# Medical Assessment Practical



## shakezula (Sep 3, 2012)

Hey y'all,

Before I start, I need to say something that might make my question easier to see in the mess that follows. I'm one of those annoying people who need to analyze simple things to the point of madness, and that's where I'm stuck right now. I just need some help getting out of it. The questions I have boil down to this:
- Can I fail for calling ALS and verbalizing rapid transport if it's not necessary?
- How should ETA for the nearest ALS unit affect a transport decision?
- What situations (for priority patients) would warrant waiting to transport? Unconscious patients with friends to question for SAMPLE? Others?

I had an issue with my practical exam (and looking at the title for this thread, you can imagine that issue was medical assessment). Embarrassing, really, because these are supposed to be cake-walks. What got me was backup/transport decisions. The check-off sheet has "Requests additional help (ALS) if necessary," and "Identifies patient priority and makes treatment/transport decision" in *Scene Size-Up* and *Primary Survey* respectively. This got me because my instructor was irritated whenever one of us mindlessly said, "Ok, I'll call for an ALS unit ... This is a load-and-go patient" in practice. As far as going down the checklist, yeah, you get your points and you dodge your critical fails that way; but I ended up trying so hard to avoid saying, "I'll call for ALS backup, load and go" for a runny nose that I missed the train for saying it in a chest pain scenario. I called for transport after SAMPLE :sad:... Live and learn.

I'm re-testing tomorrow, but I've been looking around for a couple weeks already, looking at common scenarios and when it's appropriate to say "priority status, let's initiate transport now." As far as I can see, all the scenarios I've seen/heard about for NREMT practicals are "call ALS/priority/transport immediately (i.e. after primary assessment)."

So, getting to the point (don't want to bore anyone), is it safe for me to make it a habit - like saying "scene safe/BSI" - to simply call for ALS in scene size-up and verbalize initiating transport after the primary assessment? And would it hurt me on the exam if I called for ALS/immediate transport for something that's not really critical? I'm only talking about the practical exam here, going by the form and passing the assessment. I did everything else right; it was just the one thing that tripped me.

Like I said, I'm one of those annoying people who need to analyze (and then I hit a critical fail). So if anyone could make this as simple for me to understand as it's supposed to be, I'd owe them! Again, this is just for the practical exam...

Thanks, and sorry for the essay... I'm one of those people :sad:


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## diffusiondance (Sep 20, 2012)

I don't think you can fail for calling ALS & verbalizing rapid transport if it's not necessary. I think it's definitely better to err on the side of caution. Almost every practice scenario in my EMT class was an ALS call, so I'd always say it to be safe. Besides, you can always call to cancel later if you realize you don't need assistance

Not too sure about your second Q

And for the 3rd, I can think of a couple scenarios: pregnant woman displaying eminent signs of birth (stop the ambulance and deliver), spinal is code 2 (to avoid torquing spine & causing further damage) UNLESS accompanied with further injury, like shock. & of course always stop the ambulance to use AED. that's about all I can think of off the top of my head, hope it helps!


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## Wolves (Sep 29, 2012)

In the scenario, they do want you to call for ALS but they're always busy or 20 minutes out. You should never wait for ALS to arrive in the scenario, that's not what they're testing you on, they want to see that you can do everything you need to without help. Most of the scenarios are rapid transport calls, and it's better to be cautious anyway for the test.


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## SicilianMedic07 (Sep 29, 2012)

The only things that can fail you are the following:  The critical failures at the bottom of the page OR if you miss too many points through the medical asssessment.  Rule of thumb is 80% or better.  You cannot be faulted for asking for ALS or stating that you will rendevous with and ALS truck, we teach this in the classes that I instruct/proctor.  You can also not be faulted or penalized for stating that you would rapidly transport this person and complete your SAMPLE history and further secondary assessment while en route.


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## Veneficus (Sep 29, 2012)

*test taking insight*

The NR EMS tests are not based on patient care.

They are based on recognizing life threatening emergencies and the basic steps to manage them.

You will not be tested on a non-critical patient.


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## Wolves (Sep 29, 2012)

Yeah, there are not all that many possibilities that they can test you on. They generally want you to give an intervention, and there aren't really that many we can give as EMT-B... There's nitro if the patient has it, if not, then asprin; we can assist with Epi, we can assist with an inhaler; they could test you on activated charcoal, but probably not; glucose; and O2 of course. In most cases they'll require you to use one of those, unless it's something like a stroke where the best treatment is speedy transport.


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## PewPew (Sep 29, 2012)

Sorry to hijack your thread, but does anyone know how long is the skills practical exam? Correct me if I'm wrong, but there's about 6-7 stations we need to pass on that day? Is that only it for the skills practical exam?


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## Wolves (Sep 29, 2012)

PewPew said:


> Sorry to hijack your thread, but does anyone know how long is the skills practical exam? Correct me if I'm wrong, but there's about 6-7 stations we need to pass on that day? Is that only it for the skills practical exam?



Mine was 6 I think:Medical and trauma, CPR/AED, Apnic, Ked, and Random (which I hear is usually long bone immobilisation, although it could be sling and swath). That's all you do that day.


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## DesertMedic66 (Sep 29, 2012)

PewPew said:


> Sorry to hijack your thread, but does anyone know how long is the skills practical exam? Correct me if I'm wrong, but there's about 6-7 stations we need to pass on that day? Is that only it for the skills practical exam?



There are 6 mandatory stations and then 1 random skill station.

Mandatory:

Medical Assessment
Trauma Assessment
BVM of Apenic Adult
O2 Administration via NRB 
CPR/AED
Spinal Immobilization of Supine Patient

And then 1 random skill (Some testing locations will have more then 1 but all NREMT requires is 1):

Spinal Immoilization of Seated Patient (KED)
Bleeding Control/Shock Management
Long Bone Immobilization
Joint Immobilization

That is all that is required for the skills test, unless you have to retest on one or more of the skill stations.


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## PewPew (Oct 1, 2012)

Thanks fire and wolves for the quick reply! Just completed a 12 hr ride along so exhausted


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