EMT Practical Evaluation - Trauma Score Sheet

Montgomery County Fire & Rescue Service

Montgomery County, Maryland
Trauma Score Sheet

EMT Practical Evaluation
Class Number

EMT 190EMT 191EMT 192RC55
Lead Instructor*
Lead Instructor Email
Candidate Name*
Evaluator*
Scenario*
Scene Size Up
Scene safety*

YesNo
BSI*

YesNo
Number of patients*

YesNo
MOI/NOI*

YesNo
Consider additional resources*

YesNo
Consider C-spine precautions*

YesNo
Primary Assessment
General impression*

YesNoN/A
Level of consciousness*

YesNoN/A
Airway - open or closed*

YesNoN/A
Breathing - rate/rhythm/quality*

YesNoN/A
Circulation - rate/rhythm/quality*

YesNoN/A
Skin - color/condition/temp.*

YesNoN/A
Check for bleeding*

YesNoN/A
P.O.T. and verbalizes GCS*

YesNoN/A
Secondary Assessment
Did student initiate or ask a partner to begin vital signs?*

YesNo
SAMPLE
S*

YesNo
A*

YesNo
M*

YesNo
P*

YesNo
L*

YesNo
E*

YesNo
OPQRSTU
O*

YesNo
P*

YesNo
Q*

YesNo
R*

YesNo
S*

YesNo
T*

YesNo
U*

YesNo
Physical Exam*

Rapid Trauma AssessmentFocused Physical Exam
Appropriate treatment (splinting, stabilizing, immobilizing, bleeding control, etc.)*

YesNo
Description of treatment*
Did the candidate reassess at appropriate intervals?*

YesNo
Conclusion of exam
Pass*

YesNo
Comments
Should be Empty:

Montgomery County Fire & Rescue Service