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PRESUME that you will be performing a research project on your topic ( Psychological Impact after Disaster on Healthcare providers) . You need accurate, valid, and reliable observations from a sample obtained from multiple sites by many co-investigators.You will need to craft an ‘instrument’ or ‘tool’ to facilitate the observations of most interest to your study, and an accompanying training program for those surrogate /co-investigator.Your goal is to assure inter-observer reliability, as well as overall reliability and validity of the observations.Craft your instrument and instructions, and place them in the related assignment folder.Semi structured and structured observations in research benefit from tools, or observation checklists the guide the observer to record key events, and facilitate the observer’s or investigator’s deriving meaning from the activities they witnessed.Many (most) of you are allied healthcare providers. EMT’s and Paramedics, as an example. You typically had to go through demonstration of competency laboratories. The examiner has a ‘skill sheet’ with critical behaviors listed, and often a step by step guide to the specific procedure. Miss a critical step and you would be referred to remediation; miss a minor technique point, and the examiner could record that or give ‘critique’ when you finished.In hospital settings and EMS, a similar experience in ‘disaster’ was the donning and doffing procedure for Ebola (or other Viral Hemmorhagic Fever) Personal Protective Equipment, and the “Designated Observer” who would read out the steps, and record the successful completion. The ‘record sheet’ listed the critical observations necessary to complete the task.Using these models, a check sheet of desired behaviors can be created. Perhaps a short observation is used to determine the ‘meaningful’ behaviors of the population that interest the Principal Investigator relating to their hypothesis, or to describe the population (grounded research).After you craft your ‘instrument’ (check sheet, for example), how would you TRAIN your observers to use your instrument? Do you also want them to list interesting, recurring behaviors you have not yet focused on?
nr_skillsheets.pdf

trained_observer_checklist_for_ppe_donning_highrisk.pdf

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National Registry Skill Sheets
Airway, Oxygen and Ventilation Skills/Upper Airway Adjuncts and Suction
Bag-Valve-Mask/Apneic Patient
Bleeding Control/Shock Management
Cardiac Arrest Management/AED
Immobilization Skills/Joint Injury
Immobilization Skills/Long Bone Injury
Immobilization Skills/Traction Splinting
Mouth to Mask With Supplemental Oxygen
Oxygen Administration
Patient Assessment/Management—Medical
Patient Assessment/Management—Trauma
Spinal Immobilization/Seated Patient
Spinal Immobilization/Supine Patient
Ventilatory Management/Dual Lumen Device Insertion Following an Unsuccessful
Endotracheal Intubation Attempt
Ventilatory Management/Endotracheal Intubation
Ventilatory Management/Esophageal Obturator Airway Insertion Following an
Unsuccessful Endotracheal Intubation Attempt
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Airway, Oxygen and Ventilation Skills
Upper Airway Adjuncts and Suction
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
OROPHARYNGEAL AIRWAY
Takes, or verbalizes, body substance isolation precautions
1
Selects appropriately sized airway
1
Measures airway
1
Inserts airway without pushing the tongue posteriorly
1
Note: The examiner must advise the candidate that the patient is gagging and becoming conscious
Removes the oropharyngeal airway
1
SUCTION
Note: The examiner must advise the candidate to suction the patient’s airway
Turns on/prepares suction device
1
Assures presence of mechanical suction
1
Inserts the suction tip without suction
1
Applies suction to the oropharynx/nasopharynx
1
NASOPHARYNGEAL AIRWAY
Note: The examiner must advise the candidate to insert a nasopharyngeal airway
Selects appropriately sized airway
1
Measures airway
1
Verbalizes lubrication of the nasal airway
1
Fully inserts the airway with the bevel facing toward the septum
1
TOTAL:
CRITICAL CRITERIA
Did not take, or verbalize, body substance isolation precautions
Did not obtain a patent airway with the oropharyngeal airway
Did not obtain a patent airway with the nasopharyngeal airway
Did not demonstrate an acceptable suction technique
Inserted any adjunct in a manner dangerous to the patient
13
Points
Awarded
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Bag-Valve-Mask
Apneic Patient
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
1
Voices opening the airway
1
Voices inserting an airway adjunct
1
Selects appropriately sized mask
1
Creates a proper mask-to-face seal
1
Ventilates patient at no less than 800 ml volume
(The examiner must witness for at least 30 seconds)
1
Connects reservoir and oxygen
1
Adjusts liter flow to 15 liters/minute or greater
1
The examiner indicates arrival of a second EMT. The second EMT is instructed to ventilate the patient
while the candidate controls the mask and the airway
Voices re-opening the airway
1
Creates a proper mask-to-face seal
1
Instructs assistant to resume ventilation at proper volume per breath
(The examiner must witness for at least 30 seconds)
1
TOTAL:
11
CRITICAL CRITERIA
Did not take, or verbalize, body substance isolation precautions
Did not immediately ventilate the patient
Interrupted ventilations for more than 20 seconds
Did not provide high concentration of oxygen
Did not provide, or direct assistant to provide, proper volume/breath
(more than two (2) ventilations per minute are below 800 ml)
Did not allow adequate exhalation
Points
Awarded
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Bleeding Control/Shock Management
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
1
Applies direct pressure to the wound
1
Elevates the extremity
1
Note: The examiner must now inform the candidate that the wound continues to bleed.
Applies an additional dressing to the wound
1
Note: The examiner must now inform the candidate that the wound still continues to bleed.
The second dressing does not control the bleeding.
Locates and applies pressure to appropriate arterial pressure point
1
Note: The examiner must now inform the candidate that the bleeding is controlled
Bandages the wound
1
Note: The examiner must now inform the candidate the patient is now showing signs and symptoms
indicative of hypoperfusion
Properly positions the patient
1
Applies high concentration oxygen
1
Initiates steps to prevent heat loss from the patient
1
Indicates the need for immediate transportation
1
TOTAL:
CRITICAL CRITERIA
Did not take, or verbalize, body substance isolation precautions
Did not apply high concentration of oxygen
Applied a tourniquet before attempting other methods of bleeding control
Did not control hemorrhage in a timely manner
Did not indicate a need for immediate transportation
10
Points
Awarded
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Cardiac Arrest Management/AED
With Bystander CPR in Progress
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
ASSESSMENT
Takes, or verbalizes, body substance isolation precautions
1
Briefly questions the rescuer about arrest events
1
Turns on AED power
1
Attached AED to the Patient
1
Directs rescuer to stop CPR and ensures all individuals are clear of the patient
1
Initiates analysis of the rhythm
1
Delivers shock
1
Directs resumption of CPR
1
TRANSITION
1
Gathers additional information about arrest event
1
Confirms effectiveness of CPR (ventilation and compressions)
1
INTEGRATION
Verbalizes or directs insertion of a simple airway adjunct (oral/nasal airway)
1
Ventilates, or directs ventilation of, the patient
1
Assures high concentration of oxygen is delivered to the patient
1
Assures adequate CPR continues without unnecessary/prolonged interruption
1
Continues CPR for 2 minutes
1
Directs rescuer to stop CPR and ensures all individuals are clear of the patient
1
Initiates analysis of the rhythm
1
Delivers shock
1
Directs resumption of CPR
1
TRANSPORTATION
Verbalizes transportation of patient
TOTAL:
CRITICAL CRITERIA
Did not take, or verbalize, body substance isolation precautions
Did not evaluate the need for immediate use of the AED
Did not immediately direct initiation/resumption of ventilation/compressions at appropriate times
Did not assure all individuals were clear of patient before delivering each shock
Did not operate the AED properly (inability to deliver shock)
Prevented the defibrillator from delivering indicated stacked shocks
1
20
Points
Awarded
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Immobilization Skills
Joint Injury
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
1
Directs application of manual stabilization of the shoulder injury
1
Assesses motor, sensory and circulatory function in the injured extremity
1
Note: The examiner acknowledges “motor, sensory and circulatory function are present and normal.”
Selects the proper splinting material
1
Immobilizes the site of the injury
1
Immobilizes the bone above the injured joint
1
Immobilizes the bone below the injured joint
1
Reassesses motor, sensory and circulatory function in the injured extremity
1
Note: The examiner acknowledges “motor, sensory and circulatory function are present and normal.”
TOTAL:
CRITICAL CRITERIA
Did not support the joint so that the joint did not bear distal weight
Did not immobilize the bone above and below the injured site
Did not reassess motor, sensory and circulatory function in the injured extremity before and after splinting
8
Points
Awarded
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Immobilization Skills
Long Bone Injury
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
1
Directs application of manual stabilization of the injury
1
Assesses motor, sensory and circulatory function in the injured extremity
1
Note: The examiner acknowledges “motor, sensory and circulatory function are present and normal”
Measures the splint
1
Applies the splint
1
Immobilizes the joint above the injury site
1
Immobilizes the joint below the injury site
1
Secures the entire injured extremity
1
Immobilizes the hand/foot in the position of function
1
Reassesses motor, sensory and circulatory function in the injured extremity
1
Note: The examiner acknowledges “motor, sensory and circulatory function are present and normal”
TOTAL:
CRITICAL CRITERIA
Grossly moves the injured extremity
Did not immobilize the joint above and the joint below the injury site
Did not reassess motor, sensory and circulatory function in the injured extremity before and after splinting
10
Points
Awarded
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Immobilization Skills
Traction Splinting
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
1
Directs application of manual stabilization of the injured leg
1
Directs the application of manual traction
1
Assesses motor, sensory and circulatory function in the injured extremity
1
Points
Awarded
Note: The examiner acknowledges “motor, sensory and circulatory function are present and normal”
Prepares/adjusts splint to the proper length
1
Positions the splint next to the injured leg
1
Applies the proximal securing device (e.g., ischial strap)
1
Applies the distal securing device (e.g., ankle hitch)
1
Applies mechanical traction
1
Positions/secures the support straps
1
Re-evaluates the proximal/distal securing devices
1
Reassesses motor, sensory and circulatory function in the injured extremity
1
Note: The examiner acknowledges “motor, sensory and circulatory function are present and normal”
Note: The examiner must ask the candidate how he/she would prepare the patient for transportation
Verbalizes securing the torso to the long board to immobilize the hip
1
Verbalizes securing the splint to the long board to prevent movement of the splint
1
TOTAL:
14
CRITICAL CRITERIA
Loss of traction at any point after it was applied
Did not reassess motor, sensory and circulatory function in the injured extremity before and after splinting
The foot was excessively rotated or extended after splint was applied
Did not secure the ischial strap before taking traction
Final immobilization failed to support the femur or prevent rotation of the injured leg
Secured the leg to the splint before applying mechanical traction
Note: If the Sagar splint or the Kendricks Traction Device is used without elevating the patient’s leg, application of manual traction is not necessary. The
candidate should be awarded one (1) point as if manual traction were applied.
Note: If the leg is elevated at all, manual traction must be applied before elevating the leg. The ankle hitch may be applied before elevating the leg and used
to provide manual traction.
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Mouth to Mask With Supplemental Oxygen
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
1
Connects one-way valve to mask
1
Opens patient’s airway or confirms patient’s airway is open (manually or with adjunct)
1
Establishes and maintains a proper mask to face seal
1
Ventilates the patient at the proper volume and rate (800-1200 ml per breath/10-20 breaths per minute)
1
Connects the mask to high concentration of oxygen
1
Adjusts flow rate to at least 15 liters per minute
1
Continues ventilation of the patient at the proper volume and rate
(800-1200 ml per breath/10-20 breaths per minute)
1
Note: The examiner must witness ventilations for at least 30 seconds
TOTAL:
CRITICAL CRITERIA
Did not take, or verbalize, body substance isolation precautions
Did not adjust liter flow to at least 15 liters per minute
Did not provide proper volume per breath (more than 2 ventilations per minute were below 800 ml)
Did not ventilate the patient at a rate a 10-20 breaths per minute
Did not allow for complete exhalation
8
Points
Awarded
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Oxygen Administration
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
1
Assembles the regulator to the tank
1
Opens the tank
1
Checks for leaks
1
Checks tank pressure
1
Attaches non-rebreather mask to oxygen
1
Prefills reservoir
1
Adjusts liter flow to 12 liters per minute or greater
1
Applies and adjusts the mask to the patient’s face
1
Note: The examiner must advise the candidate that the patient is not tolerating the non-rebreather mask.
The medical director has ordered you to apply a nasal cannula to the patient.
Attaches nasal cannula to oxygen
1
Adjusts liter flow to six (6) liters per minute or less
1
Applies nasal cannula to the patient
1
Note: The examiner must advise the candidate to discontinue oxygen therapy
Removes the nasal cannula from the patient
1
Shuts off the regulator
1
Relieves the pressure within the regulator
1
TOTAL:
CRITICAL CRITERIA
Did not take, or verbalize, body substance isolation precautions
Did not assemble the tank and regulator without leaks
Did not prefill the reservoir bag
Did not adjust the device to the correct liter flow for the non-rebreather mask (12 liters per minute or greater)
Did not adjust the device to the correct liter flow for the nasal cannula (6 liters per minute or less)
15
Points
Awarded
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Patient Assessment/Management—Medical
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
Points
Awarded
1
SCENE SIZE-UP
Determines the scene is safe
1
Determines the mechanism of injury/nature of illness
1
Determines the number of patients
1
Requests additional help if necessary
1
Considers stabilization of spine
1
INITIAL ASSESSMENT
Verbalizes general impression of the patient
1
Determines responsiveness/level of consciousness
1
Determines chief complaint/apparent life threats
1
Assesses airway and breathing
Assessment
Indicates appropriate oxygen therapy
Assures adequate ventilation
1
1
Assesses circulation
Assesses/controls major bleeding
Assesses pulse
Assesses skin (color, temperature, and condition)
1
1
1
Identifies priority patients/makes transport decisions
1
FOCUSED HISTORY AND PHYSICAL EXAMINATION/RAPID ASSESSMENT
Signs and symptoms (Assess history of present illness)
Respiratory
• Onset?
• Provokes?
• Quality?
• Radiates?
• Severity?
• Time?
• Interventions?
Cardiac
• Onset?
• Provokes?
• Quality?
• Radiates?
• Severity?
• Time?
• Interventions?
1
Altered Mental
Status
Allergic
Reaction
Poisoning/
Overdose
• Description of
the episode.
• Onset?
• Duration?
• Associated
Symptoms?
• Evidence of
Trauma?
• Interventions?
• Seizures?
• Fever?
• History of
allergies?
• What were
you exposed
to?
• How were
you exposed?
• Effects?
• Progression?
• Interventions?
• Substance?
• When did you
ingest/become
exposed?
• How much did
you ingest?
• Over what time
period?
• Interventions?
• Estimated
weight?
Environmental
Emergency
Obstetrics
• Source?
• Are you
• Environment?
pregnant?
• Duration?
• How long
• Loss of
have you
consciousness? been
• Effects—general pregnant?
or local?
• Pain or
contractions?
• Bleeding or
discharge?
• Do you feel
the need to
push?
• Last
menstrual
period?
Behavioral
• How do you
feel?
• Determine
suicidal
tendencies.
• Is the patient
a threat to
self or others?
• Is there a
medical
problem?
• Interventions?
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Patient Assessment/Management—Medical (continued)
Allergies
1
Medications
1
Past pertinent history
1
Last oral intake
1
Event leading to present (rule out trauma)
1
Performs focused physical examination (assesses affected body part/system or,
if indicated, completes rapid assessment)
1
Vitals (obtains baseline vital signs)
1
Interventions (obtains medical direction or verbalizes standing order
for medication interventions and verbalizes proper additional intervention/treatment)
1
Transport (re-evaluates the transport decision)
1
Verbalizes the consideration for completing a detailed physical examination
1
ONGOING ASSESSMENT (verbalized)
Repeats initial assessment
1
Repeats vital signs
1
Repeats focused assessment regarding patient complaint or injuries
1
TOTAL:
CRITICAL CRITERIA
Did not take, or verbalize, body substance isolation precautions when necessary
Did not determine scene safety
Did not obtain medical direction or verbalize standing orders for medical interventions
Did not provide high concentration of oxygen
Did not find or manage problems associated with airway, breathing, hemorrhage or shock (hypoperfusion)
Did not differentiate patient’s need for transportation versus continued assessment at the scene
Did detailed or focused history/physical examination before assessing the airway, breathing and circulation
Did not ask questions about the present illness
Administered a dangerous or inappropriate intervention
30
Emergency Care and Transportation of the Sick and Injured, Ninth Edition
National Registry Skill Sheets
Patient Assessment/Management—Trauma
Start Time:
Date:
Stop Time:
Candidate’s Name:
Evaluator’s Name:
Points
Possible
Takes, or verbalizes, body substance isolation precautions
1
SCENE SIZE-UP
Determines the scene is safe
1
Determines the mechanism of injury
1
Determines the number of patients
1
Requests additional help if necessary
1
Considers stabilization of spine
1
INITIAL ASSESSMENT
Verbalizes general impression of the patient
1
Determines responsiveness/level of consciousness
1
Determines chief complaint/apparent life threats
1
Assesses airway and breathing
Assesses circulation
Assessment
Initiates appropriate oxygen therapy
Assures adequate ventilation
Injury management
1
1
1
1
Assesses/controls major bleeding
Assesses pulse
Assesses skin (color, temperature and condition)
1
1
1
Identifies priority patients/makes transport decision
1
FOCUSED HISTORY AND PHYSICAL EXAMINATION/RAPID ASSESSMENT
Selects appropriate assessment (focused or rapid assessment)
1
Obtains, or directs assistance to obtain, baseline vital signs
1
Obtains S.A.M.P.L.E. history
1
DETAILED PHYSICAL EXAMINATION
Assesses the head
Inspects and palpates the scalp and ears
Assesses the eyes
Assesses the facial areas including oral and nasal areas
1
1
1
Assesses the neck
Inspects and palpates the neck
Assesses for JVD
Assesses for tracheal deviation
1
1
1
Assesses the chest
Inspects
Palpates
Auscultates
1
1
1
Assesses the abdomen/pelvis
Assesses the abdomen
Assesses the pelvis
Verbalizes assessment of genitalia/perineum as needed
1
1
1
Points
Awarded
Emergency Care and Transportatio …
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