Raven EMS Education Program Manual
Technical Scope of Practice (TSoP) EMT Evaluation Form

Student's name:

A final psychomotor assessment must be successfully completed at the end of classroom, laboratory, and clinical activities. Each scenario must have 100% completion of the listed skills.

Childbirth Scenario Cardiac Arrest Scenario Psychiatric/Behavioral Scenario Stroke Scenario Distressed Neonate Scenario General Medical Scenario Respiratory Scenario Trauma Scenario
Scenario number
Evaluator name
Choreograph the EMS response team.
Comply with infection control principles including appropriate use of personal protective equipment.
Assess the standardized patient, verbalizing and documenting possible illnesses, injuries, etiologies and outcomes.
Ensure life threatening problems are recognized and prioritized before non-life-threatening problems.
Apply appropriate decisions relative to interventions and transportation.
Anticipate and recognize potential problems in the patient’s condition and formulate, initiate, delegate, modify or request appropriate treatment.
Consistently initiate and perform appropriate treatment and skills without prompting.
Adapt to changes in environment, situation, and patient condition.
Provide a verbal and written patient care report.

Evaluator signature:


Change Log (5.93.000.TSPE)

DateAuthorDescription of ChangeCitations
2024-06-13Becker, T.Theron Jack BeckerCreated the TSoP Evaluation Form and added content.(NCOEMS, 2016)NCOEMS. (2016, November 21). Technical scope of practice performance evaluations. North Carolina Office of EMS. https://info.ncdhhs.gov/dhsr/ems/pdf/cred/techscope.pdf (NCOEMS, 2023)NCOEMS. (2023, December). Technical Scope of Practice Evaluation. North Carolina Office of EMS. https://oems.nc.gov/wp-content/uploads/2023/12/TSOP-122023.pdf
2024-08-01Becker, T.Theron Jack BeckerEach form previously had dedicated sub-section numbers, but they were removed for brevity and as none of the other forms are specifically numbered. 5.93.875 was the TSoP Evaluation
2025-01-09Becker, T.Theron Jack BeckerMoved online from Adobe InDesign document.



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