Team Leader Evaluation
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Hour
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Minutes
Evaluator
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Student
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Scenario
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Please Select
Adult - ACLS - Mega Code Scenario 1
Adult - ACLS - Mega Code Scenario 2
Adult - ACLS - Mega Code Scenario 3
Adult - ACLS - Mega Code Scenario 4
Pediatric - PALS - Mega Code Scenario 1
Pediatric - PALS - Mega Code Scenario 2
Pediatric - PALS - Mega Code Scenario 3
Pediatric - PALS - Mega Code Scenario 4
Pediatric - Medic Class - Drowning
Leadership
Directed team members to perform tasks with appropriate timeliness, prioritization/sequence
Maintained accountability for team's actions/outcomes
Demonstrated confidence, compassion, maturity and command presence
Maintained situational awareness (avoided task overload, unresolved conflict, tunnel vision, distracted, or failure to recognize danger to crew, patient and/or bystander)
Flexibility
Adapted treatment plan and sequence as information became available
Listened to teammates
Reconciled incongruent information
Communication
Used closed loop communication
Reported progress on tasks
Communicated clearly and professionally with team members and others
Communicated accurately and concisely while listening and encouraging feedback
Provided succinct and accurate verbal report
Affective
Established a basic rapport with the patient
Demonstrated confidence, compassion, and maturity
Delegated and listened to all, regardless of rank or experience
Interacted with patient and crew in a professional manner
Scene Size-up
Took charge
Took appropriate safety precautions
Managed scene by delegating tasks and requesting necessary resources
Addressed any safety concerns and was safety conscious at all times
Patient assessment and management
Performed appropriate primary survey within 3min (AVPU, ABC, CPR, Spinal stabilization, etc)
Created, implemented and revised an acceptable plan of action according to the patient's presentation
Assessed situation and resources accurately and modified accordingly
Performed tasks accurately and in a timely manner
Utilized appreciative inquiry (spoke directly and respectfully, solicited input/feedback from team member(s))
Determined chief complaints, mechanism of injury, associated symptoms
Received, processed, verified and prioritized information
Obtained vitals signs, performed secondary assessment, identified pertinent negatives
Obtained pertinent medical history (SAMPLE/OPQRSTU)
Created an appropriate list of differential diagnoses
Made accurate clinical judgments about patient acuity
Developed a treatment plan and implemented appropriate treatments based on patient information
Critical Criteria
Failed to take or verbalize appropriate PPE precautions
Failed to recognize life threatening injuries or illness
Failed to properly address safety concerns
Failed to provide spinal precautions when indicated
Failed to complete management of the patient given the time limit
Failed to transport within 10 minutes for a critical patient
Failed to correct any dangerous or inappropriate intervention
Failed to suggest corrective action if a harmful intervention was ordered or performed by others
Failed to manage the patient as a competent EMT
Exhibited unacceptable affect with patient or other personnel
Used or ordered a dangerous or inappropriate intervention
Evaluator Comments
Was the student successful or unsuccessful in this skill?
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Successful
Unsuccessful
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