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Return to Practice Individual Needs Self-Assessment

The goal of CPER’s Return to Practice (RTP) process is to offer a Paramedic the opportunity to reorient themselves to the clinical environment after a period of absence, in a supportive and educational manner. Please complete this form and return it to your Service. The information gathered will be used in a partnership approach with you to develop your Individualized RTP plan and to help prepare you for a safe return to the road. Confidence in a particular area is important to recognize while we touch base
in all required areas.

Please select the date
Please enter the employee name
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If your date of last clinical activity is ≥90 days and ≤180 days, please check one of the following boxes:
If your date of last clinical activity is ≥90 days and ≤180 days, please check one of the following boxes:
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As you have been away from active paramedic practice for some time, we would like you to reflect on your current comfort level with the listed skills below, from 1-5.

Cardiac

  • Cardiac Ischemia
  • Tachydysrhythmia
  • Bradyarrhythmia
  • ACPE
  • Cardiac Arrest (medical, hypothermia, FBAO, pediatric, neonatal)
  • ROSC
  • Cardiogenic Shock
  • Hyperkalemia
Select one: 1-3 Needs Review , 4-5 Confident
Select one: 1-3 Needs Review , 4-5 Confident



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Respiratory

  • Salbutamol
  • CPAP
  • Epinephrine [croup,asthma, anaphylaxis]
  • Tracheostomy Tube
  • Emergency Care (Reinsertion, Suctioning)
Select one: 1-3 Needs Review , 4-5 Confident
Select one: 1-3 Needs Review , 4-5 Confident



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LOC

  • Hypoglycemia
  • Seizure
  • Opioid Toxicity
  • Adrenal Crisis
  • Combative patient
Select one: 1-3 Needs Review , 4-5 Confident
Select one: 1-3 Needs Review , 4-5 Confident



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Procedural

  • IM drug administration
  • IV initiation
  • IO initiation
  • Airway adjuncts (NPA,OPA, intubation, SGA,Bougie)
  • Needle Thoracostomy
  • Emergency Dialysis Disconnect
  • Taser Probe Removal
  • Emergency Childbirth
Select one: 1-3 Needs Review , 4-5 Confident
Select one: 1-3 Needs Review , 4-5 Confident



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