NOTE: Areas denoted by "**" may be integrated within sequence of primary survey 42 points total

1. BSI 1 point total

a. Takes or verbalizes appropriate PPE precautions - Critical B 1 point

2. SCENE SIZE-UP 5 points total

a. Determines the scene / situation is safe - Critical C 1 point

b. Determines the mechanism of injury / nature of illness 1 point

c. Determines the number of patients 1 point

d. Requests additional help if necessary 1 point

e. Considers stabilization of spine - Critical D 1 point

3. PRIMARY SURVEY / RESUSCITATION 14 points total

a. Verbalizes general impression of the patient 1 point

b. Determines responsiveness / level of consciousness 1 point

c. Determines chief complaint / apparent life-threats - Critical I 1 point

d. Airway - Critical G, I2 points total

1. Opens and assesses airway 1 point

2. Inserts adjunct as indicated 1 point

e. Breathing - Critical G, I4 points total

1. Assess breathing 1 point

2. Assures adequate ventilation - Critical F 1 point

3. Initiates appropriate oxygen therapy - Critical E1 point

4. Manages any injury which may compromise breathing / ventilation 1 point

f. Circulation - Critical G, I4 points total

1. Checks pulse 1 point

2. Assess skin [either skin color, temperature, or condition] 1 point

3. Assesses for and controls major bleeding if present - Critical G 1 point

4. Initiates shock management - Critical G 1 point

g. Identifies priority patients / makes transport decision based upon calculated GCS - Critical A 1 point

4. HISTORY TAKING 2 points total

a. Obtains, or directs assistant to obtain, baseline vital signs 1 point

b. Attempts to obtain SAMPLE history 1 point

5. SECONDARY ASSESSMENT20 points total

1. Inspects mouth**, nose**, and assesses facial area 1 point

2. Inspects and palpates scalp and ears 1 point

3. Assesses eyes for PERRL** 1 point

b. Neck** 3 points total

1. Checks position of trachea 1 point

2. Checks jugular veins 1 point

3. Palpates cervical spine 1 point

c. Chest** 3 points total

1. Inspects chest 1 point

2. Palpates chest 1 point

3. Auscultates chest 1 point

d. Abdomen / pelvis** 3 points total

1. Inspects and palpates abdomen 1 point

2. Assesses pelvis 1 point

3. Verbalizes assessment of genitalia/perineum as needed 1 point

e. Lower extremities** 2 points total

1. Inspects, palpates, and assesses motor, sensory, and distal circulatory functions 1 point / leg

f. Upper extremities 2 points total

1. Inspects, palpates, and assesses motor, sensory, and distal circulatory functions 1 point / arm

g. Posterior thorax, lumbar, and buttocks** 2 points total

1. Inspects and palpates posterior thorax 1 point

2. Inspects and palpates lumbar and buttocks area 1 point

h. Manages secondary injuries and wounds appropriately 1 point

i. Reassesses patient 1 point

6. CRITICAL CRITERIA x 12 Success Summary

A. Failure to initiate or call for transport of the patient within 10 minute time limitTransport < 10 min.

B. Failure to take or verbalize appropriate PPE precautionsBSI / PPE

C. Failure to determine scene safetyScene safety

D. Failure to assess for and provide spinal protection when indicatedImmobilize spine

E. Failure to voice and ultimately provide high concentration of oxygenGive oxygen

F. Failure to assess / provide adequate ventilationVentilate effectively

G. Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock [hypoperfusion]ABCs, bleeding, shock

H. Failure to differentiate patient's need for immediate transportation versus continued assessment / treatment at the sceneTransport vs. treat

I. Does other detailed history or physical exam before assessing / treating threats to airway, breathing, and circulationLife threats before exam

J. Failure to manage the patient as a competent EMTCompetent management

K. Exhibits unacceptable affect with patient or other personnelProfessional manner

L. Uses or orders a dangerous or inappropriate interventionDo no harm