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Contract 60003
CSC No. 60003 --"Mq Ffl,g'r Waln i4:t FORT WORTH FIRE DEPARTMENT INITIAL EMT BASIC SELF STUDY 2023 OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX CONTENTS GENERAL INFORMATION......................................................................... 1 ORGANIZATIONAL CHART........................................................................ 2 FUNDING AND FINANCIAL RESOURCES ................................................. 3 RECORDKEEPING....................................................................................... 3 FACILITIES................................................................................................... 3 LEARNING RESOURCES AND INSTRUCTIONAL MATERIAL ................ 4-5 EQUIPMENT AND SUPPLIES..................................................................... 5 PERSONNEL, FACULTY, INSTRUCTORS ................................................ 5-6 PROGRAM AND COURSE POLICIES AND PROCEDURES .................... 7-8 CLINICAL AND FIELD INTERNSHIP........................................................ 8-9 MEDICAL DIRECTOR INVOLVEMENT....................................................... 9 OVERALL PROGRAM EVALUATION..................................................... 9-10 ATTACHMENTS 1. DICO TRAINING................................................................11 2. PSYCHOMOTOR SKILLS SHEETS-NREMT ........................12 3. PSYCHOMOTOR SKILL SHEETS -MEDICAL DIR ...............13 4. INSTRUCTOR/COURSE EVALUATION .............................14 5. FIRE TRAINEE JOB DESCRIPTION....................................15 6. FIELD INTERNSHIP - MEDSTAR.......................................16 AVAILABLE UPON REQUEST - FWFD RECRUITMENT PACKET CIVIL SERVICE CHAPTER 143 FWFD FIRE TRAINEE MANUAL CITY OF FORT WORTH EMPLOYEE CONDUCT GENERAL INFORMATION PROGRAM: FORT WORTH FIRE DEPARTMENT 509 W. FELIX ST FT WORTH TX 76115 LEVEL: EMT INITIAL -BASIC (# 600058) SPONSORING INSTITUTION: CITY OF FORT WORTH 200 TEXAS ST FT WORTH TX 76102 PROGRAM MANAGER: Captain Stephen Stegint, EMT-B (TDSHS# 178238) Fort Worth Fire Department 817-392-8841 COURSE COORDINATOR (BASIC): Paulo Gonzalez, EMT-B (TDSHS #176317) Fort Worth Fire Department 817-392-6898 COURSE COORDINATOR (ADVANCED): Gina Nix, EMT-P (TDSHS #177571) Fort Worth Fire Department 817-392-6874 LEAD INSTRUCTOR Lt. Brent Sanderson, EMT-B (TDSHS #178216) Fort Worth Fire Department 817-392-6616 MEDICAL DIRECTOR: Dr. Jeff Jarvis, MD (M5251), DSHS #16162 Emergency Physicians Advisory Board 254-295-6470 INFECTION CONTROL OFFICER: *BC Sherri Hauch, EMT-B Fort Worth Fire Department 817-392-8753 Self - Studv Preparation bv: Stephen Stegint, EMT-B - EMS Program Manager Paulo Gonzalez, EMT-B — Education Coordinator *Dedicated Infection Control Officer training See attachment 1 1 ORGANIZATIONAL CHART Fire Chief Assistant Chief, Education and Support Services Training Section Battalion Chief Captain, EMS Program Manager Education Coordinator Lead Instructor James Davis Raymond Hill Greg Dykes Stephen Stegint Paulo Gonzalez Brent Sanderson FUNDING & FINANCIAL RESOURCES Financial resources of the program are sufficient to assume the achievement of program goals. The Program is funded/sponsored by the City of Fort Worth through its General Revenue Fund. Prior to each class, approval from the City Council is obtained to fund the recruitment and hiring of individuals for the fire department. Once approval is obtained, the City Council allocates funds to the fire department as part of the annual budget. A class is not started prior to Council approval and complete funding. Anticipated Student Numbers: In general, the fire department budgets for two (2) recruit classes per year with 25-50 students per class. Actual student numbers are based on current department needs (i.e. retirement, expansion, etc.). RECORD KEEPING All program, course and student records are a combination of electronic and paper. Electronic files are restricted access to the Program Manager and Coordinator only and are generally a duplicate of paper records. Paper documents are stored in dedicated locking file cabinets. File cabinets are located in the EMS Program Manager's Office and are further protected by a locking office door. Course records are maintained by the EMS Program Manager in both paper and electronic formats. Student records are classified into two categories, (1) personnel records (personal, immunization, and hiring information) and (2) class (exams, grades, etc.) records. Personnel records are maintained in the City of Fort Worth's Human Resources Department consistent with City policy. Class records are stored within the previously mentioned locking file cabinets in the EMS Program Manager's Office. Record retention is per City of Fort Worth Record Retention Policy and TDSHS record retention time frames. Student Access to Records Upon request to the EMS Program Manager, students have access to their personal course records, including exams, assignments, certifications, etc. FACILITIES The Bob Bolen Public Safety Training Complex opened in the Spring of 2015 and is a large facility shared by the Fire and Police Departments in Fort Worth. The EMS Program has dedicated classrooms, a skills lab with storage located in the Bob Bolen Public Safety Training Center. There are also outside areas and facilities with props that provide a more realistic environment to perform patient extrication and ambulance operations classes. Classrooms Classrooms consist of both traditional style with rows of fixed tables and moveable chairs and tiered configurations with movable chairs. Each classroom includes a computer, hard -wired projector, and dual drop down display screens. Each classroom also has two (2) six by eight feet dry erase boards (6' x 8'). Both types of classrooms accommodate up to 50 students. Labs The skills lab is a separate room with ample storage for mannequins, bandaging and splinting materials, airway equipment, etc. The room has tables and chairs that can be moved for more space to appropriately practice skills. In addition, students have access to a computer lab that may be scheduled/reserved as needed. LEARNING RESOURCES AND INSTRUCTIONAL MATERIAL Each student is provided with a textbook in both hard copy and eBook for their own use. The computer lab is available for Internet searches. The program strives to maintain the latest instructional material such as skills videos and other tutorials to assist students with multiple modes of learning. Textbook The textbook currently employed for the EMT Initial Basic course is Emergency Care 10- edition Authors: Limmer, Okeefe, Dickinson. Curriculum The curriculum for the course follows The National EMS Education Standards (2021). The FWFD EMT Basic Initial Course is conducted over a period of eleven (11) weeks. Students are full-time employees of the City of Fort Worth and attend class Monday -Friday from 8:30a.m to 4:00p.m. Each course consists of a minimum 240 hours of classroom didactic and skills practice. In addition, each student must complete a minimum of one (1) eight -hour hospital shift and/or one (1) 12-hour ambulance shift, based on hospital and ambulance service availability. There is no academic credit awarded. Successful students will receive a National Registry of Emergency Medical Technician and Texas Department of State Health Services certification/license paid for by the City of Fort Worth. Course Delivery Course delivery is a combination of classroom lecture (didactic) and skills instruction (psychomotor). Psychomotor Evaluation Students are assessed by instructors using the National Registry of EMTs psychomotor skill sheets. See attachment 2 Additionally, local protocols are reviewed and psychomotor skills are tested specific to the Medical Director's orders. See attachment 3 Student Evaluations During the regular class sessions, daily quizzes and major exams are administered relating to select chapters and sections (airway, trauma, medical, etc.). A passing score for any exam or quiz is 75%. In order to graduate, students are required to maintain a 75% average throughout the course and to score a 75% or higher on the comprehensive final exam. During the skills instruction portion, Instructors and Skills Examiners observe, question, and provide positive feedback to students for the practical application of psychomotor skills. All students must demonstrate proficiency at each skill station prior to the start of clinical rotations. 4 Exam Review Students will be given the opportunity to review and correct each written exam and use it as future study material for the comprehensive final. The review process not only allows students to identify a particular area of weakness, but also gives the Instructors the opportunity to gauge (and improve) test development abilities. Instructors will provide as much one on one performance evaluation during skills practice sessions as possible. Students will also perform skills in groups that mirror fire department staffing in the field. In addition, peers will be utilized to assist students that may have problems with a particular skill. EQUIPMENT AND SUPPLIES Quantities Equipment and supplies are specifically designated for training purposes and are more than adequate to meet the needs of the program. Quantities exceed the minimum equipment necessary and are stored in a designated storeroom with lockers and can support a class of at least 50 students. The Fort Worth Fire Department has a supply warehouse that satisfies the need for equipment and supplies for 45 fire stations and 60 front line apparatus. Additional equipment and supplies for educational purposes can be requisitioned from the supply warehouse or purchased through a dedicated EMS education budget. Replacement and Repair Outdated, obsolete, or damaged equipment that is disposable and carried on a fire apparatus is replaced through the supply warehouse. Equipment that can be serviced is usually contracted with a vendor via a service agreement. Budget Larger items/equipment that is of a non -disposable nature is replaced through a requisition from a designated line item budget. The line item budget is specific to EMS equipment for initial and ongoing continuing education. The budget is administered by the EMS Program Manager. PERSONNEL, FACULTY, INSTRUCTORS Responsibilities of the Coordinator, Assistant Coordinator, and Lead Instructor/Instructor include delivery of cognitive, affective, and psychomotor lessons and objectives. Course Coordinator - Primary Paulo Gonzalez, EMT-B is certified as a TDSHS Basic Course Coordinator and serves as the Primary course coordinator and instructor. He is responsible for all planning, coordination, and delivery of the EMT Basic Initial course. Firefighter Gonzalez has extensive experience as a first responder, has several years' experience offering basic and continuing education programs, and holds a Master's Degree in Adult Education. Course Coordinator - Advanced Gina Nix, EMT-P is certified as a TDSHS Advanced Course Coordinator and serves as the secondary course coordinator and instructor. Firefighter Nix is a paramedic with many years of experience in prehospital patient care, emergency department patient care, and experience in offering basic and continuing education programs. Lead Instructor Brent Sanderson, EMT-B is certified as an EMS Instructor and serves as the lead instructor. Lt. Sanderson is an EMT/FF with many years of experience in prehospital patient care and instruction in basic and continuing education programs. Lt. Sanderson holds a Bachelor of Science Degree in Kinesiology and a Texas teaching certificate at the secondary level. Adjunct Instructors Adjunct Instructors are used to assist the lead instructor in delivery of lessons and objectives. Adjunct Instructors are primarily used for specific, singular topics and/or skills instruction. If used for skills instruction, the purpose is to provide a smaller student to instructor ratio with qualified skills instructors. Adjuncts are selected on a combination of the EMS certifications held, advanced degrees or certifications, prior teaching credentials, etc. The Coordinator/Lead Instructor is available to the Adjunct Instructors to assist and ensure that DOT objectives are satisfied. Guest Lecturers The Medical Director and/or Associate Medical Director, are utilized as Guest Lecturers. Subject Matter Experts (SME) SME's may instruct under the supervision of the Lead Instructor and selection is based on specific knowledge possessed. Psychomotor Skills Instructors Skills instructors primarily come from the pool of Adjunct Instructors. Qualifications/Credentialing All instructors are members of the fire department, hold EMS certifications, and have experience as First Responders in prehospital patient care. It is the intent of the EMS Program that all adjunct instructors obtain Instructor certification and that instructors assume greater responsibility in the future when there is a need for Lead Instructors or Course Coordinators. Skills Instructors must complete an eight (8) hour Skills Instructor Course prior to teaching or examining skills. Instructor Evaluations A student evaluation for Instructors (Lead and Adjunct) is given following individual areas of instruction. Students can anonymously evaluate and comment immediately following instruction. These evaluations are reviewed by the Lead Instructor, Coordinator, and EMS Program Manager for Quality Assurance and Quality Improvement. See attachment 4. Periodically, the Lead Instructor, Coordinator, and EMS Program Manager may monitor and audit any instructor during actual classroom instruction. Each instructor will receive objective feedback on the audit as well as a summary of the student evaluation. Areas of strengths and weaknesses will be identified. All evaluations are kept as part of the course file. In addition, an overall Course Evaluation form will be distributed to students at the conclusion of the course for additional feedback. PROGRAM AND COURSE POLICIES AND PROCEDURES Prospective Students A recruit packet is available on the City of Fort Worth's website. The recruit packet describes in detail the requirements and process for prospective employees. The City of Fort Worth Job Description gives a general summary of the position/employee class of Fire Trainee including: • Essential duties and responsibilities • KSA's • Minimum job requirements • Working conditions • Physical Demands See attachment 5 The Fort Worth Fire Department is a State Civil Service City governed by Chapter 143 of the State Civil Service Code. In addition, the voters of the City of Fort Worth have approved Collective Bargaining rights for its firefighters. Chapter 143 includes hiring practices (unless modified through collective bargaining) and applicants must compete through a written exam and physical ability exam for a position. Additionally, applicants must undergo an extensive background check and interview process prior to selection. Therefore, the program is not open to the public and applicants must meet defined minimum standards. Upon selection, applicants will be placed in the department sponsored Initial EMT Basic Course. Civil Service defines the minimum standards for entry-level positions in the fire department. Potential students must also meet the requirements listed in the Texas Department of State Health Services Functional Position Description for ECA, EMT, EMT -I, EMT-P and must be eligible for initial certification/ licensure published by TDSHS. Enrolled Students Once hired by the City of Fort Worth, enrolled students are known as Fire Trainees and are classified as "at will" employees. A Recruit/Trainee Manual is given to each Fire Trainee which outlines the requirements of the EMS course and the Fire Academy. The manuals are reviewed with the Fire Trainees by the Program Manager, Coordinator, and Fire Academy Recruit Captain and an acknowledgement is signed by each Trainee. This manual includes the expectations, rules and regulations and applicable standard operating procedures. This manual also outlines information on student/faculty relationships, failure to adhere the expectations, rules, regulations, or standard operating procedures may be cause for dismissal from the course/academy. Also addressed in this manual are the following policies: • Rules of Conduct • Attendance/Tardiness • Complaint resolution • Safety and Health • Dress code and Hygiene requirements • Cheating • Disciplinary issues • Grievance and appeals • Rules for Equal Opportunity Employment • Discrimination and Harassment Complaints • Grading • Immunizations The City of Fort Worth Personnel Regulations address issues on a Harassment -Free Workplace in Chapter 13 Employee Conduct and are reviewed with new hires during orientation. CLINICAL AND FIELD INTERNSHIPS Medical City Healthcare — Fort Worth 900 8th Avenue Fort Worth, TX 76104 Metropolitan Area EMS Authority DBA Medstar Mobile Healthcare 2900 Alta Mere Drive Fort Worth, TX 76116 Patient census and run volume will be reviewed and determined to be appropriate for the level of course and number of students. The goal for each students is contact with six (6) patients at a minimum. H. Prior to scheduling clinical rotations and field internships, the Coordinator/Lead Instructor contacts each facility to verify a patient census that is valuable to student learning and with an adequate number of available preceptors. Each institution will be given advanced notice and an opportunity to select the date, time and number of students that the institution can support. The Coordinator/Lead Instructor shall follow up with students after their rotation to ensure that the clinical experience or field internship was a valuable learning tool. In addition to different specialty programs, hospitals vary in their census and predominant clientele. The current clinical sites include Level 1 and 2 trauma centers. Clinical objectives and forms are provided for each student to detail their patient contacts, and performance. Forms are signed by the preceptor they were assigned to, reviewed by the Coordinator, and filed in their student files. Patient confidentiality is highly stressed and they are instructed to not divulge personal patient information, only clinical signs and symptoms. MEDICAL DIRECTOR INVOLVEMENT Dr. Jeff Jarvis is under contract as Medical Director for the Metropolitan Area EMS Authority (MAEMSA). This is a full-time paid Medical Director position. The Fort Worth Fire Department is part of the MAEMSA through an Inter -local Agreement. Frequent encounters with Dr. Jarvis occur in the field, for case review (QA), and at regularly scheduled First Responder Organization meetings. Any specific meeting relating to the EMT Education Programs is scheduled on an ad hoc basis. Copies of Protocols and Standing orders are provided to students for study and prior to course completion, students are tested. A set of skills/procedures specific to system protocols is also evaluated for competency. Upon request, the Medical Director may review any student application if desired. A course schedule is provided to the Medical Director (or assistant) prior to the start of each course. The Medical Director is encouraged to visit classes or skills sessions and may speak/instruct as a Guest Lecturer. Specifically, the Medical Director is invited as a guest speaker during the sections on Medical Direction/Oversight and Medical, Legal and Ethical Issues. Additionally, the Medical Director is invited to the final skills examination. Input from the Medical Director is always welcome and appreciated. OVERALL PROGRAM EVALUATION Goals and Obiectives The goal of the Fort Worth Fire Department EMT Program is to provide the highest level of patient care to the residents and visitors of the City of Fort Worth. The objective of the Fort Worth Fire Department EMT Program is to ensure that each student has the appropriate cognitive knowledge and psychomotor skills to be a successful EMT -Basic. Needs of the Community EMS calls for service continue to rise. Currently, more than 70% of the Fort Worth Fire Department's call volume is for emergency medical services. As people are without health care and rely on emergency departments, and pre -hospital providers, Emergency Medical Technicians will be tasked to do more. In the last decade, the scope of practice for the EMT has risen substantially. As Fort Worth continues to grow, our Agency will also grow to meet this need and to serve the citizens. An internal EMT Program allows the department to match citizens' needs with department abilities from the time that an employee is first hired. 01 Special Considerations Areas of concern for our Program are (1) financial constraints and (2) the availability of clinical experiences. Local officials are always attempting to improve efficiency which often affects budgets. The Program is always competing with other programs for clinical rotations due to a limited number of spots available. The Fort Worth Fire Department continues to work with other local programs to avoid overloading any one facility or provider with students. Strengths and Weaknesses A major strength of the Fort Worth Fire Department EMT Program is its Instructors. Implementation of a full- time Lead Instructor position as part of the Recruit Training section at the Training Academy has been an improvement in our program. In addition, a large department of approximately 1000 members allows for the selection of well -qualified Adjunct Instructors. This is evidenced by a consistent history of nearly perfect NREMT exam first time pass rates as compared to the national average of 69% and Texas average of 65% in 2016. The Fort Worth Fire Department EMT Program is strong, but areas of improvement can be made in specific sub -scales. A review of exam statistics from the National Registry indicates needed improvement in several sub -scale areas. From recent past test results, pass rates for the following sub -scales were recorded as below average: Airway 19%, Cardiology 4%, Trauma 13%, Medical 13%, and EMS Operations 10%. Remediation of Weaknesses Plans are being designed and implemented to remediate weaknesses. An increased focus on specific subscale areas during instruction is expected to increase the subscale percentages as well as increase the overall pass rate. To increase sub -scale scores, students will continue to be evaluated during the course over an entire section. These tests will be reviewed as will Instructor evaluations. The Coordinator/Lead Instructor and EMS Program Manager shall ensure that the material is appropriately presented and retained. The department is also evaluating additional forms of learning media to accommodate students of a more technological generation. This material includes an online component and specific software to practice scenario - based training. The desired result is a decreasing the number of students that must re -test the patient assessment skills evaluation. In addition, students will be given an independent final examination that can score them by subscale. As an independent test, it decreases the opportunity for instructor bias and better prepares the student for the National Registry exam as it is also similarly computer based. In addition, with subscale scores in hand prior to the National Registry test, students have the ability to target specific areas of weakness in preparation for their certifying exam. Finally, the department will also implement measures to develop Instructors as well as students. Although not mandated by TDSHS, the department desires that only Certified Instructors teach course material, and is committed to providing students with the highest quality instructors. The department will renew its effort to assist currently Certified Instructors maintain teaching certifications and help new Adjuncts in refining their teaching abilities with the goal of eventually becoming Certified Instructors. This process will also ensure that the department has a succession of qualified individuals that may eventually assume the role of Lead Instructor and EMS Coordinator. 10 ATTACHMENT 1 DICO TRAINING CERTIFICATE 11 Infection Control/Emerging Concepts,lnc. Certifies that: in association with the Texas EMS Institute Sherri Hauch Successfully Completed the Educational Program: Basic Designated Infection Control Officer Training This continuing education activity is approved by the Commission on Accreditation for Pre -Hospital (CAPCE) formerly the Continuing Education Coordination Board for the Emergency Medical Services (CECBEMS). CAPCE #: 11 — TEMS-F2-0005 CEH: 16.0 You have participated in a continuing education program that has receive CAPCE approval for continuing education credit. If you have any question regarding the quality of this program and or satisfaction with it, contact CAPCE at CAPCE, 12200 Ford Road - Suite 478 Dallas, Texas - 75234 or phone: (927) 247-444 This 29th Day of August 2017 Verification Number: : PTXEN,IS 6200 f R ew"- P PSYCHOMOTOR SKILL SHEETS - NREMT 12 National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination BLEEDING CONTROL/SHOCK MANAGEMENT Candidate: Examiner: Date: Signature: Possible Points Actual Time Started: Points Awarded Takes or verbalizes appropriate PPE precautions 1 Applies direct pressure to the wound 1 NOTE: The examiner must now inform candidate that the wound continues to bleed. Applies tourniquet 1 NOTE: The examiner must now inform candidate that the patient is exhibiting signs and symptoms of hypoperfusion. Properly positions the patient 1 Administers high concentration oxygen 1 Initiates steps to prevent heat loss from the patient 1 Indicates the need for immediate transportation 1 Actual Time Ended: TOTAL 7 CRITICAL CRITERIA Failure to take or verbalize appropriate PPE precautions Failure to administer high concentration oxygen Failure to control hemorrhage using correct procedures in a timely manner Failure to indicate the need for immediate transportation Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. O 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e213/10-16 0 Candidate: Date: Actual Time Started: National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination BVM VENTILATION OF AN APNEIC ADULT PATIENT Takes or verbalizes appropriate PPE precautions Checks responsiveness Examiner: Signature: Possible Points Points Awarded Requests additional EMS assistance 1 Checks breathing and pulse simultaneously 1 NOTE: After checking responsiveness, then checking breathing and pulse for no more than 10 seconds, examiner informs candidate, "The patient is unresponsive, apneic and has a weak pulse of 60." Opens airway properly 1 NOTE: The examiner must now inform the candidate, "The mouth is full of secretions and vomitus." Prepares rigid suction catheter 1 Turns on power to suction device or retrieves manual suction device 1 Inserts rigid suction catheter without applying suction 1 Suctions the mouth and oropharynx 1 NOTE: The examiner must now inform the candidate, "The mouth and oropharynx are clear." Opens the airway manually 1 Inserts oropharyngeal airway 1 NOTE: The examiner must now inform the candidate, "No gag reflex is present and the patient accepts the airway adjunct." '*Ventilates the patient immediately using a BVM device unattached to oxygen [**Award this point if candidate elects to ventilate initially with BVM attached to reservoir and oxygen so long as 1 first ventilation is delivered within 30 seconds.] NOTE: The examiner must now inform the candidate that ventilation is being properly performed without difficulty. Re -checks pulse for no more than 10 seconds 1 Attaches the BVM assembly [mask, bag, reservoir] to oxygen [15 L/minute] 1 Ventilates the patient adequately -Proper volume to cause visible chest rise (1 point) 2 -Proper rate [10 — 12/minute (1 ventilation every 5 — 6 seconds)] (1 point) Note: The examiner must now ask the candidate, "How would you know if you are delivering appropriate volumes with each ventilation?" Actual Time Ended: TOTAL 16 CRITICAL CRITERIA After suctioning the patient, failure to initiate ventilations within 30 seconds or interrupts ventilations for greater than 30 seconds at any time Failure to take or verbalize appropriate PPE precautions Failure to suction airway before ventilating the patient Suctions the patient for an excessive and prolonged time Failure to check responsiveness, then check breathing and pulse simultaneously for no more than 10 seconds Failure to voice and ultimately provide high oxygen concentration [at least 85%] Failure to ventilate the patient at a rate of 10 — 12/minute (1 ventilation every 5 — 6 seconds) Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible] Insertion or use of any adjunct in a manner dangerous to the patient Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. © 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e203/10-16 National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination CARDIAC ARREST MANAGEMENT / AED Candidate: Examiner: Date: Signature: Possible Points Actual Time Started: Points Awarded Takes or verbalizes appropriate PPE precautions Determines the scene/situation is safe Checks patient responsiveness Direct assistant to retrieve AED Requests additional EMS assistance Checks breathing and pulse simultaneously NOTE: After checking responsiveness, then checking breathing and pulse for no more than 10 seconds, examiner informs candidate, "The patient is unresponsive, apneic and pulseless." Immediately begins chest compressions [adequate depth and rate; allows the chest to recoil completely] Performs 2 minutes of high -quality, 1-rescuer adult CPR -Adequate depth and rate (1 point) -Correct compression -to -ventilation ratio (1 point) -Allows the chest to recoil completely (1 point) -Adequate volumes for each breath (1 point) -Minimal interruptions of no more than 10 seconds throughout (1 point) NOTE: After 2 minutes (5 cycles), candidate assesses patient and second rescuer resumes compressions while candidate operates AED. Turns on power to AED 1 Follows prompts and correctly attaches AED to patient 1 Stops CPR and ensures all individuals are clear of the patient during rhythm analysis 1 Ensures that all individuals are clear of the patient and delivers shock from AED 1 Immediately directs rescuer to resume chest compressions 1 Actual Time Ended: TOTAL 17 Critical Criteria Failure to take or verbalize appropriate PPE precautions Failure to check responsiveness, then check breathing and pulse simultaneously for no more than 10 seconds Failure to immediately begin chest compressions as soon as pulselessness is confirmed Failure to demonstrate acceptable high -quality, 1-rescuer adult CPR Interrupts CPR for more than 10 seconds at any point Failure to correctly attach the AED to the patient Failure to operate the AED properly Failure to deliver shock in a timely manner Failure to ensure that all individuals are clear of patient during rhythm analysis and before delivering shock [verbalizes "All clear" and observes] Failure to immediately resume compressions after shock delivered Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. © 2017 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e215/07-17 0 Candidate: Date: Actual Time Started: National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination JOINT IMMOBILIZATION Examiner: Signature: Possible Points Points Awarded Takes or verbalizes appropriate PPE precautions Directs application of manual stabilization of the injury Assesses distal motor, sensory and circulatory functions in the injured extremity NOTE: The examiner acknowledges, "Motor, sensory and circulatory functions are present and normal." Selects the proper splinting material Immobilizes the site of the injury Immobilizes the bone above the injury site Immobilizes the bone below the injury site Secures the entire injured extremity Reassesses distal motor. sensory and circulatory functions in the iniured extremity NOTE: The examiner acknowledges, "Motor, sensory and circulatory functions are present and normal." Actual Time Ended: TOTAL 9 Critical Criteria Failure to immediately stabilize the extremity manually Grossly moves the injured extremity Failure to immobilize the bone above and below the injury site Failure to reassess distal motor, sensory and circulatory functions in the injured extremity before and after splinting Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. O 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e216/10-16 National Registry of Emergency Medical Technicians° Ae Emergency Medical Technician Psychomotor Examination LONG BONE IMMOBILIZATION Candidate: Examiner: Date: Signature: Actual Time Started: Takes or verbalizes appropriate PPE precautions Directs application of manual stabilization of the injury Assesses distal motor, sensory and circulatory functions in the injured extremity Possible Points Points Awarded 1 1 1 NOTE: The examiner acknowledges, "Motor, sensory and circulatory functions are present and normal." Measures the splint Applies the splint Immobilizes the joint above the injury site Immobilizes the joint below the injury site Secures the entire injured extremity Immobilizes the hand/foot in the position of function Reassesses distal motor, sensory and circulatory functions in the injured extremity NOTE: The examiner acknowledges, "Motor, sensory and circulatory functions are present and normal." Actual Time Ended: 1 1 1 1 1 1 1 TOTAL 10 Critical Criteria Failure to immediately stabilize the extremity manually Grossly moves the injured extremity Failure to immobilize the joint above and the joint below the injury site Failure to immobilize the hand or foot in a position of function Failure to reassess distal motor, sensory and circulatory functions in the injured extremity before and after splinting Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. O 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e217/10-16 °"'`°'•• National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination OXYGEN ADMINISTRATION BY NON-REBREATHER MASK Candidate: Examiner: Date: Signature: Actual Time Started: Possible Points Points Awarded Takes or verbalizes appropriate PPE precautions 1 Gathers appropriate equipment 1 Cracks valve on the oxygen tank 1 Assembles the regulator to the oxygen tank 1 Opens the oxygen tank valve 1 Checks oxygen tank pressure 1 Checks for leaks 1 Attaches non-rebreather mask to correct port of regulator 1 Turns on oxygen flow to prefill reservoir bag 1 Adjusts regulator to assure oxygen flow rate of at least 10 L/minute 1 Attaches mask to patient's face and adjusts to fit snugly 1 Actual Time Ended: TOTAL 11 CRITICAL CRITERIA Failure to take or verbalize appropriate PPE precautions Failure to assemble the oxygen tank and regulator without leaks Failure to prefill the reservoir bag Failure to adjust the oxygen flow rate to the non-rebreather mask of at lease 10 L/minute Failure to ensure a tight mask seal to patient's face Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. © 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e204/10-16 National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination PATIENT ASSESSMENT/MANAGEMENT — MEDICAL Candidate: Examiner: Date: Signature: Scenario # Actual Time Started: Possible Points Points Awarded Takes or verbalizes appropriate PPE precautions 1 SCENE SIZE -UP Determines the scene/situation is safe 1 Determines the mechanism of injury/nature of illness 1 Determines the number of patients 1 Requests additional EMS assistance if necessary 1 Considers stabilization of the spine 1 PRIMARY SURVEYIRESUSCITATION Verbalizes the general impression of the patient 1 Determines responsiveness/level of consciousness (AVPU) 1 Determines chief complaint/apparent life -threats 1 Assesses airway and breathing -Assessment (1 point) -Assures adequate ventilation (1 point) -Initiates appropriate oxygen therapy (1 point) 3 Assesses circulation -Assesses/controls major bleeding (1 point) -Checks pulse (1 point) 3 -Assesses skin [either skin color, temperature or condition] (1 point) Identifies patient priority and makes treatment/transport decision 1 HISTORY TAKING History of the present illness -Onset (1 point) -Quality (1 point) -Severity (1 point) -Provocation (1 point) -Radiation (1 point) -Time (1 point) 8 -Clarifying questions of associated signs and symptoms related to OPQRST (2 points) Past medical history -Allergies (1 point) -Past pertinent history (1 point) -Events leading to present illness (1 point) 5 -Medications (1 point) -Last oral intake (1 point) SECONDARY ASSESSMENT Assesses affected body part/system -Cardiovascular -Neurological -Integumentary -Reproductive 5 -Pulmonary -Musculoskeletal -GI/GU -Psychological/Social VITAL SIGNS -Blood pressure (1 point) -Pulse (1 point) -Respiratory rate and quality (1 point each) 4 States field impression of patient 1 Interventions [verbalizes proper interventions/treatment] 1 REASSESSMENT Demonstrates how and when to reassess the patient to determine chanqes in condition 1 Provides accurate verbal report to arriving EMS unit Actual Time Ended: CRITICALCRITERIA TOTAL 42 Failure to initiate or call for transport of the patient within 15 minute time limit Failure to take or verbalize appropriate PPE precautions Failure to determine scene safety before approaching patient Failure to voice and ultimately provide appropriate oxygen therapy Failure to assess/provide adequate ventilation Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock Failure to differentiate patient's need for immediate transportation versus continued assessment or treatment at the sceim Performs secondary examination before assessing and treating threats to airway, breathing and circulation Orders a dangerous or inappropriate intervention Failure to provide accurate report to arriving EMS unit Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. O 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e202/10-16 National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination PATIENT ASSESSMENT/MANAGEMENT — TRAUMA Candidate: Examiner: Date: Signature: Scenario # Actual Time Started: Note: Areas denoted by "* may be integrated within sequence of Primary Survey/Resuscitation Takes or verbalizes appropriate PPE precautions SCENE SIZE -UP Determines the scene/situation is safe Determines the mechanism of injury/nature of illness Determines the number of patients Requests additional EMS assistance if necessary Considers stabilization of the spine PRIMARY SURVEY/RESUSCITATION Verbalizes general impression of the patient Determines responsiveness/level of consciousness Determines chief complaint/apparent life -threats Airway -Opens and assesses airway (1 point) Breathing -Assess breathing (1 point) -Initiates appropriate oxygen therapy (1 point) -Inserts adjunct as indicated (1 point) -Assures adequate ventilation (1 point) -Manages any injury which may compromise breathing/ventilation (1 point) Circulation -Checks pulse (1 point) -Assess skin [either skin color, temperature or condition] (1 point) -Assesses for and controls major bleeding if present (1 point) -Initiates shock management [positions patient properly, conserves body heat] (1 point) Identifies patient priority and makes treatment/transport decision (based upon calculated GCS) HISTORY TAKING Obtains baseline vital signs [must include BP, P and R] (1 point) Attempts to obtain SAMPLE history SECONDARY ASSESSMENT Head -Inspects and palpates scalp and ears (1 point) ** -Assesses eyes (1 point) -Inspects mouth**, nose** and assesses facial area (1 point) Neck** -Checks position of trachea (1 point) -Checks jugular veins (1 point) Chest** -Inspects chest (1 point) -Palpates chest (1 point) Abdomen/pelvis** -Inspects and palpates abdomen (1 point) -Assesses pelvis (1 point) -Verbalizes assessment of genitalia/perineum as needed (1 point) Lower extremities- -Inspects, palpates and assesses motor, sensory and distal circulatory functions (1 point/leg) Upper extremities -Inspects, palpates and assesses motor, sensory and distal circulatory functions (1 point/arm) Posterior thorax, lumbar and buttocks— -Palpates cervical spine (1 point) -Auscultates chest (1 point) Possible Points Points Awarded -Inspects and palpates posterior thorax (1 point) -Inspects and palpates lumbar and buttocks areas (1 point) ` Manages secondary injuries and wounds appropriately 1 REASSESSMENT Demonstrates how and when to reassess the patient 1 Actual Time Ended: TOTAL 42 CRITICAL CRITERIA Failure to initiate or call for transport of the patient within 10 minute time limit Failure to take or verbalize appropriate PPE precautions Failure to determine scene safety Failure to assess for and provide spinal protection when indicated Failure to voice and ultimately provide high concentration oxygen Failure to assess/provide adequate ventilation Failure to find or appropriately manage problems associated with airway, breathing, hemorrhage or shock Failure to differentiate patient's need for immediate transportation versus continued assessment/treatment at the scene Performs other assessment before assessing/treating threats to airway, breathing and circulation Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. O 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e201/10-16 0 Candidate: Date Actual Time Started: National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination SPINAL IMMOBILIZATION (SEATED PATIENT) Takes or verbalizes appropriate PPE precautions Directs assistant to place/maintain head in the neutral, in -line position Directs assistant to maintain manual stabilization of the head Reassesses motor, sensory and circulatory functions in each extremity Applies appropriately sized extrication collar Positions the immobilization device behind the patient Secures the device to the patient's torso Evaluates torso fixation and adjusts as necessary Evaluates and pads behind the patient's head as necessary Secures the patient's head to the device Verbalizes moving the patient to a long backboard Reassesses motor, sensory and circulatory function in each extremity Actual Time Ended: Examiner: Signature: Possible Points Points Awarded TOTAL 12 CRITICAL CRITERIA Failure to immediately direct or take manual stabilization of the head Failure to properly apply appropriately sized cervical collar before ordering release of manual stabilization Released or ordered release of manual stabilization before it was maintained mechanically Manipulated or moved patient excessively causing potential spinal compromise Head immobilized to the device before device sufficiently secured to the torso Device moves excessively up, down, left or right on the patient's torso Head immobilization allows for excessive movement Torso fixation inhibits chest rise, resulting in respiratory compromise Upon completion of immobilization, head is not in a neutral, in -line position Failure to reassess motor, sensory and circulatory functions in each extremity after voicing immobilization to the long backboard Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. O 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e211/10-16 0 Candidate: Date: Actual Time Started: National Registry of Emergency Medical Technicians° Emergency Medical Technician Psychomotor Examination SPINAL IMMOBILIZATION (SUPINE PATIENT) Examiner: Signature: Takes or verbalizes appropriate PPE precautions Directs assistant to place/maintain head in the neutral, in -line position Directs assistant to maintain manual stabilization of the head Reassesses motor, sensory and circulatory function in each extremity Applies appropriately sized extrication collar Positions the immobilization device appropriately Directs movement of the patient onto the device without compromisina the intearitv of the spine Applies padding to void between the torso and the device as necessary Immobilizes the patient's torso to the device Evaluates and pads behind the patient's head as necessary Immobilizes the patient's head to the device Secures the patient's leqs to the device Secures the patient's arms to the device Reassesses motor, sensory and circulatory function in each extremity Actual Time Ended: Possible Points Points Awarded TOTAL 14 CRITICAL CRITERIA Failure to immediately direct or take manual stabilization of the head Failure to properly apply appropriately sized cervical collar before ordering release of manual stabilization Released or ordered release of manual stabilization before it was maintained mechanically Manipulated or moved the patient excessively causing potential spinal compromise Head immobilized to the device before device sufficiently secured to the torso Patient moves excessively up, down, left or right on the device Head immobilization allows for excessive movement Upon completion of immobilization, head is not in a neutral, in -line position Failure to reassess motor, sensory and circulatory functions in each extremity after immobilizing patient to the device Failure to manage the patient as a competent EMT Exhibits unacceptable affect with patient or other personnel Uses or orders a dangerous or inappropriate intervention You must factually document your rationale for checking any of the above critical items on the reverse side of this form. O 2016 by the National Registry of Emergency Medical Technicians, Inc., Columbus, OH All materials subject to this copyright may be photocopied for the non-commercial purpose of educational or scientific advancement. e212110-16 ATTACHMENT 3 PSYCHOMOTOR SKILL SHEETS OFFICE OF THE MEDICAL DIRECTOR 13 12 -Lead ECG V0 Verbalizes indications for 12-Lead EKG: • Complaints of chest pain or atypical symptoms suggestive of ACS (nausea, palpitations, SOB, dizziness, syncope, weakness) • Electrical Injuries • Suspected cardiotoxic overdose • Suspected severe electrolyte derangement • Cardiac arrhythmia Prepares patient's skin for electrode application: • Bares patient's chest. • Shaves excessive hair. • For oily skin, cleans with alcohol pad. • For diaphoresis/poor adhesion, uses benzoin. • Gently scrapes skin to remove surface layer of dead cells. • Rub site briskly to dry. Presses the 12-Lead quick access key, then the Patient Info quick access key. Enters the patient's first and last name, age and gender. Applies electrodes to ankles and wrists (avoiding tendons and major muscle masses) and to precordial lead sites. Limb Lead Sites (AHA Labels): Precordial Lead Electrode Sites: RA Right Arm V 1 C 1 Fourth intercostal space to the right of the sternum LA Left Arm V2 C2 Fourth intercostal space to the left of the sternum RL Right Leg V3 C3 Directly between leads V2/C2 and V4/C4 LL Left Leg V4 C4 Fifth intercostal space at midclavicular line V5 C5 Level with V4/C4 at left anterior auxiliary line V6 C6 Level with V5/C5 at left mid-axillary line Assures patient is resting quietly with all limbs fully supported. Encourages patient to remain as still as possible during data acquisition. Verbalizes need to transmit 12 Lead to receiving ED and attach to PCR. Critical Criteria Failure to place leads appropriately Failure to manage equipment appropriately Factual documentation is required on the reverse side if any, of the above critical criteria are checked Examiner: Signature: Pass: Fail: 34 ASSISTED VENTILATIONS Selects appropriately sized mask. Assembles required equipment for max BVM • BVM • PEEP • OPA/NPA's • HFNC If one rescuer: • Creates a strong mask -to -face seal using a E-C grip If two -rescuer: • Creates a strong mask -to -face seal using a two handed jaw thrust and thenar grip In the perfusing patient, begins ventilations as soon as possible at a rate of. • Adults - Titrate to SP02 > 90 and eucapnea (as appropriate) • Pediatrics - 12-20 Breaths per minute (every 3-5 seconds) In Cardiac Arrest, ventilates at a rate of: • Adults — 12 Breaths per minute (1 every 5 seconds) • Pediatrics — 5 compressions to 1 breath (most arrests are asphyxia) Position patient for patency: • Ear to Sternal Notch (ETSN) • OPA and/or up to 2 NPAs Attaches Nasal Cannula EtCO2 device to patient. Connects reservoir to oxygen. Adjusts oxygen flow to 15 liters/min. Confirms 4 phase EtCO2 waveform for every breath. Verbalizes additional maneuvers for persistent hypoxia (max BVM) • Elevate HOB 30 degree (in absence of trauma) • Second 02 source (HFNC) • Increasing PEEP Critical Criteria Candidate must pass 10000to pass station YO Factual documentation is required on the reverse side if any of the above critical criteria are checked Examiner: Pass: Signature: Fail: 35 NIPPV — BPAP/BiLevel EL VO Verbalizes indications to procedure: • Respiratory distress with resistant hypoxia • Awake, able to cooperate for device application • Ability to wear adult size mask Verbalizes contraindications to procedure: • Pending respiratory failure • Penetrating chest trauma • Suspected pneumothorax • Uncontrolled/persistent vomiting • Facial deformity (traumatic or anatomic) preventing mask seal Places patient in an upright sitting position. Explains the procedure to the patient. Connects Oz tubing to oxygen source. Turns on oxygen source Ensures the device is in Bilevel mode by rotating the green switch to the Bilevel setting. Secures the face mask snugly to patient's face using head harness Slowly increases the oxygen flow to 15 LPM, to achieve goal IPAP of roughly 8-10 cm H2O Checks the mask fit and the device connections for leaks Adjusts the EPAP knob until manometer reaches 5 cm H2O during exhalation Continuously monitors the patient's waveform capnography, CO2 values, pulse oximetry, mental status, heart rate and blood pressure. When asked if respiratory status or level of consciousness deteriorates, immediately discontinues the device and considers BVM and/or advanced airway management. Verbalizes understanding of the limitations of not being able to perform simultaneous bronchodilators while in BiLevel mode *Proctor states "Your patient requires a nebulizer"* • Switches BiLevel to CPAP mode • Slowly increases the oxygen flow to roughly 6-81pm • Adjust the flowmeter until desired pressure is obtained Flow of 12-14 is required to reach CPAP pressure of 8.5-10 cm H2O Critical Criteria Candidate must pass 1000o to pass station Factual documentation is required on the reverse side if any of the above critical criteria are checked Examiner: Pass: Signature: Fail: 36 SUPRAGLOTTIC AIRWAY (KING LTS-D) Verbalizes indications: • Cardiac Arrest and/or respiratory failure and contraindications to procedure: • Caustic ingestions • Known esophageal disease Verbalizes indications for removal of the device: • Inability to confirm ventilation in five or less five breaths with waveform CO2 • Significant gastric contents, secretions, or vomitus in the ventilation port, with absent CO2 waveform Pre -oxygenates the patient (or instructs someone else to do so). Selects the correct size of King LTD-S based on the manufacturer's recommendation. Tests cuff and inflation system for leaks by injecting the maximum recommended volume of air into the cuffs. Lubricates the distal end of the tube. Places patient's head in an ear to sternal notch position. Opens the patient's mouth using a tongue -jaw lift maneuver. With the King LTD-S rotated laterally 45-90 degrees such that the blue orientation line is touching the corner of the mouth, introduces tip into mouth and advances behind the base of the tongue. As tube tip passes under tongue, rotates tube back to midline (blue orientation line faces chin). Without exerting excessive force, advances tube until base of connector is aligned with teeth or gums. Using the syringe provided, inflates the cuffs to manufacture's recommended "seal" volume. Attaches in -line capnography to King LTD-S and connect to patient monitor. Attaches and ventilate using BVM, withdrawing the King LTD-S as needed. Confirms ventilation with 4-phase waveform AND EtCO2 more than 5 mmHg for every breath. Secures tube with a commercial device. Applies c-collar. Gastric Tube Insertion in King Airway Device Lubricates the gastric tube (up to an 18 French) prior to inserting into the gastric access lumen. Inserts the gastric tube until resistance is met or the connector meets the access lumen. After the tube is firmly secured, connects the proximal end to suction device and aspirates as needed. For intubated patients, places orogastric tube in lieu of nasogastric tube. Critical Criteria Failure to place inline EtCO2 Failure to place airway successfully Failure to manage equipment appropriately Factual documentation is required on the reverse side if any of the above critical criteria are checked Examiner: Pass: Signature: Fail: 37 SPINAL MOTION RESTRICTION (SMR) Verbalizes contraindications to procedure • Penetrating trauma States ALL of the following inclusion criteria for Cervical Collar: • Age less than 13 and greater than 64 • Limited ability to sense or communicate pain (AMS, LOC, intoxicated, head trauma, language barrier, mental retardation) • Distracting injury (long bone fracture, visceral trauma (abdomen, pelvis), large laceration, crush injury, large burn) • Neurologic deficit (motor/sensory loss or paresthesia, Midline cervical tenderness to palpation) • Dangerous mechanism of injury 1. Fall > 3-feet or 5-stairs 2. Axial loading injury to the head (diving accident/sports injury) 3. Vehicular accident 4. High speed motor vehicle accident > 60 mph 5. Motorized recreational vehicle accident 6. Ejection 7. Bicycle collision with immobile object (tree, parked car) 8. Struck by large vehicle 9. Roll-over ***Spinal motion restriction may be deferred ONLY IF ALL OF THESE FINDINGS ARE ABSENT*** Palpates for midline cervical tenderness. Assesses motor, sensory and circulatory function in the injured extremity. Performs active range of motion test (actively rotate neck 45' both left and right without pain or paresthesia). Places cervical collar. Uses device below to move patient to stretcher. M:/:16.11 • Vacuum Splint • Scoop stretcher • Backboard Moves patient with as little movement as possible, maintain in -line stabilization. Secures patient SUPINE to stretcher with ALL COT STRAPS. Removes extrication devices and verbalizes that backboards and scoop stretchers are patient movement devices ONLY and are NOT to be left in place for transport. See next page for critical falls 38 SPINAL MOTION RESTRICTION (SMR) Critical Criteria Unable to state indications Unable to state contraindications Unable to recognize inclusion criteria Gross movement of the spine Factual documentation is required on the reverse side if any, of the above critical criteria are checked Examiner: Pass: Signature: Fail: 39 PELVIC BINDER YO Verbalizes indications of the pelvic binder to a patient with moderate to severe blunt mechanism of injury who has any of the following criteria: • Obvious signs of pelvic injury/instability on physical exam • Signs of hemorrhagic shock and: o reports pelvic or low back pain/tenderness even if the pelvis seems stable o altered mental status regardless of the presence or absence of pelvic pain or instability • Blunt traumatic arrest Verbalizes contraindications of application: • Isolated proximal femur fracture (isolated "hip fracture") Removes clothing from patient's pelvic area. Palpates the patients pelvis in an appropriate manner without "rocking/springing" the pelvis Places the black side up beneath patient at the level of the greater trochanters. Places black strap through buckle and pulls completely through. Holds orange strap and pulls black strap in opposite direction until buckle click is felt and heard. Maintains tension, immediately presses black strap onto surface of the pelvic sling to secure. Moves the patient using a scoop stretcher or another device that avoids log -rolling Critical Criteria Unable to state indications Unable to state contraindications Places the device on the patient incorrectly Unable to show competence when using the device Factual documentation is required on the reverse side if any of the above critical criteria are checked Examiner: Pass: Signature: Fail: 40 APPLYING A SAGER TRACTION SPLINT YO Verbalizes indications of application: • Isolated closed mid shaft femoral fractures Verbalizes contraindications of application: • Injuries close to the knee or involving the knee itself • Hip or pelvic injuries • Lower leg or ankle injuries After exposing the injured area, checks the patient's pulse and motor and sensory function. Adjusts the thigh strap so that it lies anteriorly when secured. Estimates the proper length of the splint by placing it next to the injured limb. Fits the ankle pads to the ankle. Places the splint at the inner thigh, applies the thigh strap at the upper thigh, secures snugly. Tightens the ankle harness just above the malleoli. Snugs the cable ring against the bottom of the foot. Extends the splint's inner shaft to apply traction at about 10 % of body weight. Secures the splint with elasticized cravats. Checks pulse, motor, and sensory functions. Critical Criteria Unable to state indications Unable to state contraindications Failure to place ischium strap prior to traction attempt Places the device on the patient incorrectly Unable to show competence when using the device Factual documentation is required on the reverse side if any of the above critical criteria are checked Examiner: Pass: Signature: Fail: 41 NEBULIZER YO 6 "R's" — Right Patient, Right Drug, Right Dose, Right Route, Right Date, Right Documentation. Inquires about allergies and previous medication reactions. Observes solution clarity and expiration date. Places the specific amount of medication into the nebulizer medication container. Adjusts the oxygen flow to achieve the desired misting effect (usually between 6-10 liters per minute) and waits for a slight mist to exit the end of the tube. Verbalizes recheck of the medication label. Instructs the patient to place the mouth piece to their mouth and breathe normally. May also be administered through mask. Critical Criteria Unable to state the 6 rights of medication administration Does not choose the correct medication from the bin Factual documentation is required on the reverse side if any of the above critical criteria are checked Examiner: Pass: Signature: Fail: 42 BY MOUTH (PO) 6 "R's" — Right Patient, Right Drug, Right Dose, Right Route, Right Date, Right Documentation. Inquires about allergies and previous medication reactions. Observes Dose and expiration date. States the contraindications to administration of PO medication. a. Unconscious unresponsive patients. b. Unable to protect airway. c. Unable to swallow Acetaminophen: a. Ensure dosage G 5mg/kg PO) Aspirin: a. Aspirin should be chewed and swallowed. b. Allow the patient to use a small amount of water to assist in swallowing the tablets. Glucose Paste: a. May be given to the conscious patient to swallow or to the semiconscious patient by applying to a tongue depressor and placing in the mouth between the cheek and gum to be absorbed. Critical Criteria Unable to state the 6 rights of medication administration Does not choose the correct medication from the bin Factual documentation is required on the reverse side if any, of the above critical criteria are checked Examiner: Pass: Signature: Fail: 43 SUBLINGUAL (SL) k- -FV0- 6 "R's" — Right Patient, Right Drug, Right Dose, Right Route, Right Date, Right Documentation. Inquires about allergies and previous medication reactions. Observes Dose and expiration date. States the contraindications to administration of medication. Instructs the patient to open their mouth and lift their tongue. Places the medication under the tongue. Critical Criteria Unable to state the 6 rights of medication administration Does not choose the correct medication from the bin Factual documentation is required on the reverse side if any of the above critical criteria are checked Examiner: Pass: Signature: Fail: 44 INTRANASAL (IN) 6 "R's" — Right Patient, Right Drug, Right Dose, Right Route, Right Date, Right Documentation. Inquires about allergies and previous medication reactions. Observes solution clarity, dose and expiration date. States the contraindications to administration of intranasal. Loads the appropriate size syringe with the selected medication. Attaches the nasal atomizer on to the syringe. Places atomizer 1.5 cm into the selected nostril. Briskly compresses they syringe to administer the loading dose of medication. Removes and repeats into the other nostril, if necessary, until all of the medication has been administered. Critical Criteria Unable to state the 6 rights of medication administration Does not choose the correct medication from the bin Factual documentation is required on the reverse side if any of the above critical criteria are checked Examiner: Pass: Signature: Fail: 45 INTRAMUSCULAR (IM) I- AMENEEk-- 6 "R's" — Right Patient, Right Drug, Right Dose, Right Route, Right Date, Right Documentation. Inquires about allergies and previous medication reactions. Observes solution clarity, dose and expiration date. Selects the appropriate administration site: Deltoid Muscle Type: IM Size: 23 to 25 G, 5/8" to 1" Range: 0.5 to 2 mL Vastus Lateralis Muscle Type: IM Size: 23 to 25 G, 5/8" to 1 '/2" Range: 1 to 5 mL Dorsogluteal Muscle Type: IM Size: 20 to 23 G, 1 '/z" to 3" Range: 1 to 5 mL Ventrogluteal Muscle Type: IM Size: 20 to 23 G, 1 '/z" to 3" Range: 1 to 5 mL Stretches skin and hold tight. Hold the syringe at a 90 degree angle to the skin and insert the needle into the muscle tissue with a steady sharp and controlled motion. Releases the tension on the skin. Aspirate for blood return. If present, discontinue administration. Administers correct dose of medication at the proper push rate. Thigh ww"WWkwab %ftis0#4 www MW wog to t4 s+wim" to "b kno tv pElei t tm is ?..-Sine 11-3 LVw bxsdcW bel 9w kow 4dp of upwase rams of the saph am de ohimAe7 kw Critical Criteria Unable to state the 6 rights of medication administration Does not choose the correct medication from the bin Hip _. ..mP" AWMW �... to Odin WWWaNditafto so our Inc W wets to affow of fir X below to ad" 4* O"t Buttocks rm darmVit t.9 sMr is abw an Mwonay kw bnow 9* Qt&m oodww atd to pR16 1w Rg"Ir"atsta* ti4*** w ad u4ww 10 ft ft*%" irf Factual documentation is required on the reverse side if any, of the above critical criteria are checked Examiner: Pass: Signature: Fail: ATTACHMENT 4 INSTRUCTOR EVALUATION & COURSE EVALUATION 14 FWFD EMS Course Evaluation This is a course evaluation designed to provide the program with your feedback for use in course design, improvement and overall program evaluation. This evaluation is anonymous, there will be no repercussions/retaliation based on responses, thus honest, constructive, and professional feedback is encouraged. The goal of this survey is to improve the quality of the EMS Program and Instructors EVALUATION SCALE i = Unsatisfactory Standards not met in a satisfactory manner 2 = Inconsistent Standards met inconsistently 3 = Satisfactory Standards met in a consistent manner 4 = Excellent Standards were exceeded and provided a quality learning experience Circle the number that represents vour opinion based on the Evaluation Scale CLASSROOM Classroom was comfortable and a well -suited learning environment 1 2 3 4 Visual aids and technology were current and appropriate 1 2 3 4 Classroom climate (circle one) Too Warm / Too Cool / Appropriate INSTRUCTORS Instructors were well prepared, knowledgeable, and organized 1 2 3 4 Instructors stressed important concepts in a sequence logical to the course content 1 2 3 4 Instructors had positive attitudes towards the students and the profession 1 2 3 4 Instructors encouraged student participation 1 2 3 4 Instructors regularly met scheduled classes for the full class period 1 2 3 4 Instructors provided clear objectives for lessons 1 2 3 4 Instructors reviewed exams and provided feedback 1 2 3 4 COURSE CONTENT SKILLS Skills equipment was clean and in good operating condition 1 2 3 4 Skills equipment was present in sufficient quantities 1 2 3 4 Instructor to student ratio was met 1 2 3 4 Time spent on skills was appropriate 1 2 3 4 DIDACTIC Resources (textbook, handouts, PowerPoints, etc.) were appropriate 1 2 3 4 Weekly exams covered the material taught 1 2 3 4 Critical thinking/Problem solving skills were emphasized 1 2 3 4 CLINICAL ROTATIONS/FIELD INTERNSHIPS Objectives for the Clinical Rotations (hospital) were clearly presented 1 2 3 4 Objectives for the Field Internships (ambulance) were clearly presented 1 2 3 4 Students were provided with orientations for both clinical and field rotations 1 2 3 4 Students were provided with expectations for both clinical and field rotations 1 2 3 4 Emergency procedures and contacts were provided to students 1 2 3 4 Preceptors (hospital & ambulance) were knowledgeable/informative 1 2 3 4 Hospital & ambulance rotations provided valuable learning experiences 1 2 3 4 OVERALL The course provided the base knowledge and skills of the topics needed to be successful pass the National Registry of EMTs examination 1 2 3 4 Please make additional comments in the space provided on the back of this sheet ADDITIONAL COMMENTS: FWFD EMS Instructor Evaluation Instructor: Chapter & Subject This instructor evaluation is designed to provide the program with your feedback for use in course design, improvement and overall program evaluation. It is required that instructors receive an evaluation for each lesson taught. These evaluations are anonvmous, there will be no repercussions/retaliation based on responses, thus honest, constructive, and professional feedback is encouraged. The goal of these surveys is to continually improve the quality of the EMS Program and Instructors EVALUATION SCALE i = Unsatisfactory Instructor did not demonstrate the standards in a satisfactory manner 2 = Inconsistent Instructor demonstrated the standards inconsistently 3 = Satisfactory Instructor demonstrated the standards in a consistent manner 4 = Excellent Instructor exceeded standards and provided a quality learning experience Circle the number that represents vour opinion based on the Evaluation Scale PREPARATION The Instructor... Was punctual 1 2 3 4 Presented himself/herself professionally in appearance 1 2 3 4 Presented himself/herself professionally in demeanor/attitude 1 2 3 4 Was well organized and prepared to instruct 1 2 3 4 Was knowledgeable and familiar with the subject matter 1 2 3 4 PRESENTATION The Instructor... Clearly communicated lesson goals & objectives to students 1 2 3 4 Created interest and established a need to know 1 2 3 4 Related lesson objectives to past sessions/lessons (if relevant) 1 2 3 4 Created and maintains a positive learning environment 1 2 3 4 Presented course material using a variety of instructional strategies 1 2 3 4 Used visual aids and/or supplementary teaching items 1 2 3 4 Presented material in an organized manner with vocabulary at the course level 1 2 3 4 Presented skills in a logical step-by-step sequence 1 2 3 4 Stayed on subject -communicated personal experience related to the lesson 1 2 3 4 Encouraged student participation 1 2 3 4 Encouraged critical thinking and problem solving 1 2 3 4 Was able to answer questions and/or clarify concepts 1 2 3 4 CLASSROOM MANAGEMENT The Instructor... Demonstrated effective use of time management 1 2 3 4 Allowed for breaks every 6o-go minutes (or as appropriate) 1 2 3 4 Allowed time to practice skills after lectures (if appropriate) 1 2 3 4 OVERALL The Instructor enhanced my understanding of the material covered in the chapter (Circle one) Strongly Agree Agree No Opinion Disagree Strongly Disagree Please make additional comments in the space provided on the back of this sheet ADDITIONAL COMMENTS: ATTACHMENT 5 JOB DESCRIPTION FIRE TRAINEE 15 City of Fort Worth, Texas Job Description TClassification Title Fire Fighter Job Code: 1032 Pay Grade Y01 FLSA Status Non Exempt GENERAL SUMMARY Job Family: Fire Date Reviewed: 09/30/15 Date Revised: Works under the supervision of a ranking officer and is responsible for completion of orders and directives set to assist in mitigation of emergencies and to prevent fires and unsafe conditions. May work independently in the completion of duties related to the Fire Department EMS program and other special assignments. ESSENTIAL DUTIES & RESPONSIBILITIES The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job -related tasks other than those specifically presented in this description. Fire Fiqhter- Operations: 1. While under the direction of a superior officer, responds to emergency calls, fire alarms and situations of a non -emergency nature. 2. Administers first aid and emergency medical technologies. 3. May reposition apparatus, lay, connect and advance hose lines; raises and climb ladders. 4. Assists in rescuing persons from dangerous situations. 5. Uses chemical extinguishers, axes, hooks, lines, power driven tools, and other equipment. 6. When necessary, and under the direction of a ranking officer, be assertive at the scene of incidents to secure and preserve life safety achieve incident stabilization and ensure property conservation. 7. Preserves, cleans, services and returns apparatus and equipment to emergency readiness. 8. Maintains and tests emergency equipment. 9. May be required to perform all duties relative to the Fort Worth Fire Department EMS Program including; act as fire department liaison for the Police Department, Careflight and Medstar and to support the contagious disease and hazardous materials response policies. 10. May act in a higher capacity as Fire Engineer and will be expected to perform all required and related duties for that rank. Page 1 of 3 11. Maintain general knowledge of response territory in order to select the most efficient route to be taken to emergency calls. 12. Meet minimum physical fitness requirements to work in fire suppression. 13. Performs other related duties as required. 14.Adheres to assigned work schedule as outlined in the Department and City attendance policies and procedures; ensures all behaviors comply with the City's Personnel Rules and Regulations. Firefighter — Staff: 1. Performs the duties of their assigned staff position in accordance with, and in support of the Fire Department's Mission Statement. 2. Assists the Training Division with the administration of training sessions relevant to their assigned staff position. 3. May act in a higher capacity as Fire Engineer and will be expected to perform all required and related duties of their immediate supervisor. 4. Performs other related duties as required. 5. Adheres to assigned work schedule as outlined in the Department and City attendance policies and procedures; ensures all behaviors comply with the City's Personnel Rules and Regulations. Other Job Functions: 1. Cleans and maintains station quarters and grounds. 2. Participates in drills and training sessions. 3. May work on assignment in any Fire Department Division. 4. Assists in company fire safety assessments of homes and business places within assigned Battalion. 5. May be required to operate a motor vehicle. 6. Operates a computer utilizing various software packages and electronic mail. 7. Performs other related duties as assigned. KNOWLEDGE, SKILLS & ABILITIES • Knowledge of: ➢ Principles and practices of fire prevention and suppression. ➢ Uses and maintenance of firefighting equipment and apparatus. ➢ Departmental rules and regulations. ➢ Geography of the city. ➢ Fire hazards and firefighting resources. Page 2 of 3 • Skill in: ➢ Application of first aid and resuscitation techniques. • Ability to: ➢ Learn the principles and practices of modern firefighting and apply techniques. ➢ React quickly and calmly (in emergencies. ➢ Learn to operate relatively complex equipment. ➢ Establishes and maintain effective working/living relationships with the public and other employees. MINIMUM JOB REQUIREMENTS High School graduate or GED. No experience required. OTHER REQUIREMENTS Valid Texas Drivers License Class "C" or equivalent and an acceptable driving record; must attend and pass training at Fort Worth Fire Training Academy; must pass Civil Service examination. WORKING CONDITIONS The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Inside/outside working conditions exposed to all extremes of the environment; exposed to toxic and non -toxic odors, fumes, dusts, mists, gases, extreme heat, and other hazards of firefighting. Typing and filing. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Lifting objects in excess of 100 lbs. with frequent lifting and/or carrying of objects weighing 50 lbs. or more; able to maintain body equilibrium when climbing and walking on slippery surfaces. Page 3 of 3 ATTACHMENT 6 FIELD INTERNSHIP AFFILIATION AGREEMENT MEDSTAR MOBILE HEALTHCARE 16 CLINICAL AFFILIATION AGREEMENT BETWEEN CSC No. 56365 CITY OF FORT WORTH AND METROPOLITAN AREA EMS AUTHORITY This Clinical Affiliation Agreement ("Agreement"), is entered into, effective this 1 st day of October, 2021, by and between the City of Fort Worth ("City") and Metropolitan Area EMS Authority dba Medstar Mobile Healthcare, a governmental agency created under the provisions of Section 773.051 of the Texas Health and Safety Code and the provisions of Chapter 791 of the Texas Government Code, which operates an emergency medical services ("EMS") agency located at 2900 Alta Mere Fort Worth, TX ("Facility"). City and Facility agree to the following: WHEREAS, Fort Worth Fire Department, a department of City ("Department") has an Emergency Medical Technology Program ("Program") through which City provides Department trainees (hereinafter referred to as "Students" or individually as "Student") academic and clinical experience. WHEREAS, City desires for Facility to provide Students with clinical experience through Facility's clinical facilities, and Facility is willing to provide such experience. ARTICLE 1. RESPONSIBILITIES OF CITY City shall: 1.1. Plan the educational activities for the Students' clinical experience at Facility after consultation with and approval by Facility. 1.2. provide qualified teachers from Department to teach the pre -requisite core curriculum and support courses in the Program; 1.3. Provide administrative functions for each Student in the Program. 1.4. Provide a faculty member at Facility to be available for consultation at all times Students are at Facility to supervise Students participating in the Program. 1.5. Instruct Students to abide by Facility's patient care policies and guidelines. Information regarding Facility's applicable policies and guidelines will be available at the time of student orientation at Facility. 1.6. If applicable, provide Facility with the appropriate forms to be used in evaluating the performance of Students in the Program. 1.7. Require Students to comply with the regulatory and accreditation standards provided by the Facility at the time of student orientation at Facility. 1.8. Provide information to each Student regarding the Hepatitis B vaccine, its efficacy, safety, method of administration and benefits of being vaccinated and suggest that Students be vaccinated for Hepatitis B. 1.9. Confirm Students have been tested for tuberculosis within one (1) year of commencement of the Program and are tested at least annually while participating in the Program and provide evidence of such testing and the results to Facility prior to commencement of the Program or upon request of Facility thereafter. 1.10. Ensure each student has current immunizations, including: Influenza, Hepatitis B, MMR, TDAP, Varicella (or titer), and a Negative TB test, and provide MedStar proof if requested. 1.11. Confirm Students have been instructed in Standard Precautions, as recommended and defined by the Centers for Disease Control and Prevention (CDC), and completed a Basic Life Support cardiopulmonary resuscitation course prior to the beginning of the Program and provide evidence of such confirmation to Facility prior to commencement of the Program or upon request of Facility thereafter. 1.12. Confirm that City is a self -insured entity and as such, generally, does not maintain a commercial liability insurance policy and that damages for which City could ultimately be found liable would be paid directly and primarily by City and not by a commercial insurance company. 1.13. At least two (2) weeks prior to commencement of the Program, provide a letter to Facility outlining the needs of Students, days and hours Students will be on patient units or service areas, names of Students and supervising faculty members, and length and dates of clinical experience. 1.14. Consider promptly any complaints made by Facility against a Student and participate in joint problem solving. Patient safety and welfare shall be the primary concern. Student issues will be documented by the Facility and communicated to the designated Faculty member and/or other representative of City. Facility may require permanent withdrawal of any Student from clinical training at or through Facility at any time for cause, as determined by Facility in its sole discretion. 1.15. Comply with Facility's substance abuse policies and, at Facility's request, remove any Student or faculty member from the Program if there is reasonable suspicion that the Student or faculty member has violated Facility's substance abuse policies. 1.16. Verify that a background evaluation, including a criminal background history in all fifty (50) states, has been performed on each Student, and verify that there are no negative findings for each Student prior to commencing any assignment at Facility. For purposes of this Agreement, a criminal background history shall include any felony conviction within the last ten (10) years. For purposes of this Agreement, a background evaluation shall include the last ten (10) years and all counties (in Texas and outside of Texas) in which the Student has been a resident of or employed in.\ 1.17. To the extent allowed by law, City shall hold Facility harmless for all claims, damages, losses, and expenses, including attorney fees, arising out of any claim for negligence resulting from the action or inaction of City, its employees, agents or Students under this Agreement for which a final judicial or other determination is made that the City, its employees agents, or Student(s) or is responsible; and 1.18. Ensure that each Student and faculty member wears a name tag, badge, or other identifying label at all times while at Facility that clearly identifies the Student or faculty members and the City. ARTICLE 2. RESPONSIBILITIES OF FACILITY Facility shall: 2.1. Provide cooperation to promote success of the Program; 2.2. Provide equipment and supplies which are necessary for clinical instruction at Facility; 2.3. Provide meeting space for Students in the Program; 2.4. Provide suitable clinical experience situations as prescribed by the curriculum provided by City; 2.5. Assist with clinical teaching and supervision of agreed upon number of Students in the Program; 2.6. Upon request by City, formally evaluate performance of Students in the Program using the form provided by City; 2.7. Retain responsibility for patient care; 2.8. Reserve the right to determine the manner in which its equipment shall be operated; 2.9. To the extent allowed by law, assume no professional or financial liability for injury to Students or faculty except that which might occur as a member of the public, unless due to Facility's negligence or gross misconduct; and 2.10. Provide access to acute emergency care at Student's expense in the event of an accident or injury to a student on Facility's campus. ARTICLE 3. RESPONSIBILITIES OF CITY AND FACILITY City and Facility shall: 3.1. Agree upon the number of Students to be placed in Facility for clinical rotations prior to the beginning of each semester in which Students are assigned to and accepted by Facility. 3.2. Mutually plan, schedule and provide an orientation of faculty and Students to Facility and assigned units. 2 3.3. Understand there will be no exchange of monies between City and Facility for this Program. 3.4. Revise or modify this Agreement in writing if both parties agree to the revisions or modifications. 3.5. Comply with all applicable federal, state, and local laws, rules, regulations, and ordinances. ARTICLE 4. TERM AND TERMINATION 4.1. This Agreement shall remain in effect for two (2) years beginning October 1 st, 2023 ("Effective Date") and ending on September 30th, 2025, unless sooner terminated as provided herein. This Agreement may be terminated by either party upon ninety (90) days written notice in accordance with Section 5.1 below. The termination shall not take effect until Students who are enrolled at the time such notice is given have completed the courses in which they are enrolled. ARTICLE 5. NOTICE 5.1. Notices. All notices provided for by this Agreement shall be made in writing either (a) by actual delivery (e.g., personally, by commercial courier service, or by confirmed telefacsimile) of the notice, or (b) by the mailing of the notice by United States Postal Service certified or registered mail, return receipt requested, and addressed to the Party to be notified at the address set forth below (or at such other address as may be given by notice by a Party). The notice shall be deemed to be received (i) if by actual delivery, on the date of its receipt by the Party, or (ii) if by mail, on the second day on which mail is delivered following the date of deposit in the United States Postal Service. If to Facility: MedStar Mobile Healthcare Attention: General Counsel 2900 Alta Mere Fort Worth, Texas 76116 If to City: Fort Worth Fire Department Attention: EMS Division 509 W. Felix St. Fort Worth, Texas 76115 ARTICLE 6. STATUS OF STUDENTS 6.1. City and Facility understand and agree that while faculty and Students are participating in the Program, faculty and students are not employees of Facility. Accordingly, faculty and Students are not entitled to any of the rights or benefits established for Facility's employees, such as salary, vacation, sick leave with pay, paid holidays, insurance, and/or worker's compensation coverage. Further, nothing herein shall be construed as creating a partnership or joint venture between City and Facility, its officers, agents, employees and subcontractors, and doctrine of respondeat superior has no application as between the City and Facility. ARTICLE 7. MISCELLANEOUS 7.1. Non-discrimination. City and Facility shall not unlawfully discriminate in their respective performance of this Agreement against any person because of age, disability, race, color, religion, sex, sexual orientation, national origin, gender expression, gender identity, transgender, familial status, or protected legal status. 7.2. Entire Agreement. This Agreement constitutes the entire agreement between the Parties, and supersedes any and all prior and contemporaneous oral or written understandings. This Agreement may not be altered, amended, or modified except by a written document executed by both parties. 7.3. Governing Law, Jurisdiction and Venue. This Agreement shall be governed by the laws of the State of Texas without regard to its conflict of laws provisions. The venue of any litigation arising from this Agreement will be in the United States District Courts, Fort Worth Division of the Northern District of Texas if the litigation arises in Federal Court or in the District Courts of Tarrant County, Texas if the litigation arises in State Court. The venue of any dispute resolution activity shall be in Fort Worth, Tarrant County, Texas. 7.4. Severability. Should any part, term, or provision of this Agreement be declared to be invalid, void, or unenforceable, all remaining parts, terms, and provisions hereof shall remain in full force and effect, and shall in no way be invalidated, impaired, or affected thereby. Each invalid provision shall be revised only to the extent necessary to bring it within the requirements of such law or regulation. 7.5. No Waiver. No waiver by City or Facility of any breach of any term, provision or condition contained in this Agreement, or the failure to insist upon strict performance thereof shall be deemed to be a waiver of such term, provision or condition as to any subsequent breach thereof or a waiver of any other term, provision or condition contained in this Agreement. The exercise of any right or remedy hereunder shall not be deemed to preclude or affect the exercise of any other right or remedy provided herein. 7.6. HIPAA Obligations. Both Parties acknowledge that they have obligations "under the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. § 1320(d) ("HIPAA") and its implementing regulations, including 45 C.F.R. parts 160 and 164, subparts A and E ("Privacy Rule") and 45 C.F.R. parts 160 and 164, subparts A and C ("Security Rule), and agree to comply with the Health Information Technology for Economic and Clinical Health Act of 2009 (42 U.S.C. 17921-53) and its implementing regulations. 7.7. Subject Headings. The subject headings of the sections, paragraphs, and subparagraphs of this Agreement are included herein solely for the purposes of convenience and reference, and shall not be deemed to explain, modify, limit, amplify, or aid in the meaning, construction, or interpretation of any of the provisions of this Agreement. This Agreement is effective as of the Effective Date set forth above and is executed by and between City and Facility through their duly authorized officers, thereby binding themselves, their successors and assigns and representatives for the faithful and full performance of the terms and provision of this Agreement. [signatures on next page] 2 ACCEPTED AND AGREED: CITY OF FORT WORTH By: Valerie Washington (Aug 28,202321:30 CDT) Name: Valerie Washington Title: Assistant City Manager Aug 28, 2023 APPROVAL RECOMMENDED: Rp� CONTRACT COMPLIANCE MANAGER: By signing I acknowledge that I am the person responsible for the monitoring and administration of this contract, including ensuring all performance and reporting requirements. 5 By: � A4 S Name: Gina Santillan Title: Assistant Director Fire APPROVED AS TO FORM AND LEGALITY: By: J s Davis 24, 2023 11:51 CDT) Name: James Davis Title: Fire Chief By. `9 P 4b44FOR t �� F°°°°°°°°°�oodd Name: Andrea Phillips ATTEST: of o�'-�$ Title: Assistant City Attorney Pv8 o=d 0 v Aan�t FX**o** CONTRACT AUTHORIZATION: By: U nn��a4 M&C: N/A Name: Janette Goodall Form 1295: N/A Title: City Secretary FACILITY: By: Ken 5( g 23, 202319:39 CDT) Name: Kenneth J. Simpson Title: Chief Executive Officer Chief Operations Officer w , .L� By: O Name: Jeffrey Jarvis, M.D. Title: System Medical Director Chief Medical Officer OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX FWFD RECRUIT EMT CLASS DAY/DATE TIME CHAPTER TOPIC MINUTES HOURS LEAD INSTRUCTOR ADJUNCT/SHILLS WEEK 1 2 Well -Being of the EMT 150 2.5 3 Lifting and Moving Patients 65 1 4 Medical, Legal & Ethical Issues 80 1.5 6 Anatomy & Physiology 105 1.75 7 Principles of Pathophysiology 150 2.5 WEEK 2 Test 1 9 Airway Management 220 3.75 10 Respiration & Artificial Ventilation 200 3.5 13 Vital Signs & Monitoring Devices 95 1.75 WEEK 3 Test 2 11 Scene Size -up 45 0.75 12 The Primary Assessment 65 1 14 Principles of Assessment 150 2.5 15 Secondary Assessment 110 2 16 Reassessment 30 0.5 WEEK Test 3 19 Respiratory Emergencies 150 2.5 20 Cardiac Emergencies 90 1.5 21 Resuscitation 115 2 22 Diabetic & Altered Mental Status 155 2.75 FWFD RECRUIT EMT CLASS TIME I CHAPTERI TOPIC MINUTES I HOURS I LEAD INSTRUCTOR ADJUNCT/SHILLS WEEK 5 Test 4 23 Allergic Reaction 90 1.5 26 Abdominal Emergencies 120 2 25 Poisoning & Ovedose Emergencies 95 1.5 27 Behavioral and Psychiatric Emergencies 105 1.75 WEEK 6 Test 5 29 Bleeding & Shock 98 1.75 30 Soft -Tissue Trauma 185 3.25 31 Chest & Abdominal Trauma 115 2 32 Musculoskeletal Trauma 100 1.75 33 Trauma to the Head, Neck, & Spine 205 3.5 WEEK 7 Test 6 35 Environmental Emergencies 170 3 36 Obstetric & Gynecological Emergencies 180 3 37 Emergencies for Patients with Special Challenges 185 3.25 WEEK Course Final Final Skills Evaluations Final Skills Evaluations Final Skills Evaluations FWFD RECRUIT EMT CLASS DAY/DATE TIME CHAPTER TOPIC MINUTES HOURS LEAD INSTRUCTOR ADJUNCT/SHILLS WEEK 9 Clinicals Clinicals Clinicals Clinicals WEEK 10 Clinicals Clinicals Clinicals Clinicals WEEK 11 NREMT NREMT NREMT NREMT EMT BASIC COURSE ENDS FWFD RECRUIT EMT CLASS Introduction to EMS 130 2.25 2 Well -Being of the EMT 150 2.5 3 Lifting and Moving Patients 65 1 4 Medical, Legal & Ethical Issues 80 1.5 dical Terminology 55 1 6 Anatomy & Physiology 105 1.75 7 Principles of Pathophysiology 150 2.5 Life Span Development 1.5 9 Airway Management 220 3.75 10 Respiration & Artificial Ventilation 200 3.5 11 Scene Size -up 45 0.75 12 The Primary Assessment 65 1 13 Vital Signs & Monitoring Devices 95 1.75 14 Principles of Assessment 150 2.5 15 Secondary Assessment 110 2 16 Reassessment 30 0.5 17 Communication & Documentation 110 2 18 General Pharmacology 135 2.25 19 Respiratory Emergencies 150 2.5 20 Cardiac Emergencies 90 1.5 21 Resuscitation 115 2 22 Diabetic & Altered Mental Status 155 2.75 23 Allergic Reaction 90 1.5 Infectious Diseases and Sepsis 150 2.5 25 Poisoning & Ovedose Emergencies 95 1.75 26 Abdominal Emergencies 120 2 27 Behavioral and Psychiatric Emergencies 105 1.75 28 Hematological & Renal Emergencies 1.5 FWFD RECRUIT EMT CLASS 29 Bleeding & Shock 98 1.75 30 Soft -Tissue Trauma 185 3.25 31 Chest & Abdominal Trauma 115 2 32 Musculoskeletal Trauma 100 1.75 33 Trauma to the Head, Neck, & Spine 205 3.5 W 34 Multisystem Trauma 65 1.25 35 Environmental Emergencies 170 3 36 Obstetric & Gynecological Emergencies 180 3 37 Emergencies for Patients with Special Challenges 185 3.'_5 38 EMS Operations 145 2.5 39 Hazardous Materials, Multi -Casualty Incidents & Incident Management 105 1.75 40 Highway Safety & Vehicle Extrication 85 1.5 41 EMS Response to Terrorism 220 3.75 Total 4993 86 ,I've Medic. f � vovement. ��1co Rile s m d � � n Area ESQ Monday, June 19, 2023 To Whom It May Concern: I serve as the EMS medical director for the Fort Worth Fire Department and their EMT education program. The affiliation agreement between the FWFD and MedStar for student clinical rotations included in the current self -study was signed by my predecessor, Dr. Veer Vithalani. We are the in the process of getting this agreement updated, but in the meantime, I am aware of the agreement, am supportive of it, and am fully committed to this EMT program and its continued success. Sincerely, Je fey L. Jarvis, MD, MS, EMT-P, FACEP, FAEMS Chief Medical Officer Office of the Medical Director Metropolitan Area EMS Authority Fort Worth, Texas Our Vision: To be an integral member of a high -quality, evidenced -based, and outcome driven mobile healthcare system. Our Mission: Build quality into the mobile healthcare system through the enrichment of clinicians.