# A bit about my NREMT



## DoubleOSpoon (Feb 8, 2010)

Hey guys,

Thought I'd share my story for anyone else who's trying to get their NREMT-B, or just for anyone who's interested. As much as I hate to admit it, I went for my third and final stab at my NREMT-B on Saturday. Got my results this morning and I finally passed, got cut at 75 I believe. It sucked having to go for it three times, but I believe I'll be a better EMT because of all of the studying I've put into it. I've been in my town's volunteer fire/EMS department for almost three years, and I've been a certified firefighter for about a year. I've been riding the ambulance since I joined, and as most of you know there's a huge difference in the real world versus the textbook. I think this hurt me when it came to taking the test in the long run, but now I can finally focus on my real world skills.

I'd like to thank all of the regulars here, I've been lurking since I took my exam and have been nervous all weekend. Your kind words to the other NREMT candidates helped me boost my confidence when waiting for my own results. It made the waiting game a lot less painful. I'm looking forward picking up some tricks of the trade from you all in the future.


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## mcdonl (Feb 9, 2010)

DoubleOSpoon said:


> I've been riding the ambulance since I joined, and as most of you know there's a huge difference in the real world versus the textbook. I think this hurt me when it came to taking the test in the long run, but now I can finally focus on my real world skills.



I a scared :censored::censored::censored::censored:less about taking the test. I have been fortunate, because even though what you say about the real world being different then what the NREMT exam wants for answers the medics on my department are by the book. It is refreshing to read something in the book and see it done in the field primarily the same way.

Still though, I sweat it big time. I take a 150 question test on line... there are four of them... my class gives a 25 question test every week, I have 3 work books and I study 2-3 hours a day. I have met so many smart people who have failed it just makes my stomach churn thinking about the exam.


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## TraprMike (Feb 9, 2010)

DoubleOSpoon said:


> Hey guys,
> 
> department for almost three years, and I've been a certified firefighter for about a year. I've been riding the ambulance since I joined, and as most of you know there's a huge difference in the real world versus the textbook. I think this hurt me when it came to taking the test in the long run, but now I can finally focus on my real world skills.



yup, try forgeting almost 20 years of real life stuff, for 4 months. for evereyone that is in the same boat, You got to think of it as a new dept. you are training for.. the NREMT Dept.. and you have to do it thier way. 

forget the stuff you've seen done,


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## Ridryder911 (Feb 20, 2010)

If you are doing other than the "NREMT" way your idiots! Seriously! Do you even know where the test questions are obtained from? Duh.... let me guess your one of the ignorant providers that believe in the old .... field way and then the textbook.. way? 

Here is the REAL facts! As a writer for the NREMT all test questions are obtained from the NHTSA EMT curriculum. Obviously something you must not be aware of. You know what the textbooks are based upon AND what you will be held accountable for in a court of law! 

Second, your ignorance of medicine is displaying brightly by describing any methods of text vs real life. Guess what skippy, I've been providing prehospital care for over 32 years and there is NO difference... if you provide care properly and non-negligible. Yes, you may have to modify and adjust accordingly... but the basis of the care BETTER be according to the standards... again, what you will be held against in a court of law. 

So if you fail the test three times, and then to consider that this test is one of the easiest and well written medical test... maybe you should consider other ideas? Possible test taking courses, review your study habits or maybe even not to enter the profession. Not to be rude but not everyone can nor should be allowed to enter it. 

R/r 911


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## TransportJockey (Feb 20, 2010)

Ridryder911 said:


> If you are doing other than the "NREMT" way your idiots! Seriously! Do you even know where the test questions are obtained from? Duh.... let me guess your one of the ignorant providers that believe in the old .... field way and then the textbook.. way?
> 
> Here is the REAL facts! As a writer for the NREMT all test questions are obtained from the NHTSA EMT curriculum. Obviously something you must not be aware of. You know what the textbooks are based upon AND what you will be held accountable for in a court of law!
> 
> ...



Hey Rid, long time no see  

And +1 to his diatribe.


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## firetender (Feb 20, 2010)

Ridryder911 said:


> So if you fail the test three times, and then to consider that this test is one of the easiest and well written medical test... maybe you should consider other ideas? Possible test taking courses, review your study habits or maybe even not to enter the profession. Not to be rude but not everyone can nor should be allowed to enter it.  R/r 911



Glad to hear from you, Rid, and maybe you're right, "Skippy" here might need some help with study, test taking and the like. _*And*_, if he's had the balls to keep going back and challenging himself, he might just have what it takes to grow into the field. Rude? No. But a bit dismissive for someone with a clear desire to contribute.


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## ExpatMedic0 (Feb 20, 2010)

Congrats on passing the exam:excl:


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## DoubleOSpoon (Feb 26, 2010)

Ridryder911 said:


> If you are doing other than the "NREMT" way your idiots! Seriously! Do you even know where the test questions are obtained from? Duh.... let me guess your one of the ignorant providers that believe in the old .... field way and then the textbook.. way?
> 
> Here is the REAL facts! As a writer for the NREMT all test questions are obtained from the NHTSA EMT curriculum. Obviously something you must not be aware of. You know what the textbooks are based upon AND what you will be held accountable for in a court of law!
> 
> ...



It's a shame that an attempt I made to really thank the helpful contributors here is met with a reply such as this. I wasn't asking about your medical background or the like, as respectable as it may be it's really of no interest to me. Coming from a volunteer background, there is a difference than what I've seen and the "textbook way" in some cases. Am I saying that everything is that way like you are implying? No absolutely not, it was a simple statement.

Thanks for your irrelevant advice on my test taking skills too, my readiness to admit my number of tries was meant to encourage others not to quit. Your hostility is amusing but unappreciated.


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## TraprMike (Feb 26, 2010)

Ridryder911 said:


> If you are doing other than the "NREMT" way your idiots!
> R/r 911



slow down Skippy,,,,
does the nat'l EMT b cover IV's and IO's? how about glucagon?  well, guess what, there are a lot of BLS services that do this.. So, that said, on the nat'l test, and one of the answers is something like , "start an IV and monitor vitals".. the student has to revert back to the Nat'l EMT-B way of doing things..  On the few services I've worked with over the years they all do above and beyond the EMT-B Level

that is what I meant. I'm sorry if you think there is only one class of "B's" out there.


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## VentMedic (Feb 26, 2010)

TraprMike said:


> slow down Skippy,,,,
> *does the nat'l EMT b cover IV's and IO's?* *how about glucagon? well, guess what, there are a lot of BLS services that do this*.. So, that said, on the nat'l test, and one of the answers is something like , "start an IV and monitor vitals".. the student has to revert back to the Nat'l EMT-B way of doing things.. On the few services I've worked with over the years they all do above and beyond the EMT-B Level
> 
> that is what I meant. I'm sorry if you think there is only one class of "B's" out there.


 
I think you are a little confused about what has been stated there "Skippy". No one stated you can't learn additional skills or gain more education but the issue is not to confuse "street medicine" or made up "facts" with what is found in the text book. 

Many professions expand upon what they were initially tested upon. Some RNs can intubate, place central lines and chest tubes. These skills probably were not on their Boards. RRTs do ECMO and that wasn't part of their national test. 

Let's look again at Rid's post.



Ridryder911 said:


> If you are doing other than the "NREMT" way your idiots! Seriously! *Do you even know where the test questions are obtained from?* Duh.... let me guess your one of the ignorant providers that believe in the old .... *field way and then the textbook*.. way?
> 
> Here is the REAL facts! As a writer for the NREMT all test questions are obtained from *the NHTSA EMT curriculum*. Obviously something you must not be aware of. *You know what the textbooks are based upon AND what you will be held accountable for in a court of law! *
> 
> ...


 


DoubleOSpoon said:


> It's a shame that an attempt I made to really thank the helpful contributors here is met with a reply such as this. I wasn't asking about your medical background or the like, as respectable as it may be it's really of no interest to me. Coming from a volunteer background, there is a difference than what I've seen and the "textbook way" in some cases. Am I saying that everything is that way like you are implying? No absolutely not, it was a simple statement.
> 
> Thanks for your irrelevant advice on my test taking skills too, my readiness to admit my number of tries was meant to encourage others not to quit. Your hostility is amusing but unappreciated.


 
Look at your original post:



DoubleOSpoon said:


> Hey guys,
> 
> Thought I'd share my story for anyone else who's trying to get their NREMT-B, or just for anyone who's interested. As much as I hate to admit it, I went for my third and final stab at my NREMT-B on Saturday. Got my results this morning and I finally passed, got cut at 75 I believe. It sucked having to go for it three times, but I believe I'll be a better EMT because of all of the studying I've put into it. I've been in my town's volunteer fire/EMS department for almost three years, and I've been a certified firefighter for about a year. I've been riding the ambulance since I joined, and as most of you know there's a huge difference in the *real world versus the textbook.* I think this hurt me when it came to taking the test in the long run, but now *I can finally focus on my real world skills.*
> 
> I'd like to thank all of the regulars here, I've been lurking since I took my exam and have been nervous all weekend. Your kind words to the other NREMT candidates helped me boost my confidence when waiting for my own results. It made the waiting game a lot less painful. I'm looking forward picking up some tricks of the trade from you all in the future.


 
Is there any possibility your "real world" skills are wrong? Maybe you have been greatly misinformed by your _street medicine_ instructor who has not read the textbook or has had no one correct him/her about the wrong technique or information. 

Just because "you always done it this way" doesn't make it right. Read the text and study the material that is part of the NHTSA EMT curriculum. 

If you can not see the error of your "real world" vs "textbook" ways you will continue down the path of failure by lack of understanding the material even if you did pass the test. Thus, you will then be one to pass on your version of "street medicine" to the next new guy. Guess what that leads to?


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## Ridryder911 (Feb 26, 2010)

DoubleOSpoon said:


> It's a shame that an attempt I made to really thank the helpful contributors here is met with a reply such as this. I wasn't asking about your medical background or the like, as respectable as it may be it's really of no interest to me. Coming from a volunteer background, there is a difference than what I've seen and the "textbook way" in some cases. Am I saying that everything is that way like you are implying? No absolutely not, it was a simple statement.
> 
> Thanks for your irrelevant advice on my test taking skills too, my readiness to admit my number of tries was meant to encourage others not to quit. Your hostility is amusing but unappreciated.



Sorry that many of those that post here demonstrate ignorance on EMS and the educational background of EMS is so prevelant. Do most even understand what you will be held accountable or what medicine is really like? Do those that post have more than a "few" classes to form such an opinion? Seriously on what expert opinion do they have to offer any advice? Even discussing the _"NREMT Standards_" demonstrates ignorance. NREMT has *NO* standards, never has, never will.. it's just a testing agency and uses the NHTSA standards. Again, before anyone starts spouting opinions at least have a little bit of knowledge about such.  

Do you think authors and experts that write books and standards actually pull these methods out of the air? Again, failure to recognize how and why such standards are in place is just one of the problems in EMS. Each procedure is scientifically tested and that also includes clinical settings such as in the field setting. Why do you think CPR and other procedures change?

I will be one of those "expert witnesses" that can and *WILL* gladly to testify against any of those EMT"s that practice anectodotal methods of practicing medicine. Sorry, the "field method" and "textbook method" is only mentioned by those that fail to recognize and understand medicine and the care of such. 

Medicine is medicine. Period. Albeit in the OR suite or in the middle of the highway. The general guidelines and standards can be followed. No where else but in EMS do we have to (or even need to distinguish BLS vs ALS) because of the piss poor methods in training and education of so called providers. Do we have to modify and adjust due to elements and unique situations? .. You bet, but we better have utilized and covered the bases of the standard of care. Then to mention BLS skills has different methods is silly as it is just above the first aid level. Mentioning some additional skills above the BLS level is again demonstrating poor knowledge of EMS. As each state is allowed to modify their EMT levels and place above training but NOT under the Standard National Scope of Practice and Standards. A topic for a different thread and debate... 


Volunteer, paid, flex time, part time.. it doesn't matter ! Either perform medicine correctly or get out! Each patient deserves the best care possible.. no excuses allowed. 

R/r 911


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## JPINFV (Feb 26, 2010)

Ridryder911 said:


> Do you think authors and experts that write books and standards actually pull these methods out of the air? Again, failure to recognize how and why such standards are in place is just one of the problems in EMS. Each procedure is scientifically tested and that also includes clinical settings such as in the field setting. Why do you think CPR and other procedures change?
> 
> I will be one of those "expert witnesses" that can and *WILL* gladly to testify against any of those EMT"s that practice anectodotal methods of practicing medicine. Sorry, the "field method" and "textbook method" is only mentioned by those that fail to recognize and understand medicine and the care of such.



I'm going to play devils advocate for a bit. 

How out of date is a lot of the curriculum? I'll admit, my copy of my EMT-B book is 4-5 years old, so maybe it's included now. Is there any indication in the current text books of, say, selective spinal immobilization? Recognition that some disease pathologies (stroke, MI) may have worse outcomes with a higher FiO2, hence a NRB might not be the appropriate prophylaxis treatment? Are providers who are working in systems that suggest lower FiO2s or allow selective spinal immobilization practicing 'bad' medicine because a national curriculum isn't updated that quickly? 

Conversations like this reminds me of a recent thread in the EM residency forum of SDN where the utility of ATLS was being discussed. Now, sure, I'll be the first to admit that emergency care at the physician level changes more dynamically than at the EMS level, that physicians are better educated, and most importantly, expected to interpret the current studies in their field and implement them along side national guidelines and best practices. However, as was being discussed, the true best practices in medical care changes so fast that curriculum and tests can't keep up. Provided that providers are supported by their medical director (which requires an actual relationship past a rubberstamp. A relationship not present in a lot of EMS services), would it be better to have providers providing care based on what was know now or what was known 5 years ago when the exam was developed?

_Surgeons "Knowing" ATLS_
http://forums.studentdoctor.net/showthread.php?t=690378


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## Ridryder911 (Feb 26, 2010)

Understandably, the difference is that the "base" as in general support and treatment and care at a physician level is automatically understood. Not assessing or performing would automatically be assumed negligent, from the national standards. 

True; standards takes time to investigate and place in text books. Hence the reason of the ability to practice medicine when a physician has a license to do so and the essential importance of active medical direction is essential to ensure current and possible research methods of improving patient care in the field setting. It is only under their discretion that any deviation should be attempted otherwise one is determining to practice medicine upon their own. 

R/r 911


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## Hal9000 (Feb 26, 2010)

*So that webinar yesterday...*

Quick question for R/r or someone with knowledge:

  When writing questions, when we move to the ESs and away from the NSC, what references are going to be used for the test writing.  Kathy Robinson said something to the effect of,
"The ES will replace the NSC and allow us to be more flexible when adapting for medicine as based upon proof; the current NSC is rigid and not easily updated for current practices."   

Will this change the way questions are sourced and written?  

It is a good move, especially as we switch to rely of education, affective tests, and professionalism, rather than on the substandard current model.  Here's a visual representation that was used during the webinar:








Double-Don't let your feelings get hurt.  R/d may seem harsh, but he's looking out for the best interests of the profession, and, through that, you as well.  I used to be one of those "it's so different" type of people, but I overcame that years ago.  I left my closed, volunteer system, got an education, and realized how poorly I had been "taught."  Be a leader and proponent of excellence, even at the cost of pride.


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