2012 Paramedic Skills – Verification Sheet (1)
| WAUKESHA COUNTY TECHNICAL COLLEGE | |||
| EMT ‐ Paramedic | |||
| Practical Skills Validations | |||
| has successfully demonstrated the followings skills in the classroom and | |||
| may perform them in the clinical/field setting with a preceptor. | |||
| Date | Skill Validation | # | Evaluator’s Signature (Verify signature on back) |
| Airway Management | |||
| Ventilatory Management ‐ Combitube | 1 | ||
| Oral Endotracheal Intubation ‐ Adult | 5 | ||
| Oral Endotracheal Intubation ‐ Difficult (May include the next two skills) |
4 | ||
| Digital Intubation | 1 | ||
| Nasal Intubation | 1 | ||
| Endotracheal Tube via Trach | 1 | ||
| Tracheostomy Care | 1 | ||
| Oral Endotracheal Intubation ‐ Pediatric | 1 | ||
| Needle Cricothyrotomy | 1 | ||
| Cricothyrotomy w/ Quick Trach | 1 | ||
| Extubation | 5 | ||
| Intravenous Infusion | |||
| IV Insertion / Infusion | * | ||
| IV Push Medication Administration | 1 | ||
| IV Drip Medication Administration | 1 | ||
| Jugular Line Placement | 1 | ||
| Medication Administration | |||
| Aerosolized Medication Administration | 1 | ||
| Oral/SL Medication Administration | 1 | ||
| IM / SQ Injection | 1 ea | ||
| Advanced Cardiac Skills | |||
| Automatic Defibrillation | 1 | ||
| Manual Defibrillation | 1 | ||
| Cardioversion | 1 | ||
| Transcutaneous Pacing | 1 | ||
| 12‐Lead EKG | 1 | ||
| Completed ACLS | Yes | ||
| Completed PALS | Yes | ||
| Interosseus Infusion | |||
| IO Insertion / infusion w/ manual needle | 1 | ||
| IO Insertion / infusion w/ EZ IO | 1 | ||
| Trauma Management | |||
| Thoracentesis | 1 | ||
| Pericardiocentesis | 1 | ||
| * 5 for Basic; 1 for EMT‐Advanced or higher | |||
| Evaluator Signature Verification | |||
| Print Name Evaluator Signature | |||
| Julie Brady | |||
| Mark Spangenberg | |||
| ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | |||
| This section does not allow the Paramedic student to perform skills independently, it is strictly a communication source between preceptors. | |||
| Students should check with each preceptor prior to performing skills independently. | |||
| has shown competency in the hospital setting for the following | |||
| skill(s). As a preceptor, I am confident he/she can perform the skill(s) independently. | |||
| Date | Skill | Preceptor Printed Name & Signature | |
| IV Insertion | |||
| IV Insertion | |||
| IV Insertion | |||
| 12‐Lead EKG | |||
| 12‐Lead EKG | |||
| 12‐Lead EKG | |||
