Emergency Medical Technician
  Emergency Medical Technician
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
       
Rating Stars (Click) Skills 1 2 3 4  
Vital Sign - PULSE  
Vital Sign - RESPIRATION  
Vital Sign - LUNG SOUNDS  
Vital Sign - BLOOD PRESSURE  
Vital Sign - PULSE OXIMETRY  
Basic Airway - OROPHARYNGEAL AIRWAY (OPA)  
Basic Airway - NASOPHARYNGEAL AIRWAY (NPA)  
Basic Airway - ORAL SUCTIONING  
Basic Airway - BAG VALVE MASK  
Basic Airway - OXYGEN ADMINISTRATION  
Advanced Airway - MULTI-LUMEN AIRWAY (COMBI-TUBE)  
Patient Assessment - TRAUMA  
Patient Assessment - MEDICAL  
Bleeding Control/Shock Management  
PNEUMATIC ANTI SHOCK GARMENT (MAST)  
Spinal Immobilization - B/B (SUPINE PT.)  
Spinal Immobilization - KED (SEATED PT.)  
Helmet Removal - FOOTBALL  
Helmet Removal - MOTORCYCLE  
Splinting - LONG BONE  
Splinting - BIPOLAR TRACTION (HARE)  
Splinting - UNIPOLAR TRACTION (SAGER)  
Scoop Stretcher  
BLS/ALS - Cardiac Arrest Management (AED)  
BLS/ALS - Nitroglycerin Administration (NTG)  
BLS/ALS - Epinephrine Administration (EPI)  
CPR - ADULT / CHILD / INFANT  
FBAO - ADULT / CHILD / INFANT