date

· Procedure

. Record results

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EMT 1Model Curriculum
Blood Sample / Finger Stick Skill: Student
 EMT 1SKILL INSTRUCTOR

RESOURCE
VENOUS BLOOD DRAW FROM IV ANGIOCATH
PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in obtaining a venous blood draw from an IV angiocath.
CONDITION
The examinee will be requested to appropriately obtain a venous blood draw from an IV angiocath once an IV has been
established.
EQUIPMENT
Gloves, goggles, blood collection tubes, vacutainer device, IV infusion arm, a selection of IV solutions, Administration sets, and IV
catheters, tape, gauze pads, syringes (various sizes), tourniquet, alcohol preps, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

Skill Component Teaching Points

PREPARATION

♦ Take body substance isolation precautions · Mandatory personal protective equipment.

♦ Assemble and prepare all equipment. Inspect the · The assembly of the equipment should be done prior to
blood tubes for damage or expiration. starting the IV.

If using a vacutainer, insert the Luer-Lok into · Do not put the blood tubes into the assembled vacutainer and
vacutainer Luer-Lok until you are ready to draw the blood. This will
destroy the vacuum and the blood tubes will be useless.

♦ Once the IV has been established, do not connect · If drawing blood leave the tourniquet on until the blood is
the IV tubing. drawn.

PROCEDURE

♦ Attach the end of the Luer-Lok adapter or a syringe · Prevent blood from leaking out while attaching the vacutainer
to the hub of the cannula, while applying pressure or syringe to hub of catheter.
with finger to the vein beyond the catheter tip.
· Stabilize the catheter with one hand while attaching the
vacutainer.

· Be careful not to dislodge the catheter placement.

· Once the device is connected to the catheter hub, release the

finger pressure at distal tip of catheter.

VACUTAINER DEVICE

♦ If using a vacutainer device, insert the blood tubes · Rotating the tubes mixes the anticoagulant evenly.
so the rubber covered needle punctures the blood
tube. Blood should be pulled into the blood tube.

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EMT 1Model Curriculum
Venous Blood Draw From Angiocath Skill: Instructor Resource
 Skill Component Teaching Points

♦ Fill the blood tubes completely, gently rotate the

tubes.

♦ Release the tourniquet once the tubes are full.

♦ Reapply pressure with little finger to the vein beyond

the catheter tip to prevent blood from leaking out of
catheter hub.

♦ Disconnect the vacutainer device from hub of · Do not contaminate the hub or the connector before insertion.
catheter.

♦ Connect the IV tubing to catheter hub.

♦ Open the IV flow to ensure patency, then adjust the

flow rate of IV appropriately.

♦ Cover the IV site with appropriate dressing.

♦ Properly dispose of all sharps.

♦ Properly label all blood tubes

BLOOD DRAWN WITH SYRINGE

♦ If using a syringe, slowly withdraw the plunger to fill · If the blood flow into the syringe stops, it may mean the
the syringe with blood. pressure from pulling back on the plunger is collapsing the
vein. Slow the rate the plunger is being pulled back.

♦ Release the tourniquet once the tubes are full.

♦ Reapply pressure with little finger to the vein beyond

the catheter tip to prevent blood from leaking out of
catheter hub.

♦ Remove syringe from catheter hub and connect IV · Do not contaminate the hub or the connector before insertion.
line to catheter hub.

♦ Ensure the IV line is patent by opening the flow of IV,

then adjust the flow rate to appropriate rate.

♦ Carefully attach a transfer needle to the syringe to

puncture the top of the blood tubes. Fill the blood
tubes and gently rotate the tubes.

♦ Cover the IV site with appropriate dressing.

♦ Properly dispose of all sharps.

♦ Properly label all blood tubes

ONGOING ASSESSMENT

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KCEMT
EMT 1Model Curriculum
Venous Blood Draw From Angiocath Skill: Instructor Resource
 Skill Component Teaching Points

§ Repeat an ongoing assessment every 5 minutes: · The initial and focused examination is repeated every 15
minutes for stable patients and every 5 minutes for
· Initial assessment priority patients.

· Relevant portion of the focused assessment · Every patient must be re-evaluated at least every 5 minutes, if
any treatment was initiated or medication administered, unless
· Evaluate response to treatment changes in the patient’s condition are anticipated sooner.

· Compare results to baseline condition and vital · Priority patients are patients who have abnormal vital signs,
signs signs/symptoms of poor perfusion or if there is a suspicion that
the patient’s condition may deteriorate.

DOCUMENTATION

§ Document: · Documentation must be on an approved prehospital care

report form. Follow local policies and protocols.
· Time and date

. Number and type of tubes drawn

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KCEMT
EMT 1Model Curriculum
Venous Blood Draw From Angiocath Skill: Instructor Resource
 EMT 1SKILL

VENOUS BLOOD DRAW FROM IV ANGIOCATH

PERFORMANCE OBJECTIVES
The examinee will demonstrate proficiency in obtaining a venous blood draw from an IV angiocath once the IV has
been established.
CONDITION
The examinee will be requested to appropriately obtain a venous blood draw from an IV angiocath once an IV has been
established.
EQUIPMENT
Gloves, goggles, blood collection tubes, vacutainer device, IV infusion arm, a selection of IV solutions, Administration sets, and IV
catheters, tape, gauze pads, syringes (various sizes), tourniquet, alcohol preps, approved sharps container.
PERFORMANCE CRITERIA
100% accuracy required on all items designated by a diamond (♦) for skills testing and must manage successfully all items
indicated by double asterisks (**). Documentation, identified by the symbol (§), must be practiced but is not a required test item.

Appropriate body substance isolation precautions must be instituted.

NAME DATE / / EXAMINER(S)

PASS FAIL 1st 2nd 3rd (final)

Skill Component Yes No Comments

PREPARATION

♦ Take body substance isolation precautions

♦ Assemble and prepare all equipment. Inspect the

blood tubes for damage or expiration.

If using a vacutainer, insert the Luer-Lok into

vacutainer

♦ Once the IV has been established, do not connect

the IV tubing.

PROCEDURE

♦ Attach the end of the Luer-Lok adapter or a syringe

to the hub of the cannula, while applying pressure
with finger to the vein beyond the catheter tip.

VACUTAINER DEVICE

♦ If using a vacutainer device, insert the blood tubes

so the rubber covered needle punctures the blood
tube. Blood should be pulled into the blood tube.

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KCEMT
EMT 1Model Curriculum
Venous Blood Draw From Angiocath Skill: Student
 Skill Component Yes No Comments

♦ Fill the blood tubes completely, gently rotate the

tubes.

♦ Release the tourniquet once the tubes are full

♦ Reapply pressure with little finger to the vein beyond

the catheter tip to prevent blood from leaking out of
catheter hub.

♦ Disconnect the vacutainer device from hub of

catheter.

♦ Connect the IV tubing to catheter hub.

♦ Open the IV flow to ensure patency, then adjust the

flow rate of IV appropriately.

♦ Cover the IV site with appropriate dressing.

♦ Properly dispose of all sharps.

♦ Properly label all blood tubes

BLOOD DRAWN WITH SYRINGE

♦ If using a syringe, slowly withdraw the plunger to fill

the syringe with blood.

♦ Release the tourniquet once the tubes are full.

♦ Reapply pressure with little finger to the vein beyond

the catheter tip to prevent blood from leaking out of
catheter hub.

♦ Remove syringe from catheter hub and connect IV

line to catheter hub.

♦ Ensure the IV line is patent by opening the flow of IV,

then adjust the flow rate to appropriate rate.

♦ Carefully attach a transfer needle to the syringe to

puncture the top of the blood tubes. Fill the blood
tubes and gently rotate the tubes.

♦ Cover the IV site with appropriate dressing.

♦ Properly dispose of all sharps.

♦ Properly label all blood tubes

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Venous Blood Draw From Angiocath Skill: Student
 Skill Component Yes No Comments

ONGOING ASSESSMENT

§ Repeat an ongoing assessment every 5 minutes:

· Initial assessment

· Relevant portion of the focused assessment

· Evaluate response to treatment

· Compare results to baseline condition and vital

signs

DOCUMENTATION

§ Document:

· Time and date

. Number and types of tubes drawn

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Venous Blood Draw From Angiocath Skill: Student
Clinical
 Clinical Objectives

The following goals must be successfully accomplished within the context of the learning environment.
Clinical experiences should occur after the student has demonstrated competence in skills and
knowledge in the didactic and laboratory components of the course. Items in bold are essentials and
must be completed. Items in italics are recommendations to achieve the essential and should be
performed on actual patients in a clinical setting. Recommendations are not the only way to achieve
the essential. If the program is unable to achieve the recommendations on live patients, alternative
learning experiences (simulations, programmed patient scenarios, etc.) can be developed. If
alternatives to live patient contact are used, the program should increases in the number of times the
skill must be performed to demonstrate competence.

These recommendations are based on information from the U.S. Department of Transportation’s
EMT-Intermediate National Standard Curriculum. Programs are encouraged to adjust these
recommendations based on thorough program evaluation. For example, if the program finds that
graduates perform poorly in airway management skills, they should increase the number of intubations
and ventilations required for graduation and monitor the results.

PSYCHOMOTOR SKILLS

The student must demonstrate the ability to safely administer medications.

The student should safely, and while performing all steps of each procedure, properly
administer medications at least 10 times to live patients.

The student must demonstrate the ability to safely perform esophageal- tracheal intubation.
The student should safely, and while performing all steps of each procedure,
successfully intubate at least 5 live patients or manikins in the laboratory setting.

The student must demonstrate the ability to safely gain venous access in all age group
patients.
The student should safely, and while performing all steps of each procedure,
successfully access the venous circulation at least 10 times on live patients of
various age groups.

The student must demonstrate the ability to effectively ventilate unintubated patients of all
age groups.
The student should effectively, and while performing all steps of each procedure,
ventilate at least 5 live patients of various age groups.

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KCEMT
Model EMT 1Curriculum
Clinical Objectives 1
AGES

The student must demonstrate the ability to perform an advanced assessment on pediatric
patients.
The student should perform an advanced patient assessment on at least 5 (including
newborns, infants, toddlers, and school age) pediatric patients.

The student must demonstrate the ability to perform a compressive assessment on adult
patients.
The student should perform an advanced patient assessment on at least 10 adult
patients.

The student must demonstrate the ability to perform an advanced assessment on geriatric
patients.
The student should perform an advanced patient assessment on at least 5 geriatric
patients.

PATHOLOGIES

The student must demonstrate the ability to perform an advanced assessment on trauma
patients.
The student should perform an advanced patient assessment on at least 20 trauma
patients.

COMPLAINTS

The student must demonstrate the ability to perform an advanced assessment, formulate
and implement a treatment plan for patients with chest pain.
The student should perform an advanced patient assessment, formulate and
implement a treatment plan on at least 5 patients with chest pain.

The student must demonstrate the ability to perform an advanced assessment, formulate
and implement a treatment plan for patients with dyspnea/respiratory distress.
The student should perform an advanced patient assessment, formulate and
implement a treatment plan on at least 5 adult patients with dyspnea/respiratory
distress.

The student should perform an advanced patient assessment, formulate and

implement a treatment plan on at least 4 pediatric patients (including infants,
toddlers, and school age) with dyspnea/respiratory distress.
---------------------------------------------------------------------------------------
KCEMT
Model EMT 1Curriculum
Clinical Objectives 2
The student must demonstrate the ability to perform an advanced assessment, formulate
and implement a treatment plan for patients with abdominal complaints.
The student should perform an advanced patient assessment, formulate and
implement a treatment plan on at least 5 patients with abdominal complains (for
example: abdominal pain, nausea/vomiting, GI bleeding, gynecological complaint,
etc.)

The student must demonstrate the ability to perform an advanced assessment, formulate
and implement a treatment plan for patients with altered mental status.
The student should perform an advanced patient assessment, formulate and
implement a treatment plan on at least 5 patients with altered mental status.

TEAM LEADER SKILLS

The student must demonstrate the ability to serve as a team leader in variety of prehospital
emergency situations.
The student should serve as the team leader for at least 5 prehospital emergency
responses.

---------------------------------------------------------------------------------------
KCEMT
Model EMT 1Curriculum
Clinical Objectives 3
 KCEMT EMT 1Clinical Performance Standards
Training Program

The following performance evaluation standards have been developed as an objective measurement of the intern’s performance. These standards are to be utilized
when completing the intern’s evaluations. Interns are expected to achieve a "3" rating in every rating factor on the final major evaluation in order to be eligible for
internship.
EVALUATION FACTOR RATING 1 RATING 2 RATING 3
ASSESSMENT/PATHOLOGIES
Assessment and Interventions

Performs a initial assessment and Unable to perform a complete or Performs a complete initial Independently performs a complete
intervenes as necessary organized initial assessment without assessment, but is either slow or and organized assessment in a timely
prompting. Omits portions of the disorganized and inconsistent in manner, recognizes findings and
assessment and/or fails to recognize recognizing findings or intervening intervenes appropriately in a timely
findings or intervene appropriately. appropriately. manner.

Asks appropriate questions, Fails to ask details specific to chief Asks questions specific to the chief Asks questions pertinent to the chief
specific to patient chief complaint complaint; rambles or does not complaint but is either slow or complaint; deliberate and timely.
appear to have a focus to the disorganized.
questions.

Obtains patient history, Does not obtain pertinent information; Obtains an adequate patient Obtains an adequate patient history,
medications and allergies is incomplete or inaccurate. assessment but is either slow in medications and allergies in a fairly
assessing and/or disorganized. organized and timely manner.

Performs pertinent physical exam Fails to perform an appropriate Inconsistent or slow in performing a In a timely manner performs an
physical exam and/or findings are pertinent physical exam. Findings are appropriate physical exam pertinent to
incomplete and/or inaccurate. accurate. the patient’s chief complaint. Findings
are accurate.
Assessment Interpretation

Accurately identifies chief Unable to identify the patient’s chief Slow to identify chief complaint Identifies chief complaint correctly and
complaint complaint without prompting. in a timely manner

Identifies level of distress Fails to correctly or incorrectly Slow to identify level of distress Identifies level of distress correctly and
identifies level of distress. correctly. in a timely manner.

Interprets assessment Unable to interpret assessment Interprets assessment information Correlates information obtained in
information, correlates with information correctly or demonstrates correctly but has difficulty associating didactic; able to associate S/S with
pathophysiology a weak knowledge base. S/S with pathophysiology. related pathophysiology.

4
 EVALUATION FACTOR RATING 1 RATING 2 RATING 3

Verbalizes knowledge of Unfamiliar with drug therapy; lacks Has knowledge but needs prompting Adequate knowledge of clinical
pharmacology basic pharmacology knowledge. to convey information. pharmocology.

PSYCHOMOTOR SKILLS
Patient Management

Verbalizes appropriate treatment Fails to anticipate appropriate orders Slow to anticipate appropriate orders Anticipates appropriate orders and
plan and intervenes as necessary or intervene as needed. or intervene when necessary. intervenes as needed in a timely
manner.

Obtains vital signs and interprets Does not take vital signs at the Obtains vital signs correctly but takes Obtains accurate and pertinent vital
results appropriate time or has a problem too long to perform procedure or signs at the appropriate time.
with procedure or has problem with interpret the information. Does not put Interprets results correctly.
interpretation. in proper priority.
Skills Performance

Airway Control and Adjuncts Frequently fails to assure adequate Inconsistently assures adequate Consistently assures adequate
(02 application, basic airway, delivery of oxygen to patient. Fails to delivery of oxygen to the patient delivery of oxygen to patient. Uses
BVM) utilize appropriate airway adjuncts and/or appropriate airway adjunct. appropriate airway adjunct. Achieves
and/or maintain patency of airway in a Does not maintain airway patency in a or maintains patency of airway in a
timely manner. timely manner. timely manner.

Advanced airway Frequently fails to demonstrate Inconsistently demonstrates or Consistently demonstrates correct use
(esophageal-tracheal airway correct use of an advanced airway. recognizes need for use of an of an advanced airway in a timely and
device) advanced airway. Needs some appropriate manner.
guidance to complete the procedure.

Suctioning Fails to recognize need for suctioning Slow to recognize need for suctioning Recognizes need for suctioning and is
or performs procedure incorrectly. or needs minimal instruction to able to perform skill without instruction
perform procedure correctly. or prompting.

IV Access Frequently fails to establish IV access Inconsistently establishes IV access. Consistently uses proper techniques.
due to improper technique. Needs some direction to complete the Completes procedure in a timely
procedure. manner.

CPR Requires instruction and prompting Able to perform skill with minimal Able to perform skill without instruction
when performing skill. instruction. or prompting (competent).

Medication Administration Unfamiliar with drug administration Inconsistent knowledge of drug Consistently administers drugs
procedures. Unable to calculate administration procedure. Unable to correctly and in a timely manner.
correct drug dosages. administer drugs in a timely manner.

5
 EVALUATION FACTOR RATING 1 RATING 2 RATING 3

Equipment Operation Frequently fails to use equipment in a Inconsistently demonstrates proper Consistently demonstrates the ability
safe manner. use of equipment. Frequently needs to use all equipment correctly.
direction.

Bandaging/ Ineffective technique or treatment Recognizes need for intervention. Recognizes need for intervention.
Splinting/ causing potential harm to patient. Needs direction to complete tasks Completes task appropriately.
Spinal Immobilization Sometimes fails to initiate any appropriately.
treatment when indicated.

COMMUNICATION

Professionalism and Attitude Frequently exhibits unprofessional Professional demeanor is appropriate Consistently exhibits a professional
conduct. Is rude, abrupt, out of but is sometimes unprepared for demeanor and is well prepared.
uniform and or uses inappropriate clinical.
language.
Rapport with Patient, Family, Staff

Working Relationships with Team Frequently fails to function as a Inconsistently functions as a member Consistently functions as a member of
Members member of the patient care learn. of the patient care team. the patient care team.

Working Relationship with Demonstrates an abrupt rude or Demonstrates a caring attitude but Demonstrates a caring attitude and
Patient/Family judgmental attitude in dealing with appears unsure of effective utilizes effective verbal and nonverbal
patients. communication techniques. communication.

Documentation Frequently fails to complete patient Inconsistently completes patient care, Consistently completes patient care
care reports in an accurate, thorough reports in an accurate, thorough reports in an accurate, thorough and
and/or legible manner. and/or legible manner. legible manner.

LEADERSHIP

Initiative, Participation Frequently needs to be coaxed into Hesitates to initate experiences but Actively seeks out learning
participating. Uses clinical time when prompted participates fully. experiences. Consistently participates
poorly. in appropriate learning situations when
asked.

6
 EVALUATION FACTOR RATING 1 RATING 2 RATING 3

Feedback and Guidance Frequently fails to accept feedback. Inconsistently accepts feedback. Consistently participates in evaluation
Argues with others. Uses excuses to Does not take necessary steps to of self. Accepts feedback and
justify mistakes. change performance. suggestions. Takes necessary steps
to correct performance weaknesses.

Attendance and Appearance Frequently is either late or does not Sometimes arrives late but is dressed Consistently on time. Dressed and
follow policy in regards to and groomed appropriately. groomed appropriately.
appearance/dress code.

Vocabulary List: The following definitions for terms used in these performance standards are provided for clarification.

Consistently - Always following the same principles or course of action

Frequently - Occurring often; many times

Inconsistent - Lacking agreement, as one thing having to do with another

Sometimes - On some occasions; at times; now and then more things in relation to each other

7
 KCEMT Daily Advance EMT Clinical
Experience Log/Evaluation
Training Program

Intern: Date: Shift # Hours:

RATING CRITERIA: Refer to Performance Standards below. An intern should progress from a rating
of 1 or 2 to a minimum of 3 in each category on the final evaluation form.

Performance Standards:
1 – Requires instruction and prompting when performing assessment/skill.
2 – Able to perform assessment/skill with minimal instruction.
3 – Able to perform assessment/skill without instruction or prompting (competent).
N/A – Not applicable (Did not perform skill).

Evaluation Factors: Rating: Comments

ASSESSMENT/PATHOLOGIES

Assessment and Interventions

Assessment Interpretation

PSYCHOMOTOR SKILLS

Patient Management

Skills (IV, Meds, PTL) Performance

Equipment Operation

Bandaging/Splinting/C-Spine

COMMUNICATION

Professionalism/Attitude

Rapport with Patient, Family, Staff

Documentation

LEADERSHIP

Initiative, Participation

Feedback and Guidance

Attendance and Appearance

SUMMARY OF PERFORMANCE
Written summary of intern’s performance to date:

Plan for improvement:

Preceptor Signature: Intern Signature:

Time in: Preceptor/Charge Nurse Name: Signature:

Time out: Preceptor/Charge Nurse Name: Signature:

8
 KCEMT EMT 1CLINICAL
Major Evaluation
Program Name

Intern: _______________________ Date: ____________ Total Clinical Hours: __________

RATING CRITERIA: Refer to Performance Standards below. An intern should progress from a rating
of 1 or 2 to a minimum of 3 in each category on the final evaluation form.

Performance Standards:
1 – Requires instruction and prompting when performing skill/assessment.
2 – Able to perform skill/assessment with minimal instructions.
3 – Able to perform skill/assessment without instruction or prompting
(competent). N/A – Not applicable (Did not perform skill/assessment).

Evaluation Factors: Rating: Comments

ASSESSMENT/PATHOLOGIES

Assessment and Interventions _____ ________________________________________________

Assessment Interpretation _____ ________________________________________________

PSYCHOMOTOR SKILLS

Patient Management _____ ________________________________________________

Skills (IV, Meds , PTL) Performance _____ ________________________________________________

Equipment Operation _____ ________________________________________________

Bandaging/Splinting/C-Spine _____ ________________________________________________

COMMUNICATION

Professionalism/Attitude _____ ________________________________________________

Rapport with Patient, Family, Staff _____ ________________________________________________

Documentation _____ ________________________________________________

LEADERSHIP

Initiative, Participation _____ ________________________________________________

Feedback and Guidance _____ ________________________________________________

Attendance and Appearance _____ ________________________________________________

SUMMARY OF PERFORMANCE

Recommend: Field Internship Clinical Extension

Clinical Coordinator Signature: ___________________________ Intern Signature: _____________________________

Reviewed By:
Program Director:_____________________________________

Medical Director: ______________________________________

9
Field
 KCEMT EMT 1Field Internship Performance Standards
Training Program

The following performance evaluation standards have been developed to help preceptors determine the most appropriate rating to be given in each evaluation
category. Preceptors are expected to utilize these standards when completing the trainee's field internship evaluations. Trainees are expected to achieve a "3"
rating in every rating factor on the final evaluation in order to be eligible for certification.
EVALUATION FACTOR RATING 1 RATING 2 RATING 3
SCENE MANAGEMENT
Safety & Work Environment Frequently fails to provide a safe and Inconsistently determines or provides Consistently determines safety for
adequate work environment. a safe and adequate work patient, self and team members and
environment or slowly initiates ensures and adequate work
appropriate measures. environment in a timely manner.
Universal Precautions Frequently fails to use appropriate Inconsistently uses universal Consistently uses universal
universal precautions, personal precautions and personal protective precautions and wears appropriate
protective equipment or care for equipment or cleans equipment personal protective equipment specific
equipment appropriately. inappropriately. for patient condition. Cleans equipment
in accordance with provider
policy/procedures.
Crowd Control Frequently fails to take steps to Inconsistently initiates or delegates Consistently initiates or delegates
control crowd or deal effectively with crowd control. Deals ineffectively with appropriate crowd control and deals
family and bystanders. family and bystanders. effectively with family and bystanders.
Additional Assistance & Equipment Frequently fails to recognize the need Inconsistently or slowly recognizes the Consistently recognizes the need for
for additional assistance and/or need for additional assistance or and requests additional assistance or
equipment. equipment. equipment in a timely manner.
PATIENT ASSESSMENT
Initial Assessment & Intervention Frequently fails to perform an Inconsistently or slowly performs a Consistently performs a complete and
organized and complete initial complete and/or organized initial organized initial assessment with 60
assessment with 60 seconds or fails assessment. Does not intervene seconds and intervenes appropriately
to intervene appropriately. appropriately in a timely manner. in a timely manner.
Patient Information Frequently fails to obtain pertinent Inconsistently obtains adequate Consistently asks questions pertinent
information. Fails to ask details patient information. Is slow in to the chief complaint; deliberate and
specific to chief complaint; rambles or assessing and/or disorganized in timely. Obtains an adequate patient
does not appear to have a focus to obtaining chief complaint, and patient history, medications, and allergies in a
the questions. history. fairly organized and timely manner.
Physical Examination Frequently fails to perform a thorough Inconsistently or slowly performs an Consistently performs a thorough
exam with appropriate inquiry and/or exam. Needs assistance in being exam with appropriate inquiry and
inspection findings are inaccurate. through and systematic. inspection pertinent to the patient's
chief complaint. Findings are accurate.

1
 EVALUATION FACTOR RATING 1 RATING 2 RATING 3
Assessment Interpretation Frequently fails to determine a Inconsistently or slowly determines a Consistently interprets and correlates
working diagnosis, or substantially working diagnosis or substantially assessment information correctly.
misinterprets the patient's problem. misinterprets the patient's problem.
Cannot formulate a working diagnosis
for treatment.
Chest Auscultation Frequently fails to demonstrate Inconsistent knowledge of chest Consistently identifies breath sounds
adequate assessment and auscultation and breath sounds. accurately. Adequate knowledge of
identification of basic breath sounds. chest auscultation.
Patient Management Frequently fails to develop and Inconsistently or slowly develops or Consistently develops and implements
implement an appropriate plan of implements an appropriate plan of an appropriate plan of action.
action. action.
Patient Response to Therapy Frequently fails to assess patient Inconsistently assesses patient Consistently assesses patient
response to therapy/interventions. response to therapy/interventions. response to therapy/interventions.
INTERPERSONAL SKILLS
Rapport with Patient, Family & Frequently fails /does not attempt to Inconsistently builds rapport with Consistently builds rapport with
Bystanders establish rapport with patient, family patient, family and/or bystanders. patient, family and bystanders. Show
and/or bystanders. Is inconsiderate Inconsistently shows consideration consideration and respect for others.
and disrespectful of others. and respect for others. Does not instill Instills confidence in patients.
confidence in patients.
Communication with Team Frequently fails to report pertinent Inconsistently reports pertinent Consistently communicates all
Members information to team members. information to team members. pertinent information to team
members.
Radio Reports Frequently fails to recognize the need Inconsistently utilizes and recognizes Consistently utilizes medical control
to utilize medical control. medical control. Reports are appropriately. Reports are organized
disorganized and incomplete. and complete.
Documentation Frequently fails to complete patient Inconsistently completes patient care, Consistently completes patient care
care reports in an accurate, thorough reports in an accurate, thorough reports in an accurate, thorough and
and/or legible manner. and/or legible manner. legible manner.

Working Relationships with Team Frequently fails to function as a Inconsistently functions as a member Consistently functions as a member of
Members member of the patient care learn. of the patient care team. the patient care team.

Leadership Frequently fails to assume leadership Inconsistently assumes leadership Consistently assumes leadership role
role. Does not direct team members role and direction of team members. and directs team members
appropriately. appropriately.
Professionalism Frequently exhibits unprofessional Inconsistently exhibits a professional Consistently exhibits a professional
conduct. Is rude, abrupt, out of demeanor. demeanor.
uniform and or uses inappropriate
language.

2
 EVALUATION FACTOR RATING 1 RATING 2 RATING 3
Openness to Feedback and Frequently fails to accept feedback. Inconsistently accepts feedback. Consistently participates in evaluation
Guidance Argues with others. Uses excuses to Does not take necessary steps to of self. Accepts feedback and
justify mistakes. change performance. suggestions. Takes necessary steps
to correct performance weaknesses.

TREATMENT SKILLS
Inventory Maintenance Frequently fails to perform equipment Inconsistent in performing equipment Consistently performs equipment
inventory at the start of shift and does inventory or resupplying per provider inventory and resupplies all inventory
not resupply inventory. agency policy. per provider policy.
Equipment Operation Frequently fails to use equipment in a Inconsistently demonstrates proper Consistently demonstrates the ability
safe manner. use of equipment. Frequently needs to use all equipment correctly.
direction.

Airway Management/Oxygen Frequently fails to assure adequate Inconsistently assures adequate of Consistently assures adequacy
Therapy delivery of oxygen to patient. Fails to oxygen to patient and/or appropriate delivery of oxygen to patient. Uses
utilize appropriate airway adjuncts airway adjunct. Does not maintain appropriate airway adjunct. Achieves
and/or maintain patency of airway in a airway patency in a timely manner. or maintains patency of airway in a
timely manner. timely manner.
Advanced Airway (Esophageal- Frequently fails to demonstrate Inconsistently demonstrates or Consistently demonstrates correct use
tracheal airway device) correct use of an advanced airway. recognizes need for use of an of an advanced airway in a timely and
advanced airway. Needs some appropriate manner.
guidance to complete the procedure.
AED Operation Frequently fails to demonstrate Aware of indications for use but needs Consistently performs procedure
correct procedure and indications for some direction to perform procedure. correctly. Aware of indications for
use. appropriate use.
Intravenous Access Frequently fails to establish IV access Inconsistently establishes IV access. Consistently uses proper techniques.
due to improper technique. Needs some direction to complete the Completes procedure in a timely
procedure. manner.
CPR Frequently fails to demonstrate Inconsistently performs correct Consistently performs correct
correct procedure. Requires procedure. Able to perform skill with procedure without instruction or
instruction and prompting when minimal instruction. prompting.
performing skill.

3
 EVALUATION FACTOR RATING 1 RATING 2 RATING 3
Bandaging/Splinting Frequently fails to apply appropriate Inconsistently applies appropriate and Consistently applies appropriate and
and adequate bandages/splints in a adequate bandages/splints in a adequate bandages/splints in a
systematic and timely manner. systematic and timely manner. systematic, timely, and appropriate
'Ineffective technique or treatment Sometimes needs direction to manner.
causing potential harm to patient. complete tasks appropriately.
Sometimes fails to initiate any
treatment when indicated.
Extrication/Patient Positioning Frequently fails to initiate adequate Inconsistently initiates adequate Consistently initiates and directs
extrication/patient positioning. Does extrication/patient positioning. extrication/patient positioning in a
not have sufficient control to protect Sometimes does not have sufficient manner that protects the patient from
the patient from injury. control to protect patient from injury. injury.
Spinal Immobilization Frequently fails to initiate spinal Inconsistently initiates spinal Consistently uses spinal immobilization
immobilization when indicated. Does immobilization when indicated. Knows when indicated and appropriate. Uses
not know complete or correct complete and correct procedure but complete and correct procedure.
procedure. sometimes needs direction.
Drug Administration Unfamiliar with drug administration Inconsistent knowledge of drug Consistently administers drugs
procedures. Unable to calculate administration procedure. Unable to correctly and in a timely manner.
correct drug dosages. administer drugs in a timely manner.
Drug Knowledge Inadequate knowledge of indications, Inconsistent knowledge of indications, Consistent knowledge of indications.
contraindications, adverse effects and contraindications, adverse effects and Contraindication, adverse effects and
dosages of drug therapy. dosages of drug therapy. dosages of drug therapy.

Vocabulary List: The following definitions for terms used in these performance standards are provided for clarification.

Consistently - Always following the same principles or course of action

Frequently - Occurring often; many times

Inconsistent - Lacking agreement, as one thing having to do with another

Sometimes - On some occasions; at times; now and then more things in relation to each other

4
 KCEMT EMT 1FIELD INTERNSHIP DAILY PERFORMANCE RECORD

INTERN: DATE: TRAINING PROGRAM: INTERNING AGENCY/STATION:

TIME
SHIFT # IN: OUT: PRECEPTOR: PRECEPTOR:
DIRECTIONS: Sections are to be completed by the intern. Each run must be rated by the intern and
preceptors in each applicable category. Comments regarding runs should be made in comments area
provided. RATING: 1- Fails to Perform 2 – Borderline-inconsistent 3 - Competent

Communication
Assessment/Tx

Leadership

Skills
Treatment
Management
Scene
ALS
Patient Information and Chief Complaint Patient
Treatment Rendered Contact
( Age, Gender, Sequence #)
(Y/N)
COMMENTS
1. I
P
2. I
P
3. I
P
4. I
P
5. I
P
6. I
P
7. I
P
OVERALL DAILY PERFORMANCE (# OF PATIENT CONTACTS ON PAGE 2 OF 2 )

SUMMARY OF
Preceptor must provide a written summary of today’s performance

Drills/Demonstrations

PLAN FOR IMPROVEMENT:

PRECEPTOR’S ACTION FOR IMPROVEMENT:

PRECEPTOR SIGNATURE CERT. # PRECEPTOR SIGNATURE CERT. #

INTERN SIGNATURE SCHOOL REP. SIGNATURE

CPPD/PTI REVISED 3/06 White-Student File Canary-Field Handbook Pink- Student PAGE 1 OF 2
 KCEMT EMT 1FIELD INTERNSHIP DAILY PERFORMANCE RECORD

INTERN: DATE: TRAINING PROGRAM: INTERNING AGENCY/STATION:

TIME
SHIFT # IN: OUT: PRECEPTOR: PRECEPTOR:
DIRECTIONS: Sections are to be completed by the intern. Each run must be rated by the intern and
preceptors in each applicable category. Comments regarding runs should be made in comments area
provided. RATING: 1- Fails to Perform 2 – Borderline-inconsistent 3 - Competent

Leadership
.
Assessment/Tx
Communication

Skills
Treatment
Management
Scene
ALS
Patient Information and Chief Complaint Patient
Treatment Rendered Contact
( Age, Gender, Sequence #)
(Y/N)
COMMENTS
8. I
P
9. I
P
10. I
P
11. I
P
12. I
P
13. I
P
14. I
P
15. I
P
16. I
P
17. I
P
18. I
P
19. I
P
20. I
P
21. I

CPPD/PTI REVISED 3/06 White-Student File Canary-Field Handbook Pink- Student PAGE 2 OF 2
 KCEMT EMT 1FIELD INTERNSHIP - MAJOR EVALUATION
INTERN TRAINING PROGRAM

INTERNING AGENCY STATION & SHIFT TODAY’S DATE

PRECEPTOR (1) PRECEPTOR (2)

RATING PERIOD FROM: TO: # HOURS: #ALS CALLS TO DATE

RATING CRITERIA: Refer to Performance Evaluation Standards in the Internship Manual. An intern must attain a “3” in each
category on the final evaluation to successfully complete field internship.
1. Frequently fails to perform procedure in a competent manner
2. Inconsistent in performing procedures in a competent manner
3. Consistently performs procedure in a competent manner
N/A Not applicable. Did not perform skill.
(Skills not observed in the field shall be evaluated in a drill situation prior to the completion of internship)
EVALUATION FACTORS RATING COMMENTS: are required in each major c ategory
SCENE MANAGEMENT
1. Safety and work environment
2. Universal precautions
3. Crowd control
4. Additional assistance and equipment

ASSESSMENT/TREATMENT
5. Initial assessment and intervention
6. Patient information
7. Physical examination
8. Assessment interpretation
9. Chest auscultation
10. Patient management
11. Patient response to therapy
COMMUNICATION
12. Rapport with patient, family and
bystanders
13. Team members
14. Radio Report
15. Documentation
16. Working relationship with team
LEADERSHIP
17. Leadership
18. Professionalism
19. Feedback and guidance
EQUIPMENT
20. Inventory maintenance
21. Equipment operation
CPPD/PTI REVISED 3/06 White -Student File Canary-Field Handbook Pink - Student PAGE 1 0F 2
 MAJOR EVALUATION
TREATMENT SKILLS
EVALUATION FACTORS RATING COMMENTS: are required in each major category

AIRWAY
22. Airway management/Oxygen therapy
23. Advanced airway (Esophageal-tracheal
airway device)
CIRCULATION
24. AED Operation
25. Intravenous access
26. CPR
MUSCULOSKELETAL SKILLS
27. Bandaging/splinting
28. Extrication/patient positioning
29. Spinal immobilization
PHARMACOLOGY
30. Drug administration technique
31. Drug knowledge
EXPANDED SCOPE

OTHER SKILLS

SUMMARY OF PERFORMANCE
Preceptors must provide a written summary of the intern’s performance to date:

Plan for improvement:

Preceptor signature: Cert # Preceptor signature: Cert. #

Intern signature: School Rep signature:

CPPD/PTI REVISED 3/06 White -Student File Canary-Field Handbook Pink - Student PAGE 2 OF 2
 KCEMT EMT 1CLINICAL / FIELD Skills Check-Off
Program Name

Intern: ________________________ Class: _____________ Clinical/Field Site: ___________________

RATING CRITERIA: Refer to Performance Standards below. An intern should progress from a rating
of 1 or 2 to a minimum of 3 prior to end of clinical rotations and field internship.
Performance Standards:
1 – Requires instruction and prompting when performing skill/assessment.
2 – Able to perform skill/assessment with minimal instruction.
3 – Able to perform skill/assessment without instruction or prompting (competent).
N/A – Not applicable (Did not perform skill/assessment).
Evaluation Factors: Rating: Comments Preceptor Signature
Patient Assessment

1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

5. __________ _____ ___________________ ___________________________

6. __________ _____ ___________________ ___________________________

7. __________ _____ ___________________ ___________________________

8. __________ _____ ___________________ ___________________________

9. __________ _____ ___________________ ___________________________

10. __________ _____ ___________________ ___________________________

11. __________ _____ ___________________ ___________________________

12. __________ _____ ___________________ ___________________________

13. __________ _____ ___________________ ___________________________

14. __________ _____ ___________________ ___________________________

15. __________ _____ ___________________ ___________________________

16. __________ _____ ___________________ ___________________________

17. __________ _____ ___________________ ___________________________

18. __________ _____ ___________________ ___________________________

19. __________ _____ ___________________ ___________________________

20. __________ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

Pharyngo-tracheal lumen airway (PTL)

Date
1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

1
 KCEMT EMT 1CLINICAL / FIELD Skills Check-Off
Program Name

5. __________ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

MEDICATION ADMINISTRATION

Date Route
1. __________ _______ _____ ___________________ ___________________________

2. __________ _______ _____ ___________________ ___________________________

3. __________ _______ _____ ___________________ ___________________________

4. __________ _______ _____ ___________________ ___________________________

5. __________ _______ _____ ___________________ ___________________________

6. __________ _______ _____ ___________________ ___________________________

7. __________ _______ _____ ___________________ ___________________________

8. __________ _______ _____ ___________________ ___________________________

9. __________ _______ _____ ___________________ ___________________________

10. __________ _______ _____ ___________________ ___________________________

11. __________ _______ _____ ___________________ ___________________________

12. __________ _______ _____ ___________________ ___________________________

13. __________ _______ _____ ___________________ ___________________________

14. __________ _______ _____ ___________________ ___________________________

15. __________ _______ _____ ___________________ ___________________________

16. __________ _______ _____ ___________________ ___________________________

17. __________ _______ _____ ___________________ ___________________________

18. __________ _______ _____ ___________________ ___________________________

19. __________ _______ _____ ___________________ ___________________________

20. __________ _______ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

INITIATE IV

Date
1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

5. __________ _____ ___________________ ___________________________

2
 KCEMT EMT 1CLINICAL / FIELD Skills Check-Off
Program Name

6. __________ _____ ___________________ ___________________________

7. __________ _____ ___________________ ___________________________

8. __________ _____ ___________________ ___________________________

9. __________ _____ ___________________ ___________________________

10. __________ _____ ___________________ ___________________________

11. __________ _____ ___________________ ___________________________

12. __________ _____ ___________________ ___________________________

13. __________ _____ ___________________ ___________________________

14. __________ _____ ___________________ ___________________________

15. __________ _____ ___________________ ___________________________

16. __________ _____ ___________________ ___________________________

17. __________ _____ ___________________ ___________________________

18. __________ _____ ___________________ ___________________________

19. __________ _____ ___________________ ___________________________

20. __________ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

AED APPLICATION AND USE

Date
1. __________ _______ _____ ___________________ ___________________________

2. __________ _______ _____ ___________________ ___________________________

3. __________ _______ _____ ___________________ ___________________________

4. __________ _______ _____ ___________________ ___________________________

5. __________ _______ _____ ___________________ ___________________________

6. __________ _______ _____ ___________________ ___________________________

7. __________ _______ _____ ___________________ ___________________________

8. __________ _______ _____ ___________________ ___________________________

9. __________ _______ _____ ___________________ ___________________________

10. __________ _______ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

APPLY ELECTRODES & RHYTHM RECOGNITION

Date
1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3
 KCEMT EMT 1CLINICAL / FIELD Skills Check-Off
Program Name

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

5. __________ _____ ___________________ ___________________________

6. __________ _____ ___________________ ___________________________

7. __________ _____ ___________________ ___________________________

8. __________ _____ ___________________ ___________________________

9. __________ _____ ___________________ ___________________________

10. __________ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

DEFIBRILLATION UNDER DIRECT SUPERVISION OF PARAMEDIC, RN, MD

1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

5. __________ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

CARDIAC PATIENT ASSESSMENT/TREATMENT PLAN

Date
1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

5. __________ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

RESPIRATORY PATIENT ASSESSMENT/BREATH SOUNDS/TREATMENT PLAN

Date
1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

5. __________ _____ ___________________ ___________________________

4
 KCEMT EMT 1CLINICAL / FIELD Skills Check-Off
Program Name

Evaluation Factors: Rating: Comments Preceptor Signature

NEUROLOGICAL ASSESSMENT

Date
1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

5. __________ _____ ___________________ ___________________________

Evaluation Factors: Rating: Comments Preceptor Signature

PEDIATRIC AGE AND WEIGHT ASSESSMENT

Date
1. __________ _____ ___________________ ___________________________

2. __________ _____ ___________________ ___________________________

3. __________ _____ ___________________ ___________________________

4. __________ _____ ___________________ ___________________________

5. __________ _____ ___________________ ___________________________

6. __________ _____ ___________________ ___________________________

7. __________ _____ ___________________ ___________________________

8. __________ _____ ___________________ ___________________________