# NREMT (Basic) from the Pt.'s Eyes



## SC Bird (Nov 30, 2007)

Well on Wednesday I sat as a patient for the NREMT-B exam.  I must say that it was probably the best thing I could have done to prepare myself for my own exam (12/19).  Here are some things I noticed and didn't notice...

The first station I sat at was a random basic skills station (LSB and Bleeding Control/Shock Mgt).  The first two candidates were no nervous that their hands were shaking so bad that when he applied direct pressure to my arm...my hand started shaking. Obviously, a case of the nerves.  However, for the most part everyone was pretty solid on the bleeding/shock station.

The long spine board was a different story.  The biggest issue I observed was improper placement of straps.  A few candidates had three seperate 9 ft straps across my legs....and then only one across my stomach (just below umbilicus).  My torso was completely unsecured.

The next station I sat for was pt. assessment.  We alternated between medical and trauma.  This was a very tough station for some of the candidates.  And to be honest, I was a bit worried.  I know that in my program, we have had pt. assessment drilled into our heads.  I am not sure if it was nerves or lack of education but some candidates forgot the SAMPLE history all together on medical pts.  It was "understandable" when someone forgot to ask a portion of the hx, but some didn't ask any questions at all.  Needless to say, it has motivated me to study and study my assessment.

The third station I sat for was another random basic skills station (KED and traction splint).  The KED had the highest number of failures for the day with nine.  Failures were for improper positioning (wasn't high enough---wasn't up in the armpits) and excessive tightening to the point where it was hampering respirations on a normal, healthy patient. 

I did also watch some of the ventilation station.  One of the most painful things to watch was candidates walking up to the pediatric intubation station...removing the towel from over the face of the pt. and throw it to the side.  A lot of tunnel vision and forgetting the basics.

One of the biggest problems I witnessed was nerves.....had a candidate who was retesting after failing for having KED improperly placed and just jumped in without BSI or assessing PMS.  He was so hyped up that he forgot to take a second and breath.

I remember seeing Rid post about candidates verbalizing something and not taking the time to actually do it.  I saw a good bit of this especially with assessing PMS in LSB, KED, and pt. assessment.  Candidates would verbalize it...and the evaluator would basically have to say "Well go ahead and show me how you'd do that..."

Also, I am usually not one to criticize instructions that are given to students....but when the evaluator asks "If you hear gurgling sounds in the epigastrium, what would you do?"...I was shocked to hear from almost every student that was asked that question, "Carefully pull the tube back and reassess the lung sounds." <_<<_<<_<<_<<_<

Anyways, it helped prepare me for what I'm going to see and need to do...got to practice all of them after candidates were done.  Nailed both intubations, LSB, KED, traction and bleeding control....now just to practice assessment.


-Matt


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## Ridryder911 (Nov 30, 2007)

I think that it is good for future canidates to see the pressures of testing and see what evaluators see. I was an evaluator for several years, and yes understand "testitis and stress, nerves, etc." but ; there is also time when one can tell that they "just don't have it". 

Sorry, if one is really prepared and has been practicing and preparing for the test, it will come through. Repeated practice will ingrain good habits, even in real life. 

What I have seen that irritates me is that many perform the action but have no thought to it. Such as patient assessment, when assessing the abdomen using the ends of the fingers barely touching the abdomen more of poking at the belly and never assessing below the belt line or really each of the 4 quadrants. If one will do this on an test under stress, one would probably do this under stress on a real traumatic patient. This could be detrimental in real life. 

I believe SC has narrowed it down. Study, practice, study, practice. See a trend? If EMT training did not come natural or had more than a hard time, one will have to realize you will have to spend time to prepare for your examination. 

Good luck for those that will be testing! 

R/r 911


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## Dondo (Nov 30, 2007)

*Great advice*

Thank you SC for posting this, I too am taking my skills tests in Dec. and am really nervouse, but i have been in open lab and practicing every minute that i can.  PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE PRACTICE!!!!!!!!!


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## SC Bird (Nov 30, 2007)

Ridryder911 said:


> Sorry, if one is really prepared and has been practicing and preparing for the test, it will come through. Repeated practice will ingrain good habits, even in real life.



I agree...because it was good to see some candidates come through and knock it out of the ball park.

And it just so happens that those were the ones who actually assessed...actually put pressure on the brachial artery (instead of just touching in the general area of my arm/armpit)....and actually palpate the pelvis/abdomen/etc.

-Matt


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## ohwise124 (Nov 30, 2007)

SC Bird said:


> I did also watch some of the ventilation station.  One of the most painful things to watch was candidates walking up to the pediatric intubation station...removing the towel from over the face of the pt. and throw it to the side.  A lot of tunnel vision and forgetting the basics.




I'm curious if this was for EMT-Basic National Registry?  I thought you said it was.  We don't intubate here....unless you are talking CombiTube?  We test in December and I thought we were thoroughly informed, but I don't recall any peds anything being discussed as NREMT practicals?  

Thanks!  Very interesting post to read 2 weeks before I test!


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## Ridryder911 (Nov 30, 2007)

Technically, NREMT does not have EMT Basic practical examinations per say. Although, they have suggested guidelines for a practical examination and most states and institutions utilize those standards. That is why, most Basic EMT practicals are performed in the class or school area. NREMT does not send evaluators or endorse practical testing except advanced level to Paramedic. 

Your state may require (as most) practicals exam, therefore; each state may have unique stations. Your educational program should had informed you in detail of what, how and when you will be tested. Again, if you are not prepared or unaware of testing criteria, please inform your program manager to correct this before the next class. It is a shame instructors are not clarifying this. As well, again check with your local State/County certification agency to determine what will be tested on. 

R/r 911


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## ohwise124 (Nov 30, 2007)

ah-ha!  That makes sense then.  I thought our instructor was fairly detailed on exactly what the stations were going to be, so thought it strange that didn't sound familiar.  And now that you mention it, I think she did note that the person overseeing the entire testing process is from the State.  Thanks for the information.


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## skyemt (Nov 30, 2007)

Having sat through the practical as a "patient", and as an applicant, and after numerous conversations with evaluators, it becomes apparent that many prefer to just 'memorize' the steps necessary to pass, rather than thoughtfully perform the tasks... the difference becomes clear on exam day...

during our class, we were 'tested' numerous times, thrown "curve balls", and asked many times why we did what we did...

our instructors mentality was that if we could perform under pressure, with knowledge about what we were doing and why, we would perform the same way in the field, and we would be more than covered for the exam.

we had no failures that day, and in fact had the best record in our state that day... 

all credit is due to our instructors, who passionately want to train emt's that "they would want to show up at their doorstep".

i am aware that our instructor was unfortunately in the minority, and on exam day you can easily observe sub-par preparation.

i saw applicants pass, that frankly seemed to make a mockery of the process. scary.


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## SC Bird (Dec 1, 2007)

ohwise124 said:


> I'm curious if this was for EMT-Basic National Registry?  I thought you said it was.  We don't intubate here....unless you are talking CombiTube?  We test in December and I thought we were thoroughly informed, but I don't recall any peds anything being discussed as NREMT practicals?
> 
> Thanks!  Very interesting post to read 2 weeks before I test!



Well there were two ventilation stations (Adult and Pediatric intubation), two random basic skills, and two pt. assessment. 

I know that SC is getting ready to remove intubation from the Basic scope...but for now, we still need the skill training and frankly, I thoroughly enjoy every bit of practice I can get when it comes to droppin' my tube.


-Matt


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