Raven EMS Education Program ManualTrauma Splint SAM Evaluation Form
Date:
Student name:
Evaluator name:
Steps:
Take BSI precautions.
Explain the procedure to the patient (if conscious).
Stabilize the injured limb.
Assess CMS.
Expose the affected area and remove any jewelry or watches to ensure circulation is not inhibited as additional swelling occurs.
If applicable, attempt to gently return the injured limb to a normal anatomic position; if significant pain or resistance to movement is experienced, stop and splint in place.
Form the SAM splint.
Pad inside the splint to prevent movement and increase comfort.
Place the splint under the injured limb.
Immobilize the bone above the injured joint or joint above the injured bone.
Immobilize the bone below the injured joint or joint below the injured bone.
Secure with gauze.
Reassess CMS in the injured extremity.
Elevate the extremity and apply ice or cold packs to decrease edema, throbbing, and pain.
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.
Did not explain and reassure the patient to allow informed consent.
Grossly moves injured limb.
Fails to assess motor, sensory, and distal circulation before and after splinting.
Fails to support the joint so that the joint does not bear distal weight.
Fails to immobilize the bones or joints above and below the injured location.
Applies splint in an inappropriate manner.
Attempts to continue to place the injured joint into anatomic position after pain or resistance to movement is experienced.
