EMERGENCY DEPARTMENT SKILLS CHECKLIST One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyWork SettingsLevel I Trauma Center(Required) 1 2 3 4 Level II Trauma Center(Required) 1 2 3 4 Non-Trauma Center Emergency Department(Required) 1 2 3 4 Pediatric Emergency Department(Required) 1 2 3 4 Emergency Department - Combined Adult/Pediatric(Required) 1 2 3 4 Critical Care Transport(Required) 1 2 3 4 CardiacAcute Coronary Syndrome(Required) 1 2 3 4 Aneurysm(Required) 1 2 3 4 Congestive Heart Failure/Pulmonary Edema(Required) 1 2 3 4 Cardioversion(Required) 1 2 3 4 Transcutaneous Pacemaker(Required) 1 2 3 4 Heart Sound(Required) 1 2 3 4 PulmonaryRespiratory Failure(Required) 1 2 3 4 COPD/Asthma(Required) 1 2 3 4 Aspiration(Required) 1 2 3 4 Pneumonia(Required) 1 2 3 4 Pneumo/Hemothorax(Required) 1 2 3 4 Chest Tube Insertion/Management(Required) 1 2 3 4 Pulmonary Embolism(Required) 1 2 3 4 Tuberculosis(Required) 1 2 3 4 External CPAP/BiPAP(Required) 1 2 3 4 Intubation(Required) 1 2 3 4 Ventilated Patients(Required) 1 2 3 4 ABG Interpretation(Required) 1 2 3 4 NeurologicalCVA(Required) 1 2 3 4 Stroke Scale(Required) 1 2 3 4 Brain Injury(Required) 1 2 3 4 Glascow Coma Scale(Required) 1 2 3 4 Spinal Cord Injury(Required) 1 2 3 4 Meningitis(Required) 1 2 3 4 Seizures(Required) 1 2 3 4 OrthopedicsFractures/Casting(Required) 1 2 3 4 Open/Complex Fractures(Required) 1 2 3 4 Apply/Manage Splints(Required) 1 2 3 4 Circulation Checks(Required) 1 2 3 4 GastrointestinalGI Bleeding(Required) 1 2 3 4 Liver Disease(Required) 1 2 3 4 GI Obstruction(Required) 1 2 3 4 Abdominal Pain/Distress(Required) 1 2 3 4 Gastric Tubes(Required) 1 2 3 4 Renal/GUAcute Renal Failure(Required) 1 2 3 4 Renal Calculi(Required) 1 2 3 4 Renal Trauma(Required) 1 2 3 4 Testicular Torsion(Required) 1 2 3 4 EndocrineHypoglycemia(Required) 1 2 3 4 Hyperglycemia(Required) 1 2 3 4 DKA(Required) 1 2 3 4 Wound ManagementSkin Integrity Assessment(Required) 1 2 3 4 Wound Repair(Required) 1 2 3 4 Shock/TraumaInjury Severity Score(Required) 1 2 3 4 Trauma Code(Required) 1 2 3 4 Trauma Team Member(Required) 1 2 3 4 Major Trauma(Required) 1 2 3 4 Traumatic Amputation(Required) 1 2 3 4 Peritoneal Lavage(Required) 1 2 3 4 Hypovolemic Shock(Required) 1 2 3 4 Neurogenic Shock(Required) 1 2 3 4 Anaphylactic Shock(Required) 1 2 3 4 Septic Shock(Required) 1 2 3 4 Cardiogenic Shock(Required) 1 2 3 4 Burns - 2nd Degree(Required) 1 2 3 4 Burns - 3rd Degree(Required) 1 2 3 4 Infectious Disease/Immunosuppressed PatientsContagious/Infectious Patients(Required) 1 2 3 4 Isolation(Required) 1 2 3 4 Neutropenia/Reverse Isolation(Required) 1 2 3 4 Women's HealthPlacenta Abruptio/Previa(Required) 1 2 3 4 Precipitous Delivery(Required) 1 2 3 4 Pregnancy Induced Hypertension(Required) 1 2 3 4 Fetal Heart Tones(Required) 1 2 3 4 Sexual Assault(Required) 1 2 3 4 Reporting Acts of Violence(Required) 1 2 3 4 PediatricsManagement of Pediatric Emergency Patients(Required) 1 2 3 4 Identification/Reporting Abuse(Required) 1 2 3 4 Abdominal Pain(Required) 1 2 3 4 Epiglottitis(Required) 1 2 3 4 Asthma/Reactive Airway Disease(Required) 1 2 3 4 Fractures(Required) 1 2 3 4 Head/Spinal Injury(Required) 1 2 3 4 Poison Ingestion(Required) 1 2 3 4 Seizures(Required) 1 2 3 4 Sickle Cell Crisis(Required) 1 2 3 4 PsychiatricAcute Psychotic Patient(Required) 1 2 3 4 Managing Violent Behavior(Required) 1 2 3 4 Drug /ETOH Overdose/Withdrawal(Required) 1 2 3 4 Psychiatric Hold(Required) 1 2 3 4 Suicidal Patient(Required) 1 2 3 4 MiscellaneousBites- Animal/Snake/Human(Required) 1 2 3 4 Hazardous Material Exposure(Required) 1 2 3 4 Heat Exhaustion/Stroke(Required) 1 2 3 4 Drowning(Required) 1 2 3 4 IV TherapyStarting IVs(Required) 1 2 3 4 Central Line Placement(Required) 1 2 3 4 Intraosseous Infusion(Required) 1 2 3 4 Blood Product Administration(Required) 1 2 3 4 MedicationsAnti-Arrhythmics(Required) 1 2 3 4 Anticoagulants (IV, oral, & injection)(Required) 1 2 3 4 Anti-Hypertensives(Required) 1 2 3 4 Anti-Psychotics(Required) 1 2 3 4 Anti-Seizure Medications(Required) 1 2 3 4 Benzodiazepines(Required) 1 2 3 4 Continuous IV Paralytics(Required) 1 2 3 4 Continuous IV Sedation(Required) 1 2 3 4 Procedural Sedation - Administration(Required) 1 2 3 4 Emergency Medications(Required) 1 2 3 4 Inhaled Medications(Required) 1 2 3 4 Insulin(Required) 1 2 3 4 IV Vasopressors(Required) 1 2 3 4 Narcotics/Opioid Analgesics (IV, oral, & injection)(Required) 1 2 3 4 Nitrates (Oral & Topical)(Required) 1 2 3 4 Non-Opioid Analgesics (IV, Oral, & Injection)(Required) 1 2 3 4 Reversal Agents(Required) 1 2 3 4 Thrombolytic Therapy(Required) 1 2 3 4 Steroids (IV, Oral, Inhaled)(Required) 1 2 3 4 Automated Medication Dispensing (i.e. Pyxis, Omnicell)(Required) 1 2 3 4 Cardiac Monitoring & Emergency ResponseDysrhythmia Interpretation(Required) 1 2 3 4 Dysrhythmia Management(Required) 1 2 3 4 Obtain 12 Lead EKG(Required) 1 2 3 4 Interpret 12 Lead EKG(Required) 1 2 3 4 Management of Cardiac Arrest(Required) 1 2 3 4 Professional Knowledge & SkillsTriage(Required) 1 2 3 4 Ambulance/Paramedic Radio(Required) 1 2 3 4 Charge Experience(Required) 1 2 3 4 AMA Procedures(Required) 1 2 3 4 EMTALA(Required) 1 2 3 4 National Patient Safety Goals/Core Measures(Required) 1 2 3 4 Fall Risk Assessment/Prevention(Required) 1 2 3 4 Pressure Ulcer Risk Assessment/Prevention(Required) 1 2 3 4 Restraints/Use of Least Restrictive Device(Required) 1 2 3 4 Patient/Family Teaching(Required) 1 2 3 4 Age Specific/Population-Based Care(Required) 1 2 3 4 Isolation Precautions(Required) 1 2 3 4 Infection Prevention(Required) 1 2 3 4 Pain Assessment & Management(Required) 1 2 3 4 Interpretation and Communication of Lab Values(Required) 1 2 3 4 Age Specific CompetenciesInfant (Birth - 1 year)(Required) 1 2 3 4 Preschooler (ages 2-5 years)(Required) 1 2 3 4 Childhood (ages 6-12 years)(Required) 1 2 3 4 Adolescents (ages 13-21 years)(Required) 1 2 3 4 Young Adults (ages 22-39 years)(Required) 1 2 3 4 Adults (ages 40-64 years)(Required) 1 2 3 4 Older Adults (ages 65-79 years)(Required) 1 2 3 4 Elderly (ages 80+ years)(Required) 1 2 3 4 EMREpic(Required) 1 2 3 4 Cerner(Required) 1 2 3 4 Eclipsys(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 Meditech(Required) 1 2 3 4 Allscripts(Required) 1 2 3 4 Other Computerized System(Required) 1 2 3 4 Computerized Physician Order Entry(Required) 1 2 3 4 Bar Coding for Medication Administration(Required) 1 2 3 4 EMR Conversion(Required) Yes No CertificationsBLS(Required) Yes No BLS Expiry DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ACLS(Required) Yes No ACLS Expiry DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PALS(Required) Yes No PALS Expiry DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PEARS(Required) Yes No PEARS Expiry DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920TNCC(Required) Yes No TNCC Expiry DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ENPC(Required) Yes No ENPC Expiry DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CEN(Required) Yes No CEN Expiry DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Other Certification Other ExpirationMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Other Certification 2 Other 2 ExpirationMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below. Scope of Consent By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below. Paper Copies You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies. Withdrawal of Consent You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below. Withdrawing your consent, requesting a paper copy, or updating your contact information You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices. “Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address. “Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy . “Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number. The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.