CYNET_SYSTEMS_MAIN_LOGO.gif   PARAMEDIC CHECKLIST
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group 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) PARAMEDIC SKILLS CHECKLIST 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)  
BLS/ALS - Cardiac Arrest Management (AED)  
BLS/ALS - Nitroglycerin Administration (NTG)  
BLS/ALS - Epinephrine Administration (EPI)  
CPR - ADULT / CHILD / INFANT  
FBAO - ADULT / CHILD / INFANT  
Rating Stars (Click) CARDIAC MANAGEMENT 1 2 3 4  
ECG electrode application  
12 L ECGs  
Transcutaneous pacing  
Synchronized cardioversion  
Defibrillation  
Cardiac arrest mgt: V-fib  
Cardiac arrest mgt: Asystole/PEA  
ResQPod Impedance Threshold Device  
Mechanical circulatory support - VAD  
Rating Stars (Click) TRAUMA-RELATED SKILLS 1 2 3 4  
Dressing and bandages  
(5/14) Hemorrhage control - Tourniquet  
Needle thoracostomy  
Application of rigid C-collar  
KED – Vest-type device  
Helmet removal  
Sling and swathe  
Rigid splints  
Traction splints  
Vacuum splints  
Pelvic splint  
Scoop stretcher  
START & JumpStart Primary Triage  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click) Age Specific Competencies 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)