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HomeMy WebLinkAboutPB 405.01G REVISED 5-2015_Epi PenPPPEEERRRFFFOOORRRMMMAAANNNCCCEEE BBBEEENNNCCCHHHMMMAAARRRKKKSSS 405.01G405.01G405.01G405.01G ---- Epinephrine AutoEpinephrine AutoEpinephrine AutoEpinephrine Auto----Injector (EpiInjector (EpiInjector (EpiInjector (Epi----pen)pen)pen)pen) Anne Huff, Fire Chief Beaumont Fire-Rescue Services Discipline:Discipline:Discipline:Discipline: EMTEMTEMTEMT----BLSBLSBLSBLS Effective:Effective:Effective:Effective: 9/9/9/9/16161616/2009/2009/2009/2009 ReviReviReviReviewewewewed:ed:ed:ed: 5/22/20155/22/20155/22/20155/22/2015 Replaces:Replaces:Replaces:Replaces: I. I. I. I. ObjectiveObjectiveObjectiveObjective The EMT shall be able to recognize and select the medication ordered, properly utilize the auto-injector, and administer the drug using the criteria prescribed. II. II. II. II. Instructions Instructions Instructions Instructions –––– Procedures for Achieving the ObjectiProcedures for Achieving the ObjectiProcedures for Achieving the ObjectiProcedures for Achieving the Objectiveveveve You will explain and demonstrate the proper techniques for administering the Epi –pen. You will begin at my instruction to start. The skill will end when you have completed all of the identified steps and you tell me that you are finished. Do you understand these instructions? III. III. III. III. Examiner’s NoteExaminer’s NoteExaminer’s NoteExaminer’s Note The EMT will not be allowed to review the performance steps at the time of evaluation. IV. IV. IV. IV. Preparation & EquipmentPreparation & EquipmentPreparation & EquipmentPreparation & Equipment A. Epinephrine auto-injector trainer B. Injection pad or other device capable of being injected, if needed C. Alcohol/beta dine preps D. Sharps container E. Watch or clock which displays seconds V. V. V. V. Reference SourcesReference SourcesReference SourcesReference Sources A. TSDHS EMT Skills. B. SOG 203.01A, SOG 203.01J. PB 405.01G – Epinephrine Auto-Injector Page 2 of 2 405.01G – Epinephrine Auto-Injector Discipline: EMT-BLS Name: Officer #: Evaluator: Officer #: Date: Location: If the First Responder: a) Avoids contamination of equipment or replaces contaminated equipment prior to use .............................................................................................................................. 1.0_____ b) Confirms order (medication, dosage and route) ........................................................ P/F_____ c) Informs patient of order for medications & inquires about allergies (verbalizes contraindications) ............................................................................................. 2.0_____ d) Selects correct medication from drug box as requested by Examiner ................... P/F_____ e) Verbalizes check of medication for contamination and expiration date ................ 1.0_____ f) Selects appropriate site and identifies it by pointing to (touching) the site on self ....................................................................................................................................... 1.0_____ g) Verbalizes recheck of the medication label .................................................................... 1.0_____ h) Prepares the injection site .................................................................................................... 1.0_____ i) Verbalizes recheck of the medication label .................................................................... 1.0_____ j) Removes safety cap from the injector. ............................................................................. 1.0_____ k) Performs steps a) –j) prior to step l) and performs at least one (1) recheck of the medication label ...................................................................................... P/F_____ l) Places the tip of auto-injector against the injection site and pushes the injector firmly against the injection site .................................................... 2.0____ m) Holds auto-injector against the site for 10 seconds .................................................... 1.0_____ n) Removes auto-injector and applies pressure, disposes of equipment .................... 2.0_____ Time Allocation Completes skill in allotted time .................................................................................... P/F_____ Allotted time for this skill: 5 minutes 0 seconds Actual time: _____ minutes _____ seconds Points Possible Passing Score Attempt Performance Rating (Points) PASS FAIL 14 10 First Second Medical Director’s Initials DK Date 5/22/2015