Emergency Oxygen Skills Sheet
Student Name
Instructor Name
Test Date
Instructor Number
Review the Skills Sheet with students and explain the required steps. During the skill check give assessment information, but not correct actions to take. Check off each step as it is performed successfully. If the student fails any portion of the skill check, practice, provide feedback, and retest the entire skill. Use as many skills sheets as required until proficient.
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Skill Check 1: Attach Regulator and Use Nasal Cannula Required Action
1.
Assess Environment and Equipment: Ensure it is safe for use.
2.
Clear Cylinder Valve: Slowly open and close the valve to expel particles. Use an oxygen wrench if needed.
3.
Attach Pressure Regulator: Insert o-ring, line up regulator pins w/ holes on valve, slip regulator over valve. Attach regulator using thumbscrew until hand tight.
4.
Charge Pressure Regulator: Turn pressure gauge away from rescuer and bystanders, open valve (counterclockwise) one full turn.
5.
Check Equipment: Read pressure gauge to determine amount of oxygen in cylinder, listen to tank to ensure an airtight seal.
6.
Use Nasal Cannula: Connect tubing to regulator, adjust flow rate to 6 LPM, listen for flow of oxygen. Carefully insert prongs, wrap each side around ears, secure adjusting band.
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Skill Check 2: Prepare and Use Non-Rebreather Mask Required Action
1.
Select Correct Size Mask: Select correct size mask based on manikin or volunteer.
2.
Connect Tubing & Select Liter Flow: Ensure cylinder valve is open, connect oxygen tubing. Select flow rate of 15 LPM; listen for flow of oxygen.
3.
Fill Oxygen Reservoir: Place thumb or finger over one-way valve inside mask until oxygen reservoir is filled.
4.
Apply Mask: Place mask over face, starting at bridge of nose. Ensure mask fits over mouth and nose; apply elastic band so mask fits snugly. Instruct patient to breathe as normally as possible.
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Comments
Comments
Skill Check 3: Prepare Bag Mask for Use with Emergency Oxygen Required Action Comments
1.
Select Correct Size Bag Mask: Select correct size bag and mask based on manikin or volunteer.
2.
Assemble Bag Mask: Attach face mask to top of bag. Ensure bag is fully expanded; attach oxygen reservoir to base of bag.
3.
Connect Tubing & Select Liter Flow: Connect oxygen tubing to pressure regulator, select flow rate of 15 LPM. Listen for flow of oxygen.
Instructor Signature ©2012 EMS Safety
Date Emergency Oxygen Administration
Version A