Skill Station D – Disability

ATLS Instructor Evaluation Form

Skill Station D – Disability

Ονοματεπώνυμο *

Skill Performance Disability

Perform a brief neurologic examination, which includes: A. Calculating the Glasgow Coma Scale score B. Performing pupillary examination C. Examining for lateralizing signs *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Identify the utility and limitations of head CT decision tools. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Identify the utility and limitations of cervical spine decision tools. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Perform proper evaluation of the spine while restricting spinal motion, including: A. Evaluation the spine B. Performing the logroll and removing a backboard C. Reviewing cervical spine imaging D. Reviewing head CT images. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Identify the signs, symptoms, and treatment of neurogenic shock. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Demonstrate helmet-removal technique. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Identify signs and symptoms of spinal cord injury in a simulated patient. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Demonstrate a "hand off" of a neurotrauma patient to another facility or practitioner. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Demonstrates / instructs others in skill *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Overall: knowledge, skills, attitude for this skill *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

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