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Competitors
(Particpant ID / Member ID / Team ID)
Chapter Name/Number
Judge NameJudge Phone

Minimum Criteria

Competitors/Teams that dont meet these minimum criterion may still participate in and complete their event, be scored, and receive feedback but are disqualified from awards, ranking, and placement.

Judges must circle MET or DQ for each item.

Must wear gloves in Scene EntryMetDQ
Must stay within the 10 minute time limit ( Overall Response )MetDQ
CriteriaScore RangeJudgeTotalGrand Total

Scene Entry

Advises dispatch of arrival0 - 1
Verbalizes that the scene is safe0 - 1
Verbalizes BSI0 - 1
Scene Entry Total

Assessment and Activation

Checks patient for responsiveness0 - 1
Verbalizes they are checking for breathing0 - 1
Verbalizes they are looking for medical jewelry0 - 1
Verbalizes they are looking for an injury0 - 1
Radios to dispatch/incoming medics a report on the patient0 - 1
Gives adequate information to dispatch/incoming medic about patient status0 - 5
Assessment and Activation Total

Cycle 1 of CPR (30:2)

Performs high quality compressions0 - 2
Hand placement on the lower half of the sternum0 - 1
30 compressions in no less than 15 seconds and no more than 18 seconds0 - 1
Compresses at least 2 inches0 - 1
Complete recoil after each compression0 - 1
Measures OPA properly0 - 1
Places OPA correctly and smoothly0 - 2
Gives 2 breaths with BVM0 - 1
Each breath given over 1 second0 - 2
Visible chest rise with each breath0 - 2
Resumes compressions in less than 10 seconds0 - 1
Cycle 1 of CPR (30:2) Total

Cycle 2 of CPR (30:2)

Performs high quality compressions0 - 2
Hand placement on the lower half of the sternum0 - 1
30 compressions in no less than 15 seconds and no more than 18 seconds0 - 1
Compresses at least 2 inches0 - 1
Complete recoil after each compression0 - 1
Gives 2 breaths with BVM0 - 1
Each breath given over 1 second0 - 2
Visible chest rise with each breath0 - 2
Resumes compressions in less than 10 seconds0 - 1
Cycle 2 of CPR (30:2) Total

AED

Powers on AED0 - 1
Correctly attaches pads0 - 1
Clears for analysis0 - 1
Clears to safely deliver a shock0 - 1
Resumes compressions immediately after shock delivery0 - 1
Continues compressions until advised to stop by judge0 - 1
AED Total

Stopping Bleeding and Bandaging

Applies pressure to bleeding area0 - 1
Ensures the victim stays calm0 - 5
Adds more dressings and presses harder0 - 1
Elevates the limb adequately0 - 2
Applies training tourniquet properly (if needed)0 - 1
Verbalizes time is noted when the training tourniquet is applied0 - 1
If training tourniquet is needed, it was applied at the appropriate time.0 - 2
Stopping Bleeding and Bandaging Total

Epinephrine Pen

Determines if an epinephrine pen is needed0 - 1
Holds the epinephrine pen in fist0 - 1
Takes off safety cap0 - 1
Presses epinephrine pen firmly against outer side of thigh for 10 seconds0 - 1
Removes epinephrine pen and rubs injection site for 10 seconds0 - 2
Verbalizes time epinephrine pen administered0 - 1
Epinephrine Pen Total

Overall Response

Remains calm0 - 5
Knows how to respond to the scenario0 - 5
Acts quickly0 - 5
Overall Response Total

Grand Total

81 Possible Points

Check Boxes for Applicable

NoShow

  

Disqualified

  
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