PALS Pediatric Advanced Life Support Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
BLS Skills Testing
Child BLS with AED (1-2 Rescuers) Skills Test
1 - Rescuer BLS and CPR Skills ▢ PASS
Compression Rate
Depth Rate ▢ Needs Retest
2- Rescuer CPR Skills ▢ PASS
Bag Mask
▢ Needs Retest
AED Skills ▢ PASS
▢ Needs Retest
Check if done
Steps Criteria
correctly
Single Rescuer Child BLS Skills Evaluation
Test the student’s BLS: deliver high-quality CPR for 10 cycles.
1 Ensure the scene is safe before checking responsiveness
2 Call for help: Sends someone to activate 911/call EMS
3 Checks for pulse and breathing (5-10 seconds)
Perform High Quality CPR:
● HAND PLACEMENT: 1 or 2 hands in the lower half of the breastbone
● RATE: At least 100/120min (30 chest compressions in no less than
15 and no more than 18 seconds)
4 ● DEPTH: Delivers compressions at least one third the depth of the
chest (approximately 2 inches / 5 cm)
● Allows complete chest recoil
● Minimize interruption in compressions: Delivers 2 breaths in less than
10 seconds
PALS Pediatric Advanced Life Support Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
Check if done
Steps Criteria
correctly
AED Skill and 2 Rescuers CPR Evaluation
Evaluate the ability to use the AED and 2 rescuers CPR.
1 Second rescuer arrives during 5th cycle of CPR with AED and bag-mask device
First rescuer continues compressions, now at a rate of 15:2, while second
2 rescuer turns on AED and applies pads.
3 Second rescuer clears victim, allowing AED to analyze
4 Rescuers change roles while AED analyzes rhythm
If AED indicates "SHOCK ADVISED", second rescuer clears victim again and
5 delivers shock
Resume high-quality CPR after shock delivery
● SECOND RESCUER resumes CPR with 15 compressions (less than10
6 seconds) after shock
● FIRST RESCUER delivers 2 breaths with bag-mask device
Evaluation completed after 2 cycles
BLS Skills Testing
Child BLS with AED (1-2 Rescuers) Skills Test
▢ PASS
1 - Rescuer BLS and CPR Skills (check one)
▢ Needs Retest
2- Rescuer CPR Skills ▢ PASS
Bag Mask (check one)
▢ Needs Retest
3- Thumb-Encircling Hands ▢ PASS
▢ Needs Retest
PALS Pediatric Advanced Life Support Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
Check if done
Steps Criteria
correctly
Single Rescuer Infant BLS Skills Evaluation
Test the student’s BLS: Deliver high-quality CPR for 10 cycles.
1 Ensure the scene is safe before checking responsiveness
2 Send bystander to activate EMS
3 Check pulse and breathing for no more than 10 seconds
Perform High Quality CPR:
● FINGER PLACEMENT: 2 fingers or 2 thumbs in the center of the chest,
just below the nipple line
● RATE: At least 100/120min (30 chest compressions in no less than 15
seconds and no more than 18 seconds), using 2-finger technique
4 ● DEPTH: Deliver compressions at least one third the depth of the chest
(approximately 1 ½ inches / 4 cm)
● Allows complete recoil
● Minimize interruption in compressions: Delivers 2 breaths in less than
10 seconds
● Correct finger placement
2-Rescuer CPR
Evaluate ability to give breaths with bag-mask device and give compressions by using the 2 thumb-encircling hands
technique. Also evaluate role transition from single to 2-rescuer CPR
1 Second rescuer arrives during 5th cycle of CPR with bag-mask device
2 At the end of a cycle of CPR, rescuers transition to 2 rescuer CPR
SECOND RESCUER resumes CPR with 15 compressions (less than 10
3 seconds) after shock
4 FIRST RESCUER delivers 2 breaths with bag-mask device
Evaluation completed after 2 cycles
PALS Pediatric Advanced Life Support Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
Check if done
Steps Criteria
correctly
Management of Respiratory Emergencies Checklist
Critical Competency Items
Test the student’s BLS: deliver high-quality CPR for 5 cycles.
Describe the difference between high-flow and low-flow oxygen
delivery systems
a. High flow (> 10 liters/min): 02 flow exceeds patient inspiratory flow,
preventing inhalation of room air if system is properly fit and sealed;
delivers nearly 100% oxygen. Example: non-rebreathing mask with
1 reservoir
b. Low flow (< 10 liters/min): patient inspiratory flow exceeds 02 flow,
allowing inhalation of room air; typically delivers 23%-50% oxygen.
Examples: nasal cannula, simple 02 mask
2 Identifies maximum nasal cannula flow rate: 4 L/min
Demonstrate correct technique to open airway using:
a. Head-tilt/chin-lift maneuver for patients in whom trauma is not
3 suspected
b. Jaw thrust for trauma victims
Verbalizes different indications for oropharyngeal (OPA) and nasopharyngeal
(NPA) airways
4 a. OPA used only in an unconscious victim without a gag reflex
b. NPA used for trauma victims
Demonstrates correct use of OPA
a. Selects correctly sized OPA airway by measuring from corner of
mouth to angle of mandible
b. Inserts OPA correctly
5 c. Verbalizes assessment for adequate breathing after inserting of OPA
d. Suctions with OPA in place; states suctioning not to exceed 10
seconds
6 Demonstrates correct mask size selection for ventilations
PALS Pediatric Advanced Life Support Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
Assembles bag-mask device, opens airway, and obtain seal by using E-C
7 technique
Delivers ventilations using bag-mask device
a. Delivers 1 breath every 2 to 3 seconds for about 30 seconds
8 b. Gives each breath over approximately 1 second
c. Delivers adequate volume to cause chest rise without
over-ventilation
The following steps are optional. They are demonstrated and evaluated only
when the student’s scope of practice involves endotracheal intubation.
9 a. Endotracheal intubation
b. Prepares equipment for ET intubation
c. Inserts ET tube correctly
Endotracheal intubation:
a. Describes obtaining proper equipment needed for endotracheal (ET) tube
intubation
10 b. Confirms proper ET tube placement by auscultation and by end-tidal C02
detector
c. Secures ET tube with commercial prepared device, not tape
d. Suctions ET tube correctly
▢ PASS ▢ Needs Retest
Instructor Name: _________________________________________ Date: __________________
