Paramedicine Clinical Skill Assessment Guide: Femoral Traction Splint and Needle Chest Decompression

Paramedicine Clinical Skill Assessment Framework & Marking Rubric

• Institutional Framework: Paramedicine Discipline, University of the Sunshine Coast (CRICOS Provider Number: $01595\text{D}$).
• Assessment Administrative Metadata:
  • Student ID Number
  • Student Name
  • Assigned Mark
  • Assessment Room / Location
  • Assessor Name
  • Attempt Classification: First Attempt vs. Resubmission
  • Assessment Date and Time
  • Evaluated Skill Title
• Core Marking Criteria Definitions:
  1. Skilful Practice: The seamless application of skill with no errors.
  2. Disorganised Practice: Does not follow recommended practice or proper clinical sequencing.
  3. Inefficient Practice: Does not add value or use time efficiently.
  4. Unsafe Practice: Indicates that the student is unrehearsed, unfamiliar with equipment, or unable to identify and solve clinical problems.
  5. Critical Error: Any omission or action that has the potential to do harm to the client or negatively impact client outcomes. This includes frequent prompting ($> 2$ prompts) or an inability to identify or remedy issues post-prompt, as this indicates an inability to work under indirect supervision. Assessors must provide mandatory explanatory comments whenever a critical error or practice defect occurs.
• Performance Levels and Score Allocations:
  • Proficient Practice ($5$ marks): Performance met criteria standards in all aspects, demonstrating safe, skilful, efficient, and considered practice.
  • Met Criteria Standards ($3.75$ marks): Performance met criteria standards in all aspects at the minimum level to demonstrate safe completion of the clinical practice, but there was evidence of disorganised or inefficient practice.
  • Safe ($2.5$ marks): Performance met criteria standards in all aspects at the minimum level to demonstrate safe completion of the clinical practice, but there was evidence of disorganised or inefficient practice, and multiple attempts were taken to perform the skill or prompting was required. Alternatively, performance met the criteria standards for 'Safe' or higher during a resubmission.
  • Unsafe ($0$ marks): Performance did not meet criteria standards in one or more aspects, demonstrated unsafe practice, or a critical error was made.
• Feedback Requirement: A summary of comments and feedback must be documented post-assessment.

Femoral Traction Splint (Slishman) Protocol

• Required Equipment:
  • Alcohol-based hand rub
  • Femoral traction splint (Slishman system)
• Individual Component Identification:
  • Ankle strap with end cap
  • Extension pole with adjusters and thigh belt
  • Mid-leg strap
• Clinical Indications:
  • Femoral fractures involving the shaft
• Clinical Contraindications:
  • Fracture or dislocation of the knee (must be explicitly verbalised to the examiner)
• Potential Complications:
  • Iatrogenic injury
• Critical Errors:
  • Non-adherence to infection control procedures
  • Failure to complete procedure in allocated time
  • Failure to irrigate open fractures prior to application of the traction splint
  • Sudden release of traction by releasing the black clamp once traction has been applied
  • Incorrect use of equipment
• Step-by-Step Clinical Procedure:
  • Initial Hand Hygiene:
    • Perform hand hygiene using alcohol-based hand rub.
  • Patient Preparation:
    • Gain consent if possible.
    • Discuss indication/s and explain the procedure to the patient.
    • Discuss benefits and material risks of the proposed intervention.
    • Discuss alternative treatment options where available.
    • Gain informed verbal consent.
    • Verbalise contraindications to the examiner.
  • Equipment Assembly:
    • Collect the required equipment.
    • Identify individual components to ensure the splint is complete (ankle strap with end cap; extension pole with adjusters and thigh belt; mid-leg strap).
  • Pre-Procedure Preparation:
    • Perform hand hygiene with alcohol-based hand rub.
    • Ensure the patient's affected limb is exposed.
    • Perform a neurovascular assessment of the affected limb.
    • Ensure adequate analgesia has been administered.
    • Ensure open wounds have been irrigated with at least $2\,\text{litres}$ ($\ge 2\,\text{litres}$) of $\text{NaCl}$ solution and dressed if required.
  • Procedure Execution:
    • Firmly apply the ankle strap just superior to the lateral malleolus on the affected limb, ensuring that the end cap is positioned laterally with the opening of the end cap facing cephalad.
    • Place the male buckle of the groin strap on the anterior thigh and pass the female buckle behind the patient's thigh.
    • Connect the male and female buckles and tighten the groin strap.
    • Loosen the distal (black) thumb screw and extend the pole, inserting the pole into the ankle strap end cap.
    • Once the desired length is obtained, fasten the distal (black) thumb screw.
    • Loosen the proximal (red) thumb screw and pull the traction cord to apply the desired amount of traction. Note: A second clinician may provide concurrent traction from the distal end of the splint to assist in achieving appropriate traction.
    • Once desired traction is achieved, maintain traction with the traction cord and fasten the proximal (red) thumb clamp. Note: Do not release the traction cord until the proximal (red) thumb clamp has been tightened.
    • Attach the mid-leg strap to the splint and fasten to the patient's leg, distal to the knee.
  • Post-Procedure Management:
    • Reassess and document neurovascular status of the affected limb post-traction.
    • If adjustment is required: maintain traction with the traction cord prior to loosening the proximal (red) thumb clamp to prevent sudden release of traction; adjust as necessary and retighten the red thumb clamp while still holding the cord; reassess and document neurovascular status of affected limb post-adjustment.

Needle Chest Decompression (Cannula) Protocol

• Required Equipment:
  • Alcohol-based hand rub
  • Nitrile gloves
  • Protective eyewear
  • Bluey (clean field pad)
  • Appropriate size cannula
  • Alcohol swab
  • Sharps disposal container
• Cannula Selection Guidelines:
  • Patient Weight $15\text{--}50\,\text{kg}$: Use a $14\,\text{gauge}$ cannula.
  • Patient Weight $< 15\,\text{kg}$: Use a $16\,\text{gauge}$ cannula.
• Clinical Indications:
  • Cardiac arrest with suspected chest trauma
  • Suspected tension pneumothorax
• Clinical Contraindications:
  • Nil in this emergency setting (must be explicitly verbalised to the examiner)
• Potential Complications:
  • Infection
  • Pneumothorax (if initial diagnosis is incorrect)
  • Perforation of structures within the chest (e.g., heart, lungs, major blood vessels)
  • Intercostal neuralgia
• Critical Errors:
  • Non-adherence to infection control procedures
  • Incorrect use of equipment
  • Failure to complete procedure within allocated time
  • Unsafe disposal of needle/sharp
  • Incorrect placement
• Step-by-Step Clinical Procedure:
  • Initial Hand Hygiene:
    • Perform hand hygiene with alcohol-based hand rub.
  • Patient Preparation:
    • Gain consent if possible.
    • Discuss indication/s and explain the procedure to the patient.
    • Discuss benefits and material risks of the proposed intervention.
    • Discuss alternative treatment options where available.
    • Gain informed verbal consent.
    • Verbalise contraindications to the examiner.
    • Expose patient's chest, maintaining modesty where possible.
  • Equipment Assembly & Field Preparation:
    • Collect required equipment.
    • Perform hand hygiene with alcohol-based hand rub.
    • Prepare a clean field (i.e., bluey).
    • Select an appropriate size cannula based on patient weight and open onto the clean field.
    • Ensure a sharps container is nearby to the patient.
  • Pre-Procedure Preparation:
    • Perform hand hygiene with alcohol-based hand rub.
    • Locate the $2\text{nd}$ intercostal space, midclavicular line in the affected hemithorax/es.
    • Clean selected site with an alcohol swab, starting at a central point and moving the swab in a circular motion outwards; dispose in bin and allow site to completely dry prior to insertion.
    • Don protective eyewear, perform hand hygiene (alcohol-based hand rub), and don other PPE as required.
  • Procedure Execution:
    • Select appropriate cannula, remove cannula sheath, and gently rotate the hub of the cannula to loosen the sheath.
    • Insert the cannula into the $2\text{nd}$ intercostal space at a $90^\circ$ angle, just superior to the border of the $3\text{rd}$ rib.
    • Stop inserting the cannula when a release of air is identified, or a sudden loss of resistance is felt.
    • Advance the cannula sheath until it is flush with the patient's skin.
    • Press white button to retract the needle and dispose into the sharps container.
  • Post-Procedure Management:
    • Reassess breath sounds, blood pressure, and pulse rate.
    • Frequently check for redevelopment of a tension pneumothorax.

Clinical Literature and Regulatory References

• Femoral Traction Splint (Slishman) References:
  • Rescue Essentials. (2019). Slishman Traction Splint – Directions for use. Available at: https://www.life-assist.com/Content/Docs/Slishman_splint_how_to.pdf
  • Queensland Ambulance Service. (2022). Digital clinical practice manual. Available at: www.ambulance.qld.gov.au/clinical.html
  • Howland, I. R., Howard, I. L., Pillay, Y., Ludick, B. D., & Castle, N. R. (2019). Prehospital use of the traction splint for suspected mid-shaft femur fractures. Journal of Paramedic Practice, 11(9), 390–395.
  • Document Maintenance: Last updated 13/07/2026 (Clinical Skill Assessment Sheet Page 9).
• Chest Decompression (Cannula) References:
  • Australian Commission on Safety and Quality in Health Care. (2020). Factsheet for clinicians: Informed consent in health care. Available at: https://www.safetyandquality.gov.au/sites/default/files/2020-09/sq20-030_-fact_sheet-informed_consent-_nsqhs-8.9a.pdf
  • Queensland Ambulance Service. (2022). Digital clinical practice manual. Available at: www.ambulance.qld.gov.au/clinical.html
  • Australian Resuscitation Council. (2021). ANZCOR Guideline 11.10.1 – Management of Cardiac Arrest due to Trauma. Available at: https://resus.org.au/guidelines/
  • Dezube, R. (2022). How To Do Needle Thoracostomy. MSD Manual Professional Version. Available at: https://www.msdmanuals.com/professional/pulmonary-disorders/how-to-do-pulmonary-procedures/how-to-do-needle-thoracostomy
  • Document Maintenance: Last updated 13/07/2026 (Clinical Skill Assessment Sheet Page 4).