2012 Paramedic Skills – Verification Sheet (1)

2012 Paramedic Skills - Verification Sheet (1)

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)
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