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EMT Competency Tracking FormStudent Name:Student Certification #:Instructions: The EMT-Instructor must date & initial the appropriate spaces to verify that the individual student has demonstratedcompetency in performing each of the skills listed. At course completion all skill areas must have been completed to signifyeligibility for certification testing. Competency in all relevant skills contained within the Competency-based EMT program is requiredfor state certification.Instructor Verification of Completion::Signature:Preparatory Competencies1234567891011121314Date Verified:123Must demonstrate the ability to select, don, remove and discard PPEMust demonstrate the ability to properly disinfect/clean EMS equip/ambulanceMust demonstrate the ability to properly comply w/infectious control exposure using localprotocolsMust demonstrate the ability to assess a patient for breathing difficultyMust demonstrate ability to acquire a pulse providing rate, rhythm, and strengthMust demonstrate ability to assess the skin color, temp, and condition in an adultMust demonstrate ability to assess capillary refill in pt. 6 yo.Must demonstrate ability to assess the pupils as to equality, size, reactivityMust demonstrate ability to obtain a blood pressureMust demonstrate ability to obtain a SAMPLE historyOperate stretcherOperate Stair chairMove Patient using Spine boardMove pt. from ambulance stretcher to a hospital bedVirginia Office of EMSwww.vdh.virginia.gov/oemsForm: TR-90 Revised: February 5, 2013Page 145
EMT Competency Tracking FormAirway Competencies123456789101112131415Patient Assessment Competencies1234561234512345Must demonstrate ability to perform a chin-lift during an airway scenarioMust demonstrate ability to perform a jaw thrust during an airway scenarioMust demonstrate ability to perform suctioning during an airway scenario using soft/rigidsuction devicesMust demonstrate ability to provide mouth to mouth ventilation using BSI (pocket mask)Must demonstrate ability to assemble, connect to O2 and ventilate during airway scenario usingBVMMust demonstrate ability to ventilate using a BVM for 1 min each demonstrationMust demonstrate ventilating with a flow restricted, oxygen powered ventilation deviceDemonstrate how to artificially ventilate patient w/stomaDemonstrate how to insert OP airway during an airway scenarioDemonstrate how to insert NP airway during an airway scenarioCorrectly operate O2 tanks and regulatorDemonstrate use of non-rebreather and adjust O2 flow requirements needed for use duringairway scenarioDemonstrate use of nasal cannula and adjust O2 flow requirements needed for use duringairway scenarioDemonstrate how to artificially ventilate an infant and child during scenarioDemonstrate O2 administration to infants and childrenWhile reviewing scenes identify potential hazardsDemonstrate the techniques for assessing mental status in a scenarioDemonstrate techniques for assessing the airway in a scenarioDemonstrate techniques for assessing if pt. is breathing in a scenarioDemonstrate techniques for assessing if pt. has a pulse scenarioDemonstrate Techniques for assessing pt. for external bleeding in a scenarioVirginia Office of EMSwww.vdh.virginia.gov/oemsForm: TR-90 Revised: February 5, 2013Page 2
EMT Competency Tracking FormPatient Assessment Competencies7891011121314151617Medical, Behavioral and OB/GYN Competencies123456789101112131234512345Demonstrate techniques for assessing pt. skin color, temp. condition in scenarioDemonstrate the ability to prioritize pt. in scenarioDemonstrate rapid trauma assess based on mech. of injury in scenarioDemonstrate pt. assessment skills in responsive pt. with no known history in scenarioDemonstrate pt. assessment skills in an unconscious/ALOC pt. in scenarioDemonstrate skills in detailed physical examDemonstrate skills in ongoing assessmentPerform a simulated, organized, concise radio transmission (lab setting)Perform pt. report that would be given to staff at receiving facility (lab setting)Perform report that would be given to ALS provider in (lab setting)Complete pre-hospital care report (lab setting)Demonstrate General steps for assisting pt. with self administration of medsRead labels and inspect each type of medsDemonstrate emergency medical care for breathing difficulty in scenarioPerform steps in using inhaler scenarioDemonstrate assessment and care for chest pain pt. in scenarioDemonstrate application and operation of AED in scenario w/CPRDemonstrate maintenance of AEDDemonstrate assessment and documentation of patient response to AEDDemonstrate skills to complete the automated defibrillator: operators shift checklistPerform steps for use of Nitro for chest pain/discomfort in scenarioDemonstrate assessment and documentation of pt. response to nitro in scenarioPractice completing PPCR for cardiac emerg. In scenarioDemonstrate steps in emergency medical care for Pt. taking diabetic medicine w/ALOC inscenarioVirginia Office of EMSwww.vdh.virginia.gov/oemsForm: TR-90 Revised: February 5, 2013Page 3
EMT Competency Tracking FormMedical, Behavioral and OB/GYN 333435363738123Demonstrate steps in administration of oral glucose in scenarioDemonstrate assessment and documentation of pt response to oral glucose in scenarioDemonstrate how to complete PPCR for Pt. w/diabetic emerg in scenarioDemonstrate care for Pt. w/allergic reaction in scenarioDemonstrate use of EPI-Pen in scenarioAssessment/documentation of Pt. in response to EPI-Pen in scenarioDemonstrate proper disposal of equipment in scenariodemonstrate completion of PPCR for Pt. Allergic reaction in scenarioDemonstrate care of Pt. w/possible overdose scenarioDemonstrate assessment/care of pt. w/exposure to cold in scenarioDemonstrate assessment/care of pt. w/exposure to heat in scenarioAssessment/care of near drowning pt in scenarioComplete prehospital care report for pt. w/environmental emergencies in scenarioAssessment/care of pt w/behavioral emergency in scenarioDemonstrate techniques to restrain pt. with behavioral problem in scenarioDemonstrate steps to assist in normal cephalic deliveryDemonstrate necessary care for fetus as head appearsDemonstrate infant neonatal proceduresDemonstrate post delivery care of infantDemonstrate how and when to cut umbilical cordAttend to steps in the delivery of the placentaDemonstrate post-delivery care of motherDemonstrate the procedures for following abnormal deliveries (vaginal bleeding, breech birth,prolapsed cord, limb presentationDemonstrate steps in care of mother with excessive bleedingComplete PPCR of OB ptVirginia Office of EMSwww.vdh.virginia.gov/oemsForm: TR-90 Revised: February 5, 2013Page 445
EMT Competency Tracking 526123Demonstrate direct then diffuse pressure by applying dressing to the headDemonstrate direct then diffuse pressure by applying dressing to the shoulderDemonstrate direct then diffuse pressure by applying dressing an extremityDemonstrate direct then diffuse pressure by applying dressing to the hipDemonstrate use of pressure point/tourniquet at brachialDemonstrate use of pressure point/tourniquet at FemoralDemonstrate care of pt. w/signs and symptoms of internal bleeding/shockComplete PPCR on Bleeding and/or shock Pt.Demonstrate the care of closed soft tissue injuriesDemonstrate the care of open soft tissue injuriesDemonstrate care of open chest woundDemonstrate care of open abdominal woundsDemonstrate care of impaled objectDemonstrate care of pt w/amputation and the amputated partDemonstrate care of pt. with superficial burnsDemonstrate care of pt. with partial thickness burnsDemonstrate care of pt. with full thickness burnsDemonstrate care of pt. w/chemical burnsComplete PPCR w/pt. having soft tissue injuriesDemonstrate care of pt. with painful swollen deformed forearmDemonstrate care of pt. with painful swollen deformed armDemonstrate care of pt. with painful swollen deformed clavicleDemonstrate care of pt. with painful swollen deformed thighDemonstrate care of pt. with painful swollen deformed calfDemonstrate care of pt. with painful swollen deformed ankle/footComplete PPCR w/pt. having painful, swollen deformityVirginia Office of EMSwww.vdh.virginia.gov/oemsForm: TR-90 Revised: February 5, 2013Page 545
EMT Competency Tracking te evaluating a responsive patient with a suspected spinal cord injury. (duringscenario)Demonstrate stabilization of the cervical spine. (during scenario)Demonstrate the four person log roll for a pt. with a suspected spinal cord injury (during scenario)Demonstrate how to log roll a pt. with a suspected spinal cord injury using two people (duringscenario)Demonstrate securing a pt to a long spine board (during scenario)Demonstrate using the short board techniqueDemonstrate procedure for rapid extricationDemonstrate preferred methods for stabilization of a helmetDemonstrate helmet removal techniquesDemonstrate completing a PPCR for Pt.s with head and spinal injuriesInfants and Children and Operations12345671Demonstrate opening airway in pt. with suspected spinal cord injury. (during scenario)Demonstrate the techniques of foreign body airway obstruction removal in the infantDemonstrate the techniques of foreign body airway obstruction removal in the childDemonstrate the assessment of an infant and a childDemonstrate bag-valve-mask artificial ventilations for the infantDemonstrate bag-valve-mask artificial ventilations for the childDemonstrate oxygen delivery for the infant and childGiven a scenario of a mass casualty incident perform triageVirginia Office of EMSwww.vdh.virginia.gov/oemsForm: TR-90 Revised: February 5, 2013Page 6
Virginia Office of EMS www.vdh.virginia.gov/oems Form: TR-90 Revised: February 5, 2013 Page 2 EMT Competency Tracking Form Airway Competencies 1 2 3 4 5
