Nys Emergency Medical Services Emt Clinical Evaluation Form printable pdf download

Clinical Internship Objectives for

Emergency Department & Ambulance Rotations

The EMT-B candidate is required to perform clinical skill objectives based on the

performance criteria in the NYS EMT-B curriculum and the current standard of care. The

Certified Instructor Coordinator will review the course sponsor’s clinical internship policy

and procedures prior to the EMT-B’s clinical assignment.

The Certified Instructor Coordinator shall review the following clinical internship objectives

with each candidate and ambulance or emergency department preceptors identifying

candidate performance and evaluation criteria. In addition, a clinical evaluation form will be

completed by the preceptor and returned to the Certified Instructor Coordinator. Prior to

each clinical rotation, both the clinical staff and candidate(s) are encouraged to complete an

orientation of expected behavior pertaining to the time before, during and after each clinical

and ambulance rotation.

Clinical Internship Objectives

During emergency department or ambulance clinical rotations, the student should be under

direct supervision and demonstrate proficiency for each of the following:

Emergency Department/Ambulance Clinical Objectives:

G Perform patient assessment including medical history and conducting a physical

examination. Minimum assessment skills should include taking and recording vital signs

and auscultation of lung sounds.

G Assists and reviews the treatment of trauma emergencies

G Assists and reviews the treatment of medical emergencies

G Assists in triaging patients.

G Assists in and use appropriate body substance isolation techniques.

G Assists in hemorrhage control.

G Assists in splinting.

G Assists in respiratory and/or cardiac arrest, including the performance of CPR, basic

airway management and on-scene defibrillation.

G Assists in administration of Epinephrine Auto Injector

G Assists in use of Bronchodilator.

G Assists in use of Nitroglycerine.

G Assists/observes in obtaining medical control

G Assists/observes in transfer of patient information and referral

Ambulance Operations Objectives:

G Assists with rig-checkout/restock. Locates, inspects and prepares equipment for use

G Assists with safe-scene operations. Locates and is familiar with safety equipment.

G Assists with lifting and carrying. Locates and is familiar with safe operation.

G Assists with communications. Locates and operates equipment.

G Assists with patient care report completion and transfer of information to ED.

The following evaluation form is to be completed by the student’s preceptor for the

emergency department or ambulance staff. The completed form must be submitted to the

Certified Instructor Coordinator for the candidate to be eligible for course completion.

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Nys Emergency Medical Services Emt Clinical Evaluation Form