EMT Policy and Procedure

EMT INSTRUCTOR MONITORING FORM

Instructor Name: □ EMT (i) □ EMT Aide Location: Date: Module Number: Skill:

SCENARIO LAB

SKILLS LAB

TESTING

□ Has instructor guidance for that activity at station □ Began skill practice within 5 minutes of start of station □ Equipment set is complete and in working order at station □ Assigns team leader role □ Has students enter scene with Equipment □ Has students take real vital signs within their skill level □ Has students utilize equipment in Cohort Bag (oxygen, tourniquet, etc.) □ Has students lift/move patient □ All students active at same time □ Corrects skills performance without critical language □ Repeats activity with <3 minutes of idle time between repetitions □ Debriefs by reviewing key points of skills station at end of scenario □ Brings ET3 device to station (check this box if the instructor was not assigned an ET3) □ Has no more than 2 minutes of idle time before dismissing students TOTAL ALL POINTS ABOVE □ Successful monitoring (12+ pts) □ Unsuccessful monitoring(<12 pts)

□ Has instructor guidance for that activity at station

□ Reads scripted guidance to student

□ Began skill practice within 5 minutes of start of station □ Equipment set is complete and in working order at station □ All students active at same time □ Corrects skills performance without critical language □ Repeats activity with <3 minutes of idle time between repetitions □ Debriefs by reviewing key points of skills station at end of station □ Brings ET3 device to station (check this box if the instructor was not assigned an ET3)

□ Student(s) performs skill without prompting from instructor □ Documents all student steps performed □ Notes steps student did not Perform (check this box if student performed perfectly)

□ Has no more than 2 minutes of idle time before dismissing students

TOTAL ALL POINTS ABOVE □ Successful monitoring (5+ pts) □ Unsuccessful monitoring (<5 pts)

TOTAL ALL POINTS ABOVE □ Successful monitoring (4 pts) □ Unsuccessful monitoring(4 pts)

Monitoring Instructor:

Monitored Instructor

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Signature:

Signature