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Date
* Applicant's Name: Last
Middle Initial
* First
To ArdorHealthSolutions Healthcare Professionals:
The following checklist is a profile used to assess your clinical proficiency and assist in matching your skills with available assignments. Your employment is not dependent upon responses given in this checklist. Please rate your ability as accurately as possible by checking the appropriate box.
The information I have given here is true and accurate to the best of my knowledge. In addition, I also authorize ArdorHealthSolutions to release this skills checklist to client institutions of ArdorHealthSolutions in relation to my employment with that institution.
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* Date
Please Mark Your Level of Experience 1 - No Experience: Theory / Observed Only 2 - Intermittent Experience: < 5 Times Per Year; Needs Review 3 - Moderate Experience: > 5 Times Per Year; May Need Minimal Resource 4 - Competent: Performs on Daily or Weekly Basis; Proficient
Advanced Trauma Management
1
2
3
4
Cardiovascular
Care of Burn Patients
Care of the Patient With:
Blunt Trauma to Chest/Abdomen
Flail Chest
Gunshot/Stab Wound
Hypothermia
Care of Traumatic Amputation
Chest Tube Insertion
ED Thoracotomy
ICP Monitor Insertion
Administration of Osmotics
Principles of ICP Control
IV Line Insertion with 16 Gauge or Larger
MAST Pants:
Application of
Contraindications for Use
Removal of
Peritoneal Lavage
Principles of C-Spine Immobilization
Backboard
KEDS Jacket
Philadelphia Collar
Principles of Fluid Resuscitation
Trauma Assessment
Primary Survey
Secondary Survey
Trauma Score
Use of Rapid Infuser/Pressure Infuser
Angiography
Arrhythmia Recognition
Automate BP Monitor
Cardiac Monitoring Equipment:
Lead Placement of Electrodes
Management of Bedside Monitor
Management of Central Station
Cardiac Pacing Catheter
Cardiopulmonary Resuscitation:
Administration of Emergency Medicines
Perform CPR
Perform Defibrillation
Use of Ambu Bag
Cardioversion:
Interpretation of Monitor
Preparation
Test Synchronization
Care of Patient with Shock:
Anaphylactic
Cardiogenic
Hypovolemic
Neurogenic
Septic
Doppler
EKG:
Ability to Run 12 Lead
Identify Changes on 12 Lead
Heart Sounds: Recognition and Causes
MAST Suit:
Indications for Use
Management
Open Chest Heart Massage
Pacer Insertion Protocol:
External Pacemaker
Temporary Transvenous
Transthoracic
Pericardiocentesis:
Indications
Knowledge of Procedure
Peripheral Pulses
Recognition/Management of Dehydration
Rotation Tourniquets
Streptokinase Procedure:
Indication
Patient Management
Tissue Plasminogen Activator (TPA):
Gastrointestinal
Abdominal Assessment
Bowel Sounds
Care of Patient with:
Abdominal Trauma
Abdominal Wound
GI Bleed
Colostomy Care
Nasogastric Tube:
Insertion
Instillation
Irrigation
Lavage
Medication
Suction
General Emergency Skills
Blood Glucose Monitoring Device
Abusive Behavior
Overdose
Suicidal Behavior
Use of Restraints
Champion Trauma Score
EENT:
Ear Irrigations
Eye Irrigations
Eye Patch Application
Nasal Packing
Remove Contact Lens
Visual Acuity
Hemodialysis
Insertion of Catheters:
Foley
Suprapubic
Isolation Procedures
Kidney Stones
Knowledge of Triage Procedure
Lab Values
Perioneal Dialysis
Poison Index
Protocol for Psycho/Social Intervention:
Child Abuse Exam
Crisis Intervention
Rape Examination
Protocol for Venomous Bites
Recognition/Management of Diabetic Patient
Renal Failure
Shunts/Fistulas
