Practical Scenario Evaluation

Medical/Trauma Emergencies

Date:___\___\___ Location:_________________________________________
Scenario # __________

AIC Name:______________________________________________________  Start:_______________

Attendant Name:__________________________________________________ End:________________

Evaluator(s) Name_________________________________________________
Total Time__________

Evaluator’s Instructions - Mark only those items which are applicable to the scenario and which the candidate failed to perform. List any additional harmful actions in the comments section, as well as explanation for specific errors or omissions as marked.

Scene Survey and General Impression

___Takes appropriate PPE/BSI

___Notes hazards present

___Calls for additional assistance if needed

___Notes environmental factors

___Notes obvious patient signs and symptoms

Initial Assessment

___Checks LOC (C-spine control if indicated)

___Checks airway and breathing

         ___Opens airway appropriately

         ___Notes Rate

         ___Notes Rhythm

         ___Notes Quality

___Makes or directs appropriate interventions

___Checks Pulse(s)

         ___Notes Rate

         ___Notes Rhythm

         ___Notes Quality

___Checks Skin condition

         ___Notes Color

         ___Notes Moisture

         ___Notes Temperature

___Checks for major bleeding

___Identifies “Load and Go”            

Focused History and Physical Examination

___ Performs rapid assessment based on patient’s chief complaint, NOI, or MOI as  appropriate

___Assesses chief complaint for medical patients (OPQRST)

___Assesses head to toe as indicated

___Assesses SAMPLE history

___Obtains baseline vital signs 

Outcome:

                   ____Exceptional ____Adequate   ____Inadequate                  

Treatment/Management/Interventions

___Immediate life threats corrected in initial assessment

___Appropriate treatment previously begun as indicated (O2, C-spine, etc.)

___Other interventions taken appropriately and timely

___Interventions appropriately reassessed

Ongoing/Detailed Assessment

___Reassesses and manages changes  appropriately

Packaging and Moving

___Appropriate techniques used

___Patient properly positioned 

Comments:

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