Research, Training and Quality Improvement
Electronic Recruit EMT Response Evaluation

                                Incident Number:  E 
                                Nature Code:     
                                Date:           Field Training Officer: 
                                Recruit/Driver: Recruit/Attendant: 
                                Disposition Code: 

Rating:  N/A= Not Applicable  1= Does Not Meet Standard   2= Meets Standard   3= Exceeds Standard
Document all items with an asterisk (*) and all items rated 1 or 3 in the Comments Column

A. Call Management

Comments
1. Scene Management
2. Safety
     a. Scene
     b. Patient Compartment
3. Demeanor
     a. Appearance
     b. Call
     c. Learning
4. Communication
     a. Basic Radio/MDT
     b. Interpersonal
     c. C-MED
     d. At Hospital
5. Unit Preparation
     a. Daily
     b. Post Call
6. Documentation
B. Patient Assessment
1. Initial/Rapid
2. Focused/Detailed
3. Vital Signs
4. History/Mechanism
5. Diagnoses
     a. Differential
     b. Working
6. On-going
C. Patient Treatment
1. Treatment
2. Airway/O2 Therapy
3. Loads and Lifts
4. C-Spine Immobilization
5. Specialty Skills*
6. Total Patient Care
7. Crisis Intervention*
8. Special Documentation*
D. Driving
1. Vehicle Maintenance
2. Vehicle Operations
3. Geography
4. Assist Partner/Interface
I understand that by entering my name in the box below and hitting the "submit" button, a copy of this report will be instantly transmitted to the Recruits named above as well as to members of the Boston EMS Research, Training and Quality Improvement Bureau.

Electronic Signature (enter your full name)