scene safety, global overview / end of bed assessment .../media/files/fms/paramedic...

Scene Safety, Global Overview / End of Bed Assessment Threshold Met?

Establishes and conducts danger check and global overview

Yes / No

Performs pre-assessment infection prevention & control (IPC) elements

Conducts end of bed assessment

Introduces self, establishes capacity and gains consent

Prepares / positions patient for assessment when appropriate

Primary Survey Threshold Met?

Conducts primary survey <C>AcBCDE Approach Yes / No

Peripheral Assessment – Upper Limbs Threshold Met?

Assesses fingernails for spooning / clubbing / splinter haemorrhage

Yes / No

Assesses knuckles for rheumatoid arthritis

Assesses web-spaces for nicotine staining

Assesses palms for thenar eminence wasting / erythema / asterixis

Assesses radial pulse (rate / regularity / strength)

Assesses skin turgor

Are there any signs of recent phlebotomy or illicit drug injection sites?

Peripheral Assessment – Lower Limbs Threshold Met?

Assesses for peripheral oedema (unilateral / bilateral)

Yes / No Notes any skin colour changes

Assesses for calf tenderness / swelling / warmth

Assesses for muscle atrophy

Peripheral Assessment – Neck & Head Threshold Met?

Notes any venous distension

Yes / No

Palpates lymph nodes (cervical / submandibular / submental / supraclavicular)

Assesses for xanthalasma

Notes any scleral jaundice

Notes colour of conjunctiva

Notes any central cyanosis

Assesses mouth (sores / hydration status / disease)

Neurological – Cranial Nerves - Hearing + Smell Assessment (CN I + VIII) Threshold Met?

Tests Olfactory Nerve (CN I) - offers a familiar scent for patient to identify Yes / No

Tests Vestibulocochlear Nerve (CN V III) - assesses hearing / balance

Neurological – Cranial Nerves - Eye Assessment (CN II, III, IV + VI) Threshold Met?

Assesses Optic nerve (CN II) - assesses visual fidelity / homonymous defects / sensory inattention / pupillary light reflexes + accommodation

Yes / No

Assesses Occulomotor nerve (CN III) - assesses for accommodation + planes of movement (“H” Test)

Assesses Trochlear nerve (CN IV) - assesses planes of movement (“H Test”) and for nystagmus

Assesses Abducens nerve (CN VI) - assesses planes of movement (“H Test”) / notes any medial gaze / assesses for diplopia

Neurological – Cranial Nerves - Facial Assessment (CN V, VII + XI) Threshold Met?

Assesses Trigeminal nerve (CN V) - assesses sensation in ophthalmic, maxillary and mandibular branches. Assesses masseter tone

Yes / No Assesses Facial nerve (CN VII) - assesses facial symmetry / movement of facial muscles / open eyes against resistance / raises eyebrows

Assesses Spinal Accessory nerve (CN XI) - assesses neck rotation / shoulder raise against resistance. Notes sternocleidomastoid hypertrophy / wasting

Neurological – Cranial Nerves - Mouth Assessment (CN IX, X + XII) Threshold Met?

Notes Glossopharyngeal nerve (CN IX) and Vagus nerve (CN X) are tested simultaneously:

Stimulates gag reflex / assesses swallow function and cough strength. Assesses for uvula deviation / notes dysarthria or dysphonia Palpates inflated cheeks with closed lips

Yes / No

Assesses Hypoglossal nerve (CN XII) - notes any wasting / fasciculations / deviation of the tongue. Assesses strength of tongue through cheek.

Neurological – Cerebellar Examination Threshold Met?

Assesses patient’s gait / performs Romberg’s test / heel-to-toe walking

Yes / No Notes any hand tremor and assesses tone in arms

Assesses co-ordination - dysdiadochokenesia / finger-to-nose / heel-to-shin

Neurological – Limbs Threshold Met?

Assesses tone / power / sensation in limbs

Yes / No Assesses reflexes - brachioradialis / biceps / triceps / knee / ankle / plantar

Assesses co-ordination - dysdiadochokenesia / finger-to-nose / heel-to-shin

Neurogical – Memory and Cognitive function Threshold Met?

Performs mini-mental test or other appropriate examination Yes / No

Additional Points Threshold Met?

Additional specific tests

Yes / No

Health promotion advice

Consideration for additional relevant observations

Communication skills

Professionalism

Scene Safety, Global Overview / End of Bed Assessment Threshold

Met?


Yes / No





Primary Survey Threshold

Met?


Peripheral Assessment – Upper Limbs Threshold

Met?


Yes / No







Peripheral Assessment – Lower Limbs Threshold

Met?





Peripheral Assessment – Neck & Head Threshold

Met?


Yes / No







Cardiovascular – Inspection Threshold Met?

Checks general perfusion to skin (mottling and poor perfusion areas)

Yes / No Notes any spider naevia / telangiectasia to chest wall

Notes any scars to chest wall (sternotomy / ICD / pacemaker)

Cardiovascular – Palpation Threshold Met?

Assesses + compares pulses bilaterally (rate / strength / character)

Yes / No

Palpates apex beat (normally 5th intercostal space midclavicular line)

Notes presence / absence of cardiac thrills

Notes presence / absence of cardiac heaves

Assesses for pain alteration upon movement

Palpates mass of aorta

Cardiovascular – Percussion (N/A)

Identifies percussion is not indicated in cardiovascular examination.

Cardiovascular – Auscultation Threshold Met?

Auscultates Aortic Valve (right edge of the sternum in the 2nd ICS)

Yes / No

Auscultates Pulmonary Valve (left edge of the sternum in the 2nd ICS).

Auscultates Tricuspid Valve (left edge of the sternum in the 4th ICS).

Auscultates Mitral Valve (where the apex beat was felt)

Auscultates the bases of the chest (pulmonary oedema)

Auscultates for abdominal bruits (AAA)

Auscultates for carotid and renal bruits.

Cardiovascular – Heart Sounds Threshold Met?

Identifies any additional heart sounds (S3 / S4)

Yes / No Identifies any murmurs (systolic / diastolic)

Identifies any rub (pericarditis)

Cardiovascular – ECG Analysis (12 Lead) Threshold Met?

Follows recognised assessment method, assessing for arrhythmia, ischaemia, infarction

Yes / No



Yes / No




Professionalism



Yes / No






Conducts primary survey (<C>AcBCDE approach) Yes / No



Yes / No














Yes / No







Respiratory – Inspection Threshold Met?

Notes any tracheal deviation (lung collapse / massive effusion / cancer)

Yes / No

Assesses anterior chest wall ( hyperinflation / shape)

Assesses posterior chest wall (kyphosis / scoliosis)

Assesses quality of respirations (deep / shallow / paradoxical)

Notes any patches or scars / previous surgeries to front / back of chest

Respiratory – Palpation Threshold Met?

Palpates for chest pain

Yes / No Palpates for equal chest wall rise

Notes any tactile fremitus

Respiratory – Percussion Threshold Met?

Percusses anterior chest wall (6 locations)

Yes / No Percusses sub-axillar chest wall (3 locations on right, 2 on left)

Percusses posterior chest wall (6 locations)

Respiratory – Auscultation Threshold Met?

Optimises auscultation (instructs patient to open and inhale through mouth)

Yes / No

Auscultates sub-axillar (3 locations on right / 2 locations on left)

Auscultates posterior chest wall (6 locations)

Auscultates sub-axillar chest wall (3 locations on right, 2 on left)

Auscultates posterior chest wall (6 locations)

Considers whispered pectoriloquy / bronchophony / vocal fremitus



Yes / No




Professionalism



Yes / No









Yes / No














Yes / No







Gastrointestinal – Inspection Threshold Met?

Notes any abdominal distension or bruising (mentions “6 F’s”)

Yes / No Identifies any scars to the abdomen and recognises significance / suggestion

Notes any hernias, stomas or distended abdominal veins

Gastrointestinal – Auscultation Threshold Met?

Auscultates ascending colon

Yes / No Auscultates transverse colon

Auscultates descending colon

Auscultates umbilicus (aorta / renal arteries)

Gastrointestinal – Percussion Threshold Met?

Percusses across 9 regions

Yes / No Percusses for liver

Percusses for spleen

Notes / identifies any ascites present / absent

Gastrointestinal – Palpation Threshold Met?

Identifies any area/s of pain and adjusts examination appropriately

Yes / No

Light palpation across 9 regions (notes any guarding or tenderness)

Deep palpation across 9 regions (notes any guarding or tenderness)

Palpates aorta - identifies pulsatile mass or aneurysm

Palpates liver - identifies hepatomegaly or tenderness

Palpates spleen - identifies splenomegaly or tenderness

Ballots / assesses kidneys - identifies any CVA tenderness

Assesses for specific signs / tests



Yes / No




Professionalism



Yes / No Performs pre-assessment infection prevention & control (IPC) elements



Conducts primary survey (<C>AcBCDE approach)

Yes / No Recognises and declares cardiac arrest

Requests further resources / informs ambulance control

Rhythm Analysis & Defibrillator Use Threshold Met?

Applies / instructs defibrillator pads placed in correct anatomical locations

Yes / No Identifies rhythm correctly

If appropriate, defibrillates / instructs defibrillation at appropriate energy level

Uses defibrillator safely throughout

Basic Life Support Threshold Met?

Ensures effective chest compression rate, depth and release throughout

Yes / No

Ensures effective use of bag-valve mask / ventilation rate + depth throughout

Ensures minimal disruption to chest compressions throughout

Ensures use of basic airway adjuncts / maneuvers

Rotates CPR providers appropriately

Advanced Airway Management Threshold Met?

Declares intent to advance airway management (iGel / ETI)

Yes / No

Prepares kit dump + checks equipment

Appropriate use of direct laryngoscopy + good technique

Uses bougie if attempting ETI

Insertion of advanced airway

Attaches to circuit - ETCO2, filter, catheter mount and secures appropriately

Assesses placement - auscultates / notes chest rise / misting in tube

Assesses ETCO2 reading and waveform

Adapts ventilations appropriately (30:2 / continuous ventilations)

Intravenous / Intraosseous Access Threshold Met?

Decides upon appropriate access - IV / EJV / IO

Yes / No Performs procedure competently

Demonstrates safe sharps practice

ALS Drug Therapy Threshold Met?

Correctly identifies shockable / non-shockable algorithm drug indications

Yes / No Performs drug checks (5 D’s - Date, Dose, Drug, Damage, Debris)

Initiates drug therapy as per algorithm

Continues drug therapy as per algorithm

Examination (10 marks) Threshold Met?

Considers “4 H’s & T’s” reversible causes of cardiac arrest

Yes / No Considers appropriate secondary survey / assessments

Gains history of presenting complaint and past medical history

ROSC Management Threshold Met?

Repeats primary survey

Yes / No

Instructs ventilations to be delivered appropriately

Performs routine observations

Maintains SPO2 between 94-98%

Performs 12-lead ECG and interprets appropriately

Management Threshold Met?

Leads team effectively / communicates decisions effectively

Yes / No

Uses “pit-stop” approach to cardiac arrest

Considers onwards management of patient e.g. transport destination

Ensures re-assessment every 2 minutes

Maintains professionalism throughout



Yes / No Performs pre-assessment infection prevention & control (IPC) elements


Primary Survey + Application of HOT Principles Threshold Met?

Conducts primary survey (<C>AcBCDE approach)

Yes / No

Identifies actual or potential catastrophic haemorrhage

Addresses catastrophic haemorrhage - CAT / splinting / restoration of anatomical alignment / haemorrhage control techniques

Recognises and declares traumatic cardiac arrest

Requests advanced practitioner support - APP / CCP / HEMS / BASICS

Considers undertaking C-Spine precautions / management

Performs bilateral needle thoracentesis

Rhythm Analysis & Defibrillator Use Threshold Met?

Applies / instructs defibrillator pads placed in correct anatomical locations

Yes / No Identifies rhythm correctly

If appropriate, defibrillates / instructs defibrillation at appropriate energy level

Uses defibrillator safely throughout

Basic Life Support Threshold Met?

Ensures effective chest compression rate, depth and release throughout

Yes / No

Ensures effective use of bag-valve mask / ventilation rate + depth throughout

Ensures minimal disruption to chest compressions throughout

Ensures use of basic airway adjuncts / maneuvers

Rotates CPR providers appropriately

Advanced Airway Management Threshold Met?

Declares intent to advance airway management (iGel / ETI)

Yes / No

Prepares kit dump + checks equipment

Appropriate use of direct laryngoscopy + good technique

Uses bougie if attempting ETI

Insertion of advanced airway

Attaches to circuit - ETCO2, filter, catheter mount and secures appropriately

Assesses placement - auscultates / notes chest rise / misting in tube

Assesses ETCO2 reading and waveform

Adapts ventilations appropriately (30:2 / continuous ventilations)

Intravenous / Intraosseous Access Threshold Met?

Decides upon appropriate access - IV / EJV / IO

Yes / No Performs procedure competently

Demonstrates safe sharps practice

ALS Drug Therapy Threshold Met?

Correctly identifies shockable / non-shockable algorithm drug indications

Yes / No Performs drug checks (5 D’s - Date, Dose, Drug, Damage, Debris)

Initiates and continues drug therapy as per algorithm

Examination Threshold Met?

Considers “4 H’s & T’s” reversible causes of cardiac arrest

Yes / No Considers appropriate secondary survey / assessments

Gains history of presenting complaint and past medical history

ROSC Management Threshold Met?

Repeats primary survey

Yes / No

If indicated, instructs ventilations to be delivered appropriately

Performs relevant observations

Maintains SPO2 between 94-98% and systolic > 90mmHg

Performs 12-lead ECG and interprets appropriately

Management Threshold Met?

Leads team effectively / communicates decisions effectively

Yes / No

Uses “pit-stop” approach to cardiac arrest

Considers onwards management of patient e.g. transport destination

Ensures re-assessment every 2 minutes

Maintains professionalism throughout

scene safety, global overview / end of bed assessment .../media/files/fms/paramedic...

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