FRANKLIN COUNTY DEPARTMENT OF PUBLIC SAFETY

Standard Operating Guidelines

Training Guideline #3

EMS Provider Skills Evaluations

 

PURPOSE:

To promote the development of skilled EMS Providers and to identify potential deficient areas of performance on which to develop comprehensive training programs.

 

GUIDELINE:

 

  1. All agencies and providers operating under the medical direction of Charles Lane, MD are required to participate in this skills evaluation program. Skills evaluation forms may be utilized by the Medical Director, for, but not limited to, random quality monitoring, complaint monitoring, recertification, and certification.

 

  1. Each agency is responsible to keep one sheet on each provider practicing with that agency.  It will be the agency's responsibility to keep accurate records and maintain the files in a secure place.  It is the responsibility of the provider to be evaluated on the skills on the schedule outlined and to make sure the agency gets proper documentation that the skills have been done.

 

  1. The leadership of the agencies is encouraged to take an active role in ensuring compliance of these requirements.

 

  1. The departmental summary sheet should be submitted by the 15th day following the end of the quarter to Michael Pruitt, P.O. Box 189, 1488 Franklin Street, Rocky Mount, VA  24151. Forms may also be submitted electronically to michaelpruitt@franklincountyva.org.  Only the summary sheets should be submitted; Do NOT submit individual sheets on providers.

 

  1. Records are subject to review at any time by the Medical Director or his designee.

 

  1. Deficiencies in skill performance may result in, but not limited to the following: additional training, verbal reprimand, written reprimand, suspension of certification, or decertification.

 

  1. Forgery of the forms may also result in written reprimand, suspension of certification, or decertification of all the parties involved.

 

  1. Providers, who upgrade their certification during the year, will begin using the new requirements for their level at the start of next full quarter.

 

  1. During evaluation, evaluators should offer tips to optimize performance.  Anyone not able to master the skill should be given the opportunity to learn the skill and reattempt as necessary.

Noncompliance Corrective Action Process

 

 

A provider failing to complete the required skills check-offs for:

 

One quarter:

 

No corrective action indicated.

 

 

Two Consecutive Quarters:  

The provider must demonstrate proficiency of skills in the presence of the OMD or his designee during the next quarter.

 

 

Three Quarters:

 

Authorization to practice is immediately revoked until all of the following is completed, documented and verified by the Public Safety Training Coordinator.

 

Must demonstrate proficiency of skills in the presence of the OMD or his designee

Perform 8 hours externship (minimum of two patient contacts) with an OMD approved evaluator or 8 hours of clinical rotation in the emergency room.

Skills Evaluation Corrective Action Documentation Form

 

 

 

Providers’ Name:_____________________________  SSN:____________

 

Primary Agency:______________________Daytime Phone:____________

 

 


q    Demonstrate Proficiency of Skills in the present of an OMD approved evaluator.

 

_____________________________________________
Signature of OMD Approved Evaluator Verifying Skills

 

q    Perform 8 hours of externship (or 8 hours of clinical rotations) with an OMD approved evaluator.

 

 

 

Date

Place

Start Time

Leave Time

Skills Performed

Preceptor’s Signature

 

 

 

 

 

 

 

             

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                                                                 

 

I hereby affirm that the information on this form is true and correct.   I also realize that falsification or forgery of continuing education and/or skill evaluation requirements may be considered sufficient cause for revocation of certification.

 

Provider’s Signature:_____________________________Date:__________

 

 

As Chief EMS Operations Officer I affirm that the above mention EMS Provider is a member in good standing with this organization, and has successfully completed the requirements for re-instatement of certification.

 

Captain’s Signature:_____________________________Date:__________

Franklin County Public Safety Skills Evaluation
effective April 1, 2007

                                                   First Responder

 

Name:                                                                          CERT:_____________________

 

 

            SKILL

 

            1ST QTR

 

            2ND QTR

 

            3RD QTR

 

            4TH QTR

 

BVM / Airway Adjuncts

 

 

 

 

 

 

 

CPR / AED

 

 

 

 

 

 

 

 

 

Manual Vitals Signs

 

 

 

 

 

 

 

Integrated Scenario**

 

 

 

 

 

 

Evaluator, Please date and sign at each skill.

 

**  During the integrated scenario, the evaluator should present a realistic scenario for the technician to handle.  Using a medical or trauma patient, the technician should use good patient assessment skills to evaluate the patient and then make appropriate decisions based on the assessment.  The scenario should be complex enough that multiple skills will be demonstrated.  The scenario should be real as possible, and the technician should actually perform ALL skills indicated.  This evaluation challenges the technician ability to integrate multiple skills into the overall patient management scheme.

 

MUST BE EVALUATED BY ONE OF THE FOLLOWING:

 

EMERGENCY MEDICAL TECHNICIAN

EMT EVALUATOR

EMT INSTRUCTOR

ENHANCED

INTERMEDIATE

PARAMEDIC

OPERATIONAL MEDICAL DIRECTOR

PUBLIC SAFETY TRAINING COORDINATOR

MEDICAL DIRECTOR APPROVED EVALUATORS

Franklin County Public Safety Skills Evaluation
effective April 1, 2007

                            Emergency Medical Technician- Basic

 

Name:                                                                   CERT:_____________________

 

 

              SKILL

 

1ST QTR

 

2ND QTR

 

3RD QTR

 

4TH QTR

 

BVM / Airway Adjuncts

 

 

 

 

 

 

 

 

 

Combitube

 

 

 

 

 

 

 

 

 

CPR / AED

 

 

 

 

 

 

 

 

Patient-Assisted Medications
(Epi-Pen, Nitro, Inhalers)

 

 

 

 

 

 

 

Manual Vitals Signs

 

 

 

 

 

 

 

Integrated Scenario**

 

 

 

 

 

 

Evaluator, Please date and sign at each skill.

 

**  During the integrated scenario, the evaluator should present a realistic scenario for the technician to handle.  Using a medical or trauma patient, the technician should use good patient assessment skills to evaluate the patient and then make appropriate decisions based on the assessment.  The scenario should be complex enough that multiple skills will be demonstrated.  The scenario should be real as possible, and the technician should actually perform ALL skills indicated.  This evaluation challenges the technician ability to integrate multiple skills into the overall patient management scheme.

 

 

MUST BE EVALUATED BY ONE OF THE FOLLOWING:

EMT EVALUATOR           

EMT INSTRUCTOR          

ENHANCED

INTERMEDIATE

PARAMEDIC

OPERATIONAL MEDICAL DIRECTOR

PUBLIC SAFETY TRAINING COORDINATOR

MEDICAL DIRECTOR APPROVED EVALUATORS

Franklin County Public Safety Skills Evaluation
effective April 1, 2007

EMT- ENHANCED

(Use for Shock Trauma until provider’s VOEMS expiration)

 

Name:                                                       CERT:_____________________

 

 

              SKILL

 

1ST QTR

 

2ND QTR

 

3RD QTR

 

4TH QTR

 

BVM / Combitube

 

 

 

 

 

CPR / AED

 

 

 

 

 

IV / Saline Locks / Meds

 

 

 

 

 

 

 

Chest Decompression

 

 

 

 

 

 

 

Integrated Scenario**

 

 

 

 

 

 

                                Evaluator, Please date and sign at each skill.

 

**  During the integrated scenario, the evaluator should present a realistic scenario for the technician to handle.  Using a medical or trauma patient, the technician should use good patient assessment skills to evaluate the patient and then make appropriate decisions based on the assessment.  The scenario should be complex enough that multiple skills will be demonstrated.  The scenario should be real as possible, and the technician should actually perform ALL skills indicated.  This evaluation challenges the technician ability to integrate multiple skills into the overall patient management scheme.

 

MUST BE EVALUATED BY ONE OF THE FOLLOWING:

INTERMEDIATE

PARAMEDIC

OPERATIONAL MEDICAL DIRECTOR

PUBLIC SAFETY TRAINING COORDINATOR

MEDICAL DIRECTOR APPROVED EVALUATORS

 

Franklin County Public Safety Skills Evaluation
effective April 1, 2007

EMT- INTERMEDIATE  / EMT- PARAMEDIC

(Use for Cardiac Technicians until the provider’s VOEMS expiration)

 

Name:                                                         CERT:_____________________

 

 

              SKILL

 

1ST QTR

 

2ND QTR

 

3RD QTR

 

4TH QTR

 

Adult Medical Intubation

 

 

 

 

 

 

 

 

 

Adult Trauma Intubation

 

 

 

 

 

 

 

 

 

Pediatric Intubation

 

 

 

 

 

 

 

 

 

Nasotracheal Intubation

 

 

 

 

 

Defib / MegaCode / Pacing

 

 

 

 

 

 

 

IV / Saline Locks / Meds

 

 

 

 

 

 

 

Combitube/ LMA/ Rapid Sequence Intubation (if applicable)

 

 

 

 

 

 

 

Intraosseous / Easy IO

 

 

 

 

 

 

 

Chest Decompression

 

 

 

 

 

 

 

External Jugular IV

 

 

 

 

 

 

 

Integrated Scenario**

 

 

 

 

 

 

Evaluator, Please date and sign at each skill.

 

**  During the integrated scenario, the evaluator should present a realistic scenario for the technician to handle.  Using a medical or trauma patient, the technician should use good patient assessment skills to evaluate the patient and then make appropriate decisions based on the assessment.  The scenario should be complex enough that multiple skills will be demonstrated.  The scenario should be real as possible, and the technician should actually perform ALL skills indicated.  This evaluation challenges the technician ability to integrate multiple skills into the overall patient management scheme.

 

MUST BE EVALUATED BY ONE OF THE FOLLOWING:  

PARAMEDIC

OPERATIONAL MEDICAL DIRECTOR

PUBLIC SAFETY TRAINING COORDINATOR

OMD APPROVED EVALUATORS