# 3 scenarios



## Beaujangles (Dec 7, 2013)

Scenario 1
You have a  female patient in the back of the ambulance whose breathing rate is exceeding 25 breaths a minute. Your paramedic partner is not in the back of the rig and is  busy elsewhere. what would you do?


Scenario 2
You arrive at the hospital with a patient that is being transferred from another facility. Upon arriving you are told that the paperwork has been "lost" and that they have no bed already arranged for the patient. what do you do?

Scenario 3.
You see your partner lifting the patient, on a stretcher, in an unsafe manner. What do you do?

These are 3 scenarios I was given at an interview and I want to see what others would reply with.


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## NomadicMedic (Dec 7, 2013)

1. Get the medic. 
2. Wait til a bed was ready. 
3. Tell then to stop and lift correctly. 

Am I hired?


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## Beaujangles (Dec 7, 2013)

Well see that's the problem. These were my answers. Scenario 1: I would put the patient on 100% O2 via NRB and start a new assessment because this is still considered a BLS scenario. If the patient continued to breathe rapidly I would try and coach them down, telling them to take long, deep breaths. Per the book, it says to breath for them if they cannot get their own breathing under control, with a bvm. 

Scenario 2: I would wait with the patient until it all for sorted out, reassuring her that everything will be fine. 

Scenario 3: I said I would let him know in a non confrontational and positive way that he looked like he was lifting awkwardly. I would not do this in front of the patient. 

Also note that I did not get hired using these answers but these were the only scenario based questions of the whole interview. just curious what others would respond with to see if maybe there is a better answer out there.


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## chaz90 (Dec 7, 2013)

I can't imagine the entire interview process and decision was based on those answers. Your answers seem adequate enough, perhaps excepting the immediate application of a NRB to the mildly hyperventilating patient. Look at how the rest of the interview went, and perhaps practice with someone for your next opportunity.


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## Beaujangles (Dec 7, 2013)

chaz90 said:


> I can't imagine the entire interview process and decision was based on those answers. Your answers seem adequate enough, perhaps excepting the immediate application of a NRB to the mildly hyperventilating patient. Look at how the rest of the interview went, and perhaps practice with someone for your next opportunity.



I felt that the interview went great. All the other interview questions were based off of "how would you deal with a partner that you see stealing?" Questions like that. I of course answered them with I would not confront them directly and would go to a manager immediately. What would you have done for scenario 1?


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## chaz90 (Dec 7, 2013)

Beaujangles said:


> I felt that the interview went great. All the other interview questions were based off of "how would you deal with a partner that you see stealing?" Questions like that. I of course answered them with I would not confront them directly and would go to a manager immediately. What would you have done for scenario 1?



Interviews are an entirely subjective and holistic process. All answers can be academically correct, but sometimes candidates still aren't chosen due to perceived poor fits with the company or a better candidate already having been chosen. Believe me, I've been on the wrong end of this before. It's not great, but it's just the way things go sometimes. Learn from it, and move on to the next. Being passed over for a position can't always be traced back to poor performance on any part of the interview. 

In reference to the first scenario, I would have simply attempted to coach the breathing down, as you mentioned. If it were simply a sustained RR of 25 without other symptoms and the patient didn't appear anxious, I'd wait for it to resolve on its own. I'd refrain from applying any oxygen unless the patient appeared hypoxemic for any number of reasons, and I certainly wouldn't attempt to use a BVM on a conscious anxiety patient to attempt to slow their breathing.


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## PrincessAnika (Dec 7, 2013)

1 - why is she hyperventilating?  if its anxiety, talk her down.  25 is barely over the limit (24) so unless there are other issues indicating a need for oxygen or ALS I would simply observe.
2 - wait, contact supervisor to let them know of the delay.
3 - if its posing a potential danger to the pt I would say something immediately to my partner, but I would try to do so in such a way to not let the pt know if possible.


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## Beaujangles (Dec 7, 2013)

chaz90 said:


> Interviews are an entirely subjective and holistic process. All answers can be academically correct, but sometimes candidates still aren't chosen due to perceived poor fits with the company or a better candidate already having been chosen. Believe me, I've been on the wrong end of this before. It's not great, but it's just the way things go sometimes. Learn from it, and move on to the next. Being passed over for a position can't always be traced back to poor performance on any part of the interview.
> 
> In reference to the first scenario, I would have simply attempted to coach the breathing down, as you mentioned. If it were simply a sustained RR of 25 without other symptoms and the patient didn't appear anxious, I'd wait for it to resolve on its own. I'd refrain from applying any oxygen unless the patient appeared hypoxemic for any number of reasons, and I certainly wouldn't attempt to use a BVM on a conscious anxiety patient to attempt to slow their breathing.



Interviews are such a pain. This last time was my first time interviewing with rural metro but my 3rd time applying . I am hopefully getting a call back for an interview next week but there are no guarantees and I just wanted some good feedback on these 3 scenarios, just in case they ask them again. Thanks for your reply though.


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## Clipper1 (Dec 7, 2013)

Tachypnea and hyperventilation are not necessarily the same thing. ABGs confirm hyperventilation for low PaCO2.  
Depth and quality of respirations? The pt could be obese or sitting in a bad position. Then it would more likely be a normal MV to mild hypOventilaion. Other clinical signs need to be assessed. One number tells very little.

Contact the sending facility to resend paperwork. This will be a nurse to nurse issue.

Stop the lift before someone gets hurt and pull it together. The patient would be more upset if you did nothing and dropped the patient. It is also pointless if you said nothing and continued the lift with the chance that would be a career ender with a disabling injury.


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## Beaujangles (Dec 7, 2013)

Clipper1 said:


> Tachypnea and hyperventilation are not necessarily the same thing. ABGs confirm hyperventilation for low PaCO2.
> Depth and quality of respirations? The pt could be obese or sitting in a bad position. Then it would more likely be a normal MV to mild hypOventilaion. Other clinical signs need to be assessed. One number tells very little.
> 
> Contact the sending facility to resend paperwork. This will be a nurse to nurse issue.
> ...



For starters this is why I sometimes hate the EMS system. every test I have taken there are two obviously wrong answers and there are two right answers, but one answer is more right than the other. this applies to this situation. For the interview I was given the exact info that I gave you. I asked if there was more info or if I could obtain it and they said no. Work with what you've been given. It could have been literally ANYTHING that was causing her respirations to be a little high. I think they wanted  to see if I would leave the patient unattended to go look for the medic. 
For scenario 2 if I am asked this question again, I will add contacting the first facility to resend the transfer order. 
For scenario 3 I think they want you to not mention it in front of the patient but I'm not sure. I agree though that I would change my answer and say something to him. 

Interviews are really rigged in this field and its hard to choose what is the "best answer" when there are so many right answers but the company is looking for a specific answer to protect their *** in case something does happen.


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## Tigger (Dec 7, 2013)

Beaujangles said:


> Interviews are really rigged in this field and its hard to choose what is the "best answer" when there are so many right answers but the company is looking for a specific answer to protect their *** in case something does happen.



No, they are not. Stop making excuses for yourself. Get over your personal feelings about interviews and go in with some confidence. You aren't going to get a job with that attitude.


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## Beaujangles (Dec 7, 2013)

Tigger said:


> No, they are not. Stop making excuses for yourself. Get over your personal feelings about interviews and go in with some confidence. You aren't going to get a job with that attitude.



How are they not rigged? The book teaches one thing but its completely different, in some aspects, out in the field. I mean look at the lifting scenario. I have mentioned to people on my crew when they are lifting improperly and i have done it in front of the patient. Now what do you think I should say if I'm asked that scenario in an interview? Should I say I'd say something even if the patient hears it? Should I say I would say something but not in front of the patient? How do you say something like that to your partner and not in front of the patient? 

Maybe I am looking at this all wrong and maybe my attitude is this way because I'm nervous about interviewing again but how can I give a good specific answer if I don't know the whole story, they won't provide it, and they are looking for a specific answer? Or are they looking at how I answer them and there is no right answer?


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## Tigger (Dec 7, 2013)

Beaujangles said:


> How are they not rigged? The book teaches one thing but its completely different, in some aspects, out in the field. I mean look at the lifting scenario. I have mentioned to people on my crew when they are lifting improperly and i have done it in front of the patient. Now what do you think I should say if I'm asked that scenario in an interview? Should I say I'd say something even if the patient hears it? Should I say I would say something but not in front of the patient? How do you say something like that to your partner and not in front of the patient?
> 
> Maybe I am looking at this all wrong and maybe my attitude is this way because I'm nervous about interviewing again but how can I give a good specific answer if I don't know the whole story, they won't provide it, and they are looking for a specific answer?* Or are they looking at how I answer them and there is no right answer?*



In the event that there is more than one reasonable answer, you need to be able to rationalize why you chose the answer you did. Saying "because the book said so" is not how one goes about that, just for the record. 

Interviews are about displaying confidence. Controlling nervousness is a must in any interview, otherwise you will look unprepared or confidence-lacking, and that will in all likelihood preclude you from being hired. TAke some time to practice your interview skills before the real thing, it can pay big dividends.


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## Beaujangles (Dec 7, 2013)

Tigger said:


> In the event that there is more than one reasonable answer, you need to be able to rationalize why you chose the answer you did. Saying "because the book said so" is not how one goes about that, just for the record.
> 
> Interviews are about displaying confidence. Controlling nervousness is a must in any interview, otherwise you will look unprepared or confidence-lacking, and that will in all likelihood preclude you from being hired. TAke some time to practice your interview skills before the real thing, it can pay big dividends.



I definitely do get nervous when I interview. One thing that just clicked too is I never gave my reasoning for my answer, I just gave it. I think I will explain why I chose the answer I did. So its inheritanyly possible that I chose a good answer but I just didn't explain it enough or give a good reason why. I definitely have just had an epiphany.


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## mycrofft (Dec 8, 2013)

1. Continue vital signs and history or follow company policy.
2. Call the originating facility or follow company policy.
3. Get in there and help or follow company policy.


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