ER SKILLS EVALUATION - Page 3
ER SKILLS EVALUATION - Page 3
Personal Information
Name
*
First
Last
Title / Specialty
*
Email
*
Phone
-
(###)
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###
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Trauma / Shock
Air transport of trauma patient
Experienced
Limited Experience
No Experience
Poison index
Experienced
Limited Experience
No Experience
Triage
Experienced
Limited Experience
No Experience
Trauma / Shock - Equipment & Procedures
Air transport of trauma patient
Experienced
Limited Experience
No Experience
Application of mast suit
Experienced
Limited Experience
No Experience
Ground transport
Experienced
Limited Experience
No Experience
Trauma / Shock - Patient Care
Bites, animal
Experienced
Limited Experience
No Experience
Bites, human
Experienced
Limited Experience
No Experience
Bites, venomous snake
Experienced
Limited Experience
No Experience
Bites, venomous spider
Experienced
Limited Experience
No Experience
Trauma / Shock - Burns
Rule of nines
Experienced
Limited Experience
No Experience
First degree
Experienced
Limited Experience
No Experience
Second degree
Experienced
Limited Experience
No Experience
Third degree
Experienced
Limited Experience
No Experience
Dehydration
Experienced
Limited Experience
No Experience
Electrocution
Experienced
Limited Experience
No Experience
Gunshot / stab wound
Experienced
Limited Experience
No Experience
Hazardous material exposure
Experienced
Limited Experience
No Experience
Heat exhaustion / stroke
Experienced
Limited Experience
No Experience
Hypothermic
Experienced
Limited Experience
No Experience
Major trauma
Experienced
Limited Experience
No Experience
Minor trauma
Experienced
Limited Experience
No Experience
Radiation exposure
Experienced
Limited Experience
No Experience
Trauma / Shock - Shock Treatment
Anaphylactic
Experienced
Limited Experience
No Experience
Cariogenic
Experienced
Limited Experience
No Experience
Hypovolemic
Experienced
Limited Experience
No Experience
Neurogenic
Experienced
Limited Experience
No Experience
Septic
Experienced
Limited Experience
No Experience
Traumatic amputation
Experienced
Limited Experience
No Experience
Infectious Diseases
Interpretation of lab values
Experienced
Limited Experience
No Experience
Fever management
Experienced
Limited Experience
No Experience
Isolation
Experienced
Limited Experience
No Experience
Care of patient with AIDS
Experienced
Limited Experience
No Experience
Pain Management
Assessment of pain level
Experienced
Limited Experience
No Experience
Epidural anesthesia / analgesia
Experienced
Limited Experience
No Experience
IV conscious sedation
Experienced
Limited Experience
No Experience
Pediatrics
Child abuse / recognition / reporting
Experienced
Limited Experience
No Experience
Calculating emergency drug doses
Experienced
Limited Experience
No Experience
Obtain consent to treat
Experienced
Limited Experience
No Experience
Pediatric cariopulmonary arrest
Experienced
Limited Experience
No Experience
Pediatrics - Patient Care
Epiglottitis
Experienced
Limited Experience
No Experience
Near drowning
Experienced
Limited Experience
No Experience
Overdose / Poision ingestion
Experienced
Limited Experience
No Experience
Status ashmaticus
Experienced
Limited Experience
No Experience
Status epilepticus
Experienced
Limited Experience
No Experience
OB / GYN
Pelvic tray
Experienced
Limited Experience
No Experience
Rape Kit
Experienced
Limited Experience
No Experience
Reporting acts of violence
Experienced
Limited Experience
No Experience
OB / GYN - Patient Care
Abruptio placenta
Experienced
Limited Experience
No Experience
DIC
Experienced
Limited Experience
No Experience
Hemorrhage
Experienced
Limited Experience
No Experience
Placenta previa
Experienced
Limited Experience
No Experience
Precipitious delivery
Experienced
Limited Experience
No Experience
Preeclampsa / eclampsia
Experienced
Limited Experience
No Experience
Spontaneous abortion
Experienced
Limited Experience
No Experience
Psychiatric
Crisis intervention
Experienced
Limited Experience
No Experience
Upholding patient rights
Experienced
Limited Experience
No Experience
Suicidal patient
Experienced
Limited Experience
No Experience
Suicide precautions
Experienced
Limited Experience
No Experience
Miscellaneous
AMA procedures
Experienced
Limited Experience
No Experience
Disaster protocols
Experienced
Limited Experience
No Experience
Patient in restraints
Experienced
Limited Experience
No Experience
Age Specific Practice Criteria
Able to adapt care to incorporate normal growth and development
Newborn (0 -30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschool (3 - 5 years)
School Age (6 - 12 years)
Adolescent (13 - 18 years)
Young Adult (19 - 39 years)
Middle Adult (40 - 64 years)
Older Adult (65 + years)
Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level
Newborn (0 -30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschool (3 - 5 years)
School Age (6 - 12 years)
Adolescent (13 - 18 years)
Young Adult (19 - 39 years)
Middle Adult (40 - 64 years)
Older Adult (65 + years)
Able to ensure a safe environment to reflect needs and alter environment accordingly
Newborn (0 -30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschool (3 - 5 years)
School Age (6 - 12 years)
Adolescent (13 - 18 years)
Young Adult (19 - 39 years)
Middle Adult (40 - 64 years)
Older Adult (65 + years)
Able to administer medications appropriately and understand different meds, dosages and possible side effects
Newborn (0 -30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschool (3 - 5 years)
School Age (6 - 12 years)
Adolescent (13 - 18 years)
Young Adult (19 - 39 years)
Middle Adult (40 - 64 years)
Older Adult (65 + years)
