IWVRS_Daily_Observation_Report

IWVRS Daily Observation Report, EMT-B-P

Utilization of this form is to track precepting members and students as they move through IWVRS programs. FTO's, members, and students should understand that a low "grade" is expected durning the beginning shifts of these programs.

FTO, you are expected to acutely capture the current ability and knowledge of each student or Precepting members utizilizing a 1-5 scale or NA if skill does not apply. Please follow the guidance below for accurate "grading".

1 - represents frequent failure in knowledge, management, and skills. (Beginner)

2 - represents inconsistency in knowledge, management, and skills, needing prompting in multiple aspects. (Novice)

3 - represents consistency in knowledge, management, and skills with little prompting from mentor. (proficient)

4 - represents consistency in knowledge, management, and skills with no prompting from mentor. (Competent)

5 - represents an expert level clinician. While we should all strive for this level, it would be extremely rare to be at this level.
FTO Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preceptee/ student name
Preceptee / student level
Total Hours
Shift Start
Shift End
Total Patient Contacts
Attendance & Professional Behavior
Punctuality / Preparedness Professional appearance & demeanor Communication with staff, patients, peers Teamwork & adaptability Ethical behavior / integrity Cultural sensitivity / patient respect
Knowledge Application & Scene Management
Scene safety & situational awareness Patient assessment sequence (primary/secondary) Clinical decision-making / prioritization Use of scene time effectively Leadership / command presence (Paramedic focus)
Airway management
(BVM, OPA/NPA, advanced airway) Oxygen administration / ventilation
IV/ IO initiation & medication administration
Cardiac monitoring
ECG use, placement, and interpretation
Management of a trauma patient
Falls, hemorrhage, MVA, ect.
Management of a medical patient
Sick person, stroke, heart problems, ect
Special Populations
OB, behavioral, pediatric, ect
Critical Thinking & Clinical Judgment
Interpretation of patient findings Anticipation of patient needs Selection of appropriate interventions Evaluation of response to interventions
Documentation & Communication
Completeness & accuracy of PCR / documentation Verbal report to receiving facility Use of medical terminology Radio communications (if applicable)
Cognitive Knowledge
Psychomotor Skills
Affective Domain
The manner in which things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes, are dealt with.
FTO Summary
Strengths Observed
Areas for Improvement
Recommendations for Next Shift
FTO Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preceptee/ student comments
Preceptee/ Student Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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Should be Empty:

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