EMT

Appendix A

EMT-Intermediate: Description of the Profession

Description of the Profession
EMT-Intermediate

EMT-Intermediates have fulfilled prescribed requirements by a credentialing agency to practice the art and science of out-of-hospital medicine in conjunction with medical direction. Through performance of assessments and providing medical care, their goal is to prevent and reduce mortality and morbidity due to illness and injury for emergency patients in the out-of-hospital setting.

EMT-Intermediates possess the knowledge, skills and attitudes consistent with the expectations of the public and the profession. EMT-Intermediates recognize that they are an essential component of the continuum of care and serve as a link for emergency patients to acute care resources.

The primary roles and responsibilities of EMT-Intermediates are to maintain high quality, out-of-hospital emergency care. Ancillary roles of the EMT-Intermediate may include public education and health promotion programs as deemed appropriate by the community.

EMT-Intermediates are responsible and accountable medical direction, the public, and their peers. EMT-Intermediates recognize the importance of research. EMT-Intermediates seek to take part in life-long professional development, peer evaluation, and assume an active role in professional and community organizations.

Appendix B

EMT-Intermediate: Educational Model

EMT-INTERMEDIATE: NATIONAL STANDARD CURRICULUM
DIAGRAM OF EDUCATIONAL MODEL

	PREREQUISITE
	EMT or EMT-Basic

	PREPARATORY
Clinical/Field	Foundations of the EMT-Intermediate Overview of Human Systems Emergency Pharmacology Venous Access and Medication Administration	Clinical/Field
	AIRWAY MANAGEMENT AND VENTILATION
MEDICAL	PATIENT ASSESSMENT	TRAUMA
Respiratory Emergencies Cardiovascular Emergencies Diabetic Emergencies Allergic Reactions Poisoning/Overdose Emergencies Neurological Emergencies Non-Traumatic Abdominal Emergencies Environmental Emergencies Behavioral Emergencies Gynecological Emergencies	History Taking Techniques of Physical Examination Patient Assessment Clinical Decision Making Communications Documentation	Trauma Systems/Mechanism of Injury Hemorrhage and Shock Burns Thoracic Trauma Trauma Practical Laboratory
	SPECIAL CONSIDERATIONS
Clinical/Field	Obstetric Emergencies Neonatal Resuscitation Pediatrics Geriatrics	Clinical/Field
	ASSESSMENT BASED MANAGEMENT

	LIFE LONG LEARNING
	Continuing Education

Appendix C

Recommended Program Length

EMT-INTERMEDIATE: NATIONAL STANDARD CURRICULUM

RECOMMENDED COURSE HOURS

This project included a pilot and field testing of developmental drafts of the curriculum. Based on input from the pilot test, the field tests, national and peer review, there were significant changes to the curriculum after pilot and field testing. A panel of experts in EMS education used the pilot and field test data to develop recommended time frames for the EMT-Intermediate course. These time frames are meant only as a guide to help in program planing. 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 these recommendations, it is suggested that the course be planned for approximately 300-400 total hours of instruction (175-225 classroom/practical laboratory, 50-75 clinical, 75-100 field internship.)

	Recommended didactic time (hours)	Recommended practical laboratory time (hours)
Preparatory
Found. of the EMT-I Paramedic	3
Overview of Human System/Roles & Responsibilities	6
Emergency Pharmacology	12
Medication Administration	3	6
Module Totals	24	6
Airway Management & Ventilation
Airway and Ventilation	9	9
Module Totals	9	9
Patient Assessment
History Taking	1
Technique of Physical Examination	3	3
Patient Assessment	2	6
Clinical Decision Making	1
Communications	1	1
Documentation	1	1
Module Totals	9	11
Trauma
Trauma Systems/ Mechanism of Injury	2
Hemorrhage and Shock	2
Burns	1
Thoracic Trauma	3
Practical Laboratory		8
Module Totals	8	8
Medical
Respiratory Emergencies	9	3
Cardiac Emergencies	27	24
Diabetic Emergencies	2
Allergic Reaction	1
Poisoning/OD Emergencies	1
Neurological Emergencies	2
Abdominal Emergencies	1
Environmental Emergencies	2
Behavioral Emergencies	1
Gynecological Emergencies	2
Module Totals	48	27
Special Considerations
Obstetric Emergencies	2	1
Neonatology	2	2
Pediatrics	8	4
Geriatrics	2
Module Total	14	7
Assessment Based Management
Assessment Based Management		12
Module Totals		12

Clinical and Field
Clinical		50
Field		75

Note: These recommendations do not consider any miscellaneous classroom tine (i.e. exams, review, program administrative time, breaks, etc.)

Appendix D

Affective Evaluations

INSTRUCTIONS FOR AFFECTIVE STUDENT EVALUATIONS

There are two primary purposes of an affective evaluation system: 1) to verify competence in the affective domain, and 2) to serve as a method to change behavior. Although affective evaluation can be used to ultimately dismiss a student for unacceptable patterns of behavior, that is not the primary purpose of these forms. It is also recognized that there is some behavior that is so serious (abuse of a patient, gross insubordination, illegal activity, reporting for duty under the influence of drugs or alcohol, etc) that it would result in immediate dismissal from the educational program.

The two forms included in the EMT-Intermediate: National Standard Curricula were developed by the Joint Review Committee on Educational Programs for the EMT-Paramedic. They represent extensive experience in the evaluation of student=s affective domain. The nature of this type of evaluation makes it impossible to achieve complete objectivity, but these forms attempt to decrease the subjectivity and document affective evaluations.

In attempting to change behavior it is necessary to identify, evaluate, and document the behavior that you want. The eleven affective characteristics that form the basis of this evaluation system refer to content in the Roles and Responsibilities of the Paramedic unit of the curriculum. Typically, this information is presented early in the course and serves to inform the students what type of behavior that is expected of them. It is important that the instructor is clear about these expectations.

Cognitive and psychomotor objectives are relatively easy to operationalize in behavioral terms. Unfortunately, the nature of the affective domain makes it practically impossible to enumerate all of the possible behaviors that represent professional behavior in each of the eleven areas. For this reason, the instructor should give examples of acceptable and unacceptable behavior in each of the eleven attributes, but emphasize that these are examples and do not represent an all inclusive list.

The affective evaluation instruments included in this curriculum take two forms: A Professional Behavior Evaluation and a Professional Behavior Counseling Record. The Professional Behavior Evaluation should be completed regularly (i.e. every other week, once a month, etc.) by faculty and preceptors about each student. It is recommended that this form be completed by as many people as practically possible and that it becomes part of the students record. The more independent evaluations of the student, the more reliable are the results.

The only two options for rating the student on this form are Acompetent@ and Anot yet competent@. For each attribute, a short list of behavioral markers is listed that indicates what is generally considered a demonstration of competence for entry level paramedics. This is not an all inclusive list, but serves to help the evaluator in making judgements. Clearly there are behaviors which warrant a Anot yet competent@ evaluation that are not listed. Any ratings of Anot yet competent@ require explanation in the space provided.

Establishing a cut score to use in conjunction with the Professional Behavior Evaluation instrument is important. A cut score can be established by judgement of the local programs community of interest. The question the community should ask is, what percent score do we expect of graduates of our education program to achieve in the affective domain in order to demonstrate entry level competency for a (first month, second semester, graduate, etc.) level student?

When the cut score judgement is made on acceptability or deviation of competent behavior for each characteristic a percent score can be achieved. For example, a student may received 10 competent checks out of 11 (10 of 11 = 91%), or 5 of 7 (because 4 areas were not evaluated) for a score of 71%. This student may then continue to obtain scores of 91%, 91% 82%, etc and have a term grade of 86% in the affective domain. Each student in the program would receive an average score. Results of multiple evaluations throughout the program would indicate if the score set by the community of interest was too high or too low. When a number of evaluations had evolved adjustments in acceptable score would yield a standard for the community. This standard coupled with community of interest judgements based upon graduate student and employer survey feedbacks would identify additional validity evidence for the cut score each year. A valid cut score based upon years of investigation could then be used as a determining factor on future participation in the education program.

For all affective evaluations, the faculty member should focus on patterns of behavior, not isolated instances that fall outside the students normal performance. For example, a student who is consistently on time and prepared for class may have demonstrated competence in time management and should not be penalized for an isolated emergency that makes him late for one class. On the other hand, if the student is constantly late for class, they should be counseled and if the behavior continues, rated as Anot yet competent@ in time management. Continued behavior may result in disciplinary action.

The second form, the Professional Behavior Counseling form is used to clearly communicate to the student that their affective performance is unacceptable. This form should be used during counseling sessions in response to specific incidents (i.e. cheating, lying, falsification of documentation, disrespect/insubordination, etc.) or patterns of unacceptable behavior. As noted before, there is some behavior that is so egregious as to result in immediate disciplinary action or dismissal. In the case of such serious incidents, thorough documentation is needed to justify the disciplinary action. For less serious incidents, the Professional Behavior Counseling form can serve as an important tracking mechanism to verify competence or patterns of uncorrected behavior.

On the Professional Behavior Counseling form, the evaluator checks all of the areas that the infraction affects in the left hand column (most incidents affect more than one area) and documents the nature of the incident(s) in the right hand column. Space is provided to document any follow-up. This should include specific expectations, clearly defined positive behavior, actions that will be taken if the behavior continues, and dates of future counseling sessions.

Using a combination of these forms helps to enable the program to demonstrate that graduating students have demonstrated competence in the affective domain. This is achieved by having many independent evaluations, by different faculty members at different times, stating that the student was competent. These forms can also be used to help correct unacceptable behavior. Finally, these forms enable programs to build a strong case for dismissing students following a repeated pattern of unacceptable behavior. Having numerous, uncollaborated evaluations by faculty members documenting unacceptable behavior, and continuation of that behavior after remediation, is usually adequate grounds for dismissal.

PROFESSIONAL BEHAVIOR EVALUATION

Student's Name:_____________________________________________________________________________

Date of evaluation:___________________________________________________________________________

1. INTEGRITY	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities.
2. EMPATHY	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others.
3. SELF - MOTIVATION	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities
4. APPEARANCE AND PERSONAL HYGIENE	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.
5. SELF - CONFIDENCE	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgement; demonstrating an awareness of strengths and limitations; exercises good personal judgement.
6. COMMUNICATIONS	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations
7. TIME MANAGEMENT	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.
8. TEAMWORK AND DIPLOMACY	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.
9. RESPECT	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.
10. PATIENT ADVOCACY	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Not allowing personal bias to or feelings to interfere with patient care; placing the needs of patients above self interest; protecting and respecting patient confidentiality and dignity.
11. CAREFUL DELIVERY OF SERVICE	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Mastering and refreshing skills; performing complete equipment checks; demonstrating careful and safe ambulance operations; following policies, procedures, and protocols; following orders.

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

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_________________________________- Faculty Signature

PROFESSIONAL BEHAVIOR EVALUATION

Student=s Name: Steve R.

Date of evaluation: November 1999

1. INTEGRITY	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities.
2. EMPATHY	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others.
3. SELF - MOTIVATION	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities
4. APPEARANCE AND PERSONAL HYGIENE	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.
5. SELF - CONFIDENCE	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgement; demonstrating an awareness of strengths and limitations; exercises good personal judgement.
6. COMMUNICATIONS	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations
7. TIME MANAGEMENT	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.
8. TEAMWORK AND DIPLOMACY	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.
9. RESPECT	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.
10. PATIENT ADVOCACY	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Not allowing personal bias to or feelings to interfere with patient care; placing the needs of patients above self interest; protecting and respecting patient confidentiality and dignity.
11. CAREFUL DELIVERY OF SERVICE	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Mastering and refreshing skills; performing complete equipment checks; demonstrating careful and safe ambulance operations; following policies, procedures, and protocols; following orders.

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

#2, 5, 6, 8, & 9 Steve has demonstrated inappropriate classroom behavior by monopolizing class time, answering questions intended for other students, and making sarcastic remarks about other students answers. Steve demonstrates a superiority complex over fellow classmates belittling and has repeatedly belittled their experience, while boasting and exaggerating about his field experience.

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T. Jones - Faculty Signature

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

#2 Steve is constantly disrupting class with irrelevant questions. He is disrespectful to guest instructors, classmates and the program.

#5 Steve seems to have an impression that he is better than the others students because he has more field experience. He is overconfident and overbearing.

#6 Steve has not changed his communication skills despite verbal counseling.

#8 Steve=s disruptions are destructive to the team environment by placing his needs above those of the group.

#9 Disruptions are disrespectful.

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A. Cox -Faculty Signature

PROFESSIONAL BEHAVIOR EVALUATION

Student=s Name: Steve R.

Date of evaluation: December 1999

1. INTEGRITY	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities.
2. EMPATHY	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others.
3. SELF - MOTIVATION	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities
4. APPEARANCE AND PERSONAL HYGIENE	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.
5. SELF - CONFIDENCE	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgement; demonstrating an awareness of strengths and limitations; exercises good personal judgement.
6. COMMUNICATIONS	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations
7. TIME MANAGEMENT	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.
8. TEAMWORK AND DIPLOMACY	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.
9. RESPECT	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.
10. PATIENT ADVOCACY	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Not allowing personal bias to or feelings to interfere with patient care; placing the needs of patients above self interest; protecting and respecting patient confidentiality and dignity.
11. CAREFUL DELIVERY OF SERVICE	Competent [ ]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Mastering and refreshing skills; performing complete equipment checks; demonstrating careful and safe ambulance operations; following policies, procedures, and protocols; following orders.

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

#8 Steve=s disruptions are destructive to the team environment by placing his needs above those of the group.

A. Cox -Faculty Signature

PROFESSIONAL BEHAVIOR EVALUATION

Student=s Name: Janet L.

Date of evaluation: September 1998

1. INTEGRITY	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities.
2. EMPATHY	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Showing compassion for others; responding appropriately to the emotional response of patients and family members; demonstrating respect for others; demonstrating a calm, compassionate, and helpful demeanor toward those in need; being supportive and reassuring to others.
3. SELF - MOTIVATION	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Taking initiative to complete assignments; taking initiative to improve and/or correct behavior; taking on and following through on tasks without constant supervision; showing enthusiasm for learning and improvement; consistently striving for excellence in all aspects of patient care and professional activities; accepting constructive feedback in a positive manner; taking advantage of learning opportunities
4. APPEARANCE AND PERSONAL HYGIENE	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Clothing and uniform is appropriate, neat, clean and well maintained; good personal hygiene and grooming.
5. SELF - CONFIDENCE	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Demonstrating the ability to trust personal judgement; demonstrating an awareness of strengths and limitations; exercises good personal judgement.
6. COMMUNICATIONS	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Speaking clearly; writing legibly; listening actively; adjusting communication strategies to various situations
7. TIME MANAGEMENT	Competent [ ]	Not yet competent [T]
Examples of professional behavior include, but are not limited to: Consistent punctuality; completing tasks and assignments on time.
8. TEAMWORK AND DIPLOMACY	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Placing the success of the team above self interest; not undermining the team; helping and supporting other team members; showing respect for all team members; remaining flexible and open to change; communicating with others to resolve problems.
9. RESPECT	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Being polite to others; not using derogatory or demeaning terms; behaving in a manner that brings credit to the profession.
10. PATIENT ADVOCACY	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Not allowing personal bias to or feelings to interfere with patient care; placing the needs of patients above self interest; protecting and respecting patient confidentiality and dignity.
11. CAREFUL DELIVERY OF SERVICE	Competent [T]	Not yet competent [ ]
Examples of professional behavior include, but are not limited to: Mastering and refreshing skills; performing complete equipment checks; demonstrating careful and safe ambulance operations; following policies, procedures, and protocols; following orders.

Use the space below to explain any Anot yet competent@ ratings. When possible, use specific behaviors, and corrective actions.

� Janet=s run reports, written case reports, and home work are illegible and disorganized. She has numerous spelling and grammatical errors. � Janet repeatedly hands in assignments after due dates. She does not complete clinical time in a organized, organized manner. She did not report for five scheduled clinical shifts this semester and reported to medic 6 twice when she was not scheduled. Janet has not completed the required clinical for this semester. ______________________________________________________________________________________________________

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John Brown - Faculty Signature

PROFESSIONAL BEHAVIOR COUNSELING RECORD

Student=s Name:_____________________________________________________________________________

Date of counseling:___________________________________________________________________________

Date of incident:_____________________________________________________________________________

U	Reason for Counseling	Explanation (use back of form if more space is needed):
	Integrity
	Empathy
	Self - Motivation
	Appearance/Personal Hygiene
	Self - Confidence
	Communications
	Time Management
	Teamwork and Diplomacy
	Respect
	Patient Advocacy
	Careful delivery of service

Follow-up (include specific expectations, clearly defined positive behavior, actions that will be taken if behavior continues, dates of future counseling sessions, etc.):

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_________________________________-Faculty signature

I have read this notice and I understand it.

_________________________________-Student signature

_________________________________-Administrative or Medical Director Review

PROFESSIONAL BEHAVIOR COUNSELING RECORD

Student=s Name: Joe L.

Date of counseling: February 23, 1999 Date of incident: February 21, 1999

U	Reason for Counseling	Explanation (use back of form if more space is needed):
	Integrity	Joe reported to a field rotation 16 minutes late, he was not wearing (nor
	Empathy	did he have in his possession) a uniform belt and with Aat least 2 days
	Self - Motivation	beard growth@ according to field supervisor Johnson. When Joe was
U	Appearance/Personal Hygiene	approached regarding this situation he became argumentative and told
	Self - Confidence	Mr. Johnson to A... mind your own business.@ Joe was asked to leave.
	Communications	Others that witnessed this exchange were Paramedics Davis and
U	Time Management	Lawrence.
	Teamwork and Diplomacy
U	Respect
	Patient Advocacy
	Careful delivery of service

Follow-up (include specific expectations, clearly defined positive behavior, actions that will be taken if behavior continues, dates of future counseling sessions, etc.):

! Reviewed clinical Policies and Procedures manual section referring to personal appearance and hygiene, time management, and respect. I also reviewed the conduct at clinical rotations with Joe.

! Asked Joe to writ a letter of apology to field supervisor Johnson, and Paramedics Davis and Lawrence, which he agreed to do. ! I informed Joe that any further display of disrespectful behavior will result in dismissal from the program. A continued pattern of poor time management and/or poor appearance/personal hygiene could also result in dismissal. ____________________________________________________________________________________________

Bill Smith -Faculty signature
I have read this notice and I understand it.

Joe L. -Student signature

Dr. Jones -Administrative or Medical Director Review

PROFESSIONAL BEHAVIOR COUNSELING RECORD

Student=s Name: Steve R.

Date of counseling: December 14, 1998 Date of incident: November and December 1999

U	Reason for Counseling	Explanation (use back of form if more space is needed):
	Integrity	This counseling session was in response to the two Professional Behavior
Y	Empathy	Evaluations file by Instructors Cox and Jones. They both indicated that
	Self - Motivation	Steve has been disruptive in classes (see attached)
	Appearance/Personal Hygiene
Y	Self - Confidence
Y	Communications
	Time Management
Y	Teamwork and Diplomacy
Y	Respect
	Patient Advocacy
	Careful delivery of service

Follow-up (include specific expectations, clearly defined positive behavior, actions that will be taken if behavior continues, dates of future counseling sessions, etc.):

! Student was advised that his behavior is inappropriate and unacceptable. Continuation of this behavior will result in dismissal from class.

! Written warning from program director. ! Instructors Cox and Jones to complete Professional Behavior Evaluations bi-weekly throughout next semester ________________________________________________________________________________________________________________________________________________________________________________________

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M. Travis -Faculty signature
I have read this notice and I understand it.

Steve R. -Student signature

Dr. O=Hara -Administrative or Medical Director Review

Appendix E

Psychomotor Skills Evaluations

The following skill evaluation instruments were developed by the National Registry of EMTs. They are in draft format and have not yet been approved for usage in Advanced Level National Registry examinations.

National Registry of Emergency Medical Technicians
Advanced Level Practical Examination

PATIENT ASSESSMENT-TRAUMA

NOTE: Areas denoted by A**@ may be integrated within sequence of Initial Assessment	Possible Points	Points Awarded
Takes or verbalizes body substance isolation precautions	1
SCENE SIZE-UP
Determines the scene/situation is safe	1
Determines the mechanism of injury/nature of illness	1
Determines the number of patients	1
Requests additional help if necessary	1
Considers stabilization of spine	1
INITIAL ASSESSMENT/RESUSCITATION
Verbalizes general impression of the patient	1
Determines responsiveness/level of consciousness	1
Determines chief complaint/apparent life-threats	1
Airway -Opens and assesses airway (1 point) -Inserts adjunct as indicated (1 point)	2
Breathing -Assess breathing (1 point) -Assures adequate ventilation (1 point) -Initiates appropriate oxygen therapy (1 point) -Manages any injury which may compromise breathing/ventilation (1 point)	4
Circulation -Checks pulse (1 point) -Assess skin (either skin color, temperature or condition) (1 point) -Assesses for and controls major bleeding if present (1 point) -Initiates shock management (1 point)	4
Identifies priority patients/makes transport decision	1
FOCUSED HISTORY AND PHYSICAL EXAMINATION/RAPID TRAUMA ASSESSMENT
Selects appropriate assessment	1
Obtains, or directs assistant to obtain, baseline vital signs	1
Obtains SAMPLE history	1
DETAILED PHYSICAL EXAMINATION
Head -Inspects mouth, nose, and assesses facial area (1 point) -Inspects and palpates scalp and ears (1 point) -Assesses eyes for PEARRL **(1 point)	3
Neck** -Checks position of trachea (1 point) -Checks jugular veins (1 points) -Palpates cervical spine (1 point)	3
Chest ** -Inspects chest (1 point) -Palpates chest (1 point) -Auscultates chest (1 point)	3
Abdomen/pelvis** -Inspects and palpates abdomen (1 point) -Assesses pelvis (1 point) -Verbalizes assessment of genitalia/perineum as needed (1 point)	3
Lower extremities ** -Inspects, palpates, and assesses motor, sensory and circulatory functions (1 point/leg)	2
Upper extremities -Inspects, palpates, and assesses motor, sensory, and circulatory functions (1 point/arm)	2
Posterior thorax, lumbar, and buttocks** -Inspects and palpates posterior thorax (1 point) -Inspects and palpates lumbar and buttocks area (1 point)	2
Manages secondary injuries and wounds appropriately (1 point/injury or wound)	1
Ongoing assessment (1 point)	1
TOTAL	43

CRITICAL CRITERIA
____ Failure to initiate or call for transport of the patient within 10 minute time limit
____ Failure to take or verbalize body substance isolation precautions
____ Failure to determine scene safety
____ Failure to assess for and provide spinal protection when indicated
____ Failure to voice and ultimately provide high concentration of oxygen
____ Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock (hypoperfusion)
____ Failure to differentiate patient=s need for immediate transportation versus continued assessment and treatment at the scene
____ Does other detailed or focused history or physical examination before assessing and treating threats to airway, breathing and circulation
____ Orders a dangerous or inappropriate intervention

National Registry of Emergency Medical Technicians
Advanced Level Practical Examination

PATIENT ASSESSMENT-MEDICAL

	Possible Points	Points Awarded
Takes or verbalizes body substance isolation precautions	1
SCENE SIZE-UP
Determines the scene/situation is safe	1
Determines the mechanism of injury/nature of illness	1
Determines the number of patients	1
Requests additional help if necessary	1
Considers stabilization of spine	1
INITIAL ASSESSMENT
Verbalizes general impression of the patient
Determines responsiveness/level of consciousness	1
Determines chief complaint/apparent life-threats	1
Assesses airway and breathing -Assessment (1 point) -Assures adequate ventilation of patient (1 point) -Initiates appropriate oxygen therapy (1 point)	3
Assesses circulation -Assesses/controls major bleeding (1 point) -Assesses skin (either skin color, temperature or condition) (1 point) -Assesses pulse (1 point)	3
Identifies priority patients/makes transport decision	1
FOCUSED HISTORY AND PHYSICAL EXAMINATION/RAPID ASSESSMENT
History of present illness -Onset (1 point) -Severity (1 point) -Provocation (1 point) -Time (1 point) -Quality (1 point) -Clarify questions (2 points) -Radiation (1 point)	8
Past medical history -Allergies (1 point) -Last oral intake (1 point) -Medications (1 point) -Events leading to present illness (1 point) -Past pertinent history (1 point)	5
Performs focused physical examination (assess affected body part/system or, if indicated, completes rapid assessment) -Cardiovascular -Integumentary -Pulmonary -GI/GU -Neurological -Reproductive -Musculoskeletal -Psychological/Social	5
Vital signs -Pulse (1 point) -Respiratory rate & quality (1 point each) -Blood pressure (1 point) -AVPU (1 point)	5
Diagnostics	2
States field impression of patient	1
Verbalizes treatment plan for patient and calls for appropriate intervention(s)	1
Transport decision re-evaluated	1
ON-GOING ASSESSMENT
Repeats initial assessment	1
Repeats vital signs	1
Evaluates response to treatments	1
Repeats focused assessment regarding patient complaint or injuries	1
TOTAL	48

CRITICAL CRITERIA
_____ Failure to take or verbalize body substance isolation precautions
_____ Failure to determine scene safety
_____ Failure to voice and ultimately provide appropriate oxygen therapy
_____ Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock (hypoperfusion)
_____ Failure to differentiate patient’s need for immediate transportation versus continued assessment and treatment at the scene
_____ Does other detailed or focused history or physical examination before assessing and treating threats to airway, breathing and circulation
_____ Failure to determine the patient’s primary problem
_____ Orders a dangerous or inappropriate intervention

National Registry of Emergency Medical Technicians
Advanced Level Practical Examination

VENTILATORY MANAGEMENT (ET)

NOTE: If candidate elects to ventilate initially with BVM attached to reservoir and oxygen, full credit must be awarded for attempts denoted "**" so long as first ventilation is delivered within initial 30 seconds.