Raven EMS Education Program Manual
Assessment Secondary EMT Trauma Evaluation Form

Date:

Student name:

Evaluator name:

Steps:

• Delegate vital signs/diagnostic tools:
• BP,
• HR,
• RR,
• SpO₂,
• blood glucose,
• ECG,
• 12-lead
• Pain scale (1–10) or Wong-Baker FACES scale
• Determine chief complaint/history of present illness/injury:
• Onset
• Provocation/palliation
• Quality
• Radiation
• Severity
• Time
• Obtain the SAMPLE history: If the patient has a poor GCS score/LOC, ask bystanders or family members for pertinent information and look for medical alert tags, wallet, etc.
• Signs/symptoms
• Allergies
• Medications, medication compliance
• Past medical history
• Last oral intake
• Events leading to present illness
• Examine the head.
• Inspect the mouth, nose, and facial area.
• Inspect and palpate the scalp and ears.
• Examine the neck.
• Check the position of the trachea.
• Check for jugular vein distention.
• Palpate the cervical spine before applying a cervical collar.
• Examine the chest. Inspect, palpate, and auscultate the chest.
• Examine the abdomen and pelvis.
• Inspect and palpate all four abdominal quadrants.
• Palpate the pelvis.
• Verbalize assessment of the genitalia/perineum as needed.
• Examine the lower extremities. Inspect, palpate, and assess distal circulation and motor and sensory function.
• Examine the upper extremities. Inspect, palpate, and assess distal circulation and motor and sensory function.
• Examine the posterior thorax, lumbar, and buttocks.
• Inspect and palpate the posterior thorax.
• Inspect and palpate the lumbar and buttocks area.
• Manage any secondary injuries and wounds appropriately.
• Reassess the ABCDs.
• Reassess vital signs: HR, RR, BP, SPo2, blood glucose (as needed).
• Assess the patient’s response to any interventions and treatments.
• Repeat the focused assessment regarding the patient’s complaint or injuries.
• Accepts evaluation and criticism professionally.
• Shows willingness to learn/asks appropriate questions.
• Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).

Passing criteria:

• Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
• Fail.
• Exceeds 15 minutes.
• Fails to take BSI precautions prior to performing assessment.
• Fails to determine scene safety prior to approaching the patient.
• Fails to provide spinal protection when indicated.
• Fails to provide appropriate oxygen therapy within 3 minutes of starting the scenario.
• Performs other detailed or focused assessment or physical examination before assessing and treating threats to airway, breathing, and circulation.
• Fails to find or appropriately manage issues associated with airway, breathing, hemorrhage, and shock.
• Fails to determine the patient’s primary issue or injury.
• Performs any action that is considered dangerous or inappropriate for the performed skill.
• Fails to differentiate the patient’s need for immediate transportation versus continued assessment and treatment at the scene.
• Orders a dangerous or inappropriate intervention or drug.
• Does not complete treatment modality for the complaint of the patient/scenario.
• Fails to have a critical patient loaded up and off scene within 10 minutes (all straps on backboard must be in place).

Comments:

Evaluator signature:
Clear

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