Skills Evaluation Form

SOFT TISSUE INJURIES

IMPALED OBJECT IN THE THIGH Points √/x Remarks

1. Proper use of PPE, surveys the scene, introduce yourself and ask permission. 4
2. Stabilize patient’s thigh 3
3. Do manual stabilization of the impaled object. 4
4. Check PMS (pulse, motor and sensation) 3
5. Expose the wound 3
6. Attempt to stabilize the impaled object by using bulky dressings. 4
7. Secure the dressing in place using a bandage. 4
8. Reassess PMS (pulse, motor and sensation) 3
9. Apply pressure points on the femoral pulse if still bleeding. Indicate if patient is
4
ready for transport.
Others: Observe aseptic technique/clean working area. Provide TLC in handling the
3
patient provide emotional support.
TOTAL 35
CONTROLLING BLEEDING FROM THE FOREARM Points √/x Remarks
1. Proper use of PPE, Scene safety, Introduce yourself and ask permission. 4
2. Check PMS (pulse, motor and sensation) 3
3. Apply direct pressure using gloved hand or gauze dressings or clean cloth. 4
4. If the wound bleeds through the dressings, add more dressings. 4
5. Wrap the wound with dressings using rolled gauze bandage. 4
6. Elevate wounded extremity 4
7. Apply pressure points on the brachial pulse if still bleeding. 3
8. Reassess PMS (pulse, motor and sensation) 3
9. Indicate if patient is ready for transport. 3
Others: Observed aseptic technique/clean working area. Provided TLC in handling the
3
patient with emotional support.
TOTAL 35
EXTRUDED EYEBALL Points √/x Remarks
1. Proper use of PPE, Scene safety, Introduce yourself and ask permission. 5
2. Cover the good eye. 4
3. Cover the affected eye, using moist sterile gauze (PNSS or sterile water) 4
4. Used plastic/ styro cup to cover affected eye, wrap it with bandage. 4
5. Reassure patient. 4
6. Indicate if patient is ready to transport. 4
Others: Observed aseptic technique/clean working area. Provided TLC in handling the
5
patient with emotional support.
TOTAL 30
Name:_________________________________________________________ Date:_________________ Group:_____________

Score: ________________
Minimum passing score: 80 points

Instructor’s Name: ________________________________

Instructor’s Signature: _____________________________

COMMENTS: _________________________________