# Observations from an EMT-B Examination



## medicdan (May 5, 2007)

I went to a state practical exam today for students who had finished their class about a month ago. The session was held at a suburban campus for the training center... The examiners were various instructors and I think the state sent over a chief examiner to coordinate everything. There were about 50 candidates. I came to be a patient...  
I have a few observations. I am in the middle of my class now, and while we have not done splinting or backboarding, I have learned in the past. As a "patient" I am not allowed to help candidates at all, but am but into numerous situations where I do subconsciously. For example, when the examiner says I have an ulna fracture, I raise my arm to the proper position, etc.
I was very surprised at both the lack of technical skills and ability to read off protocols of the candidates. I know that I am going to be taking the test in about two months-- am I going to be that bad? I hope now that I have seen it I can prepare better. 
I was a patient for every station but CPR (splinting/bandaging, backboarding, pt assesment). Here is my analysis of each:

Splinting/bandaging:
I see those skills as purely technical with slight variation based on the patient. Some candidates were better then others and I was unable to get any read from the examiners as to who passed and who did not. Many of the candidates were fumbling with the equipment either due to not knowing that brand or incompetence. I assumed the latter. To my surprise, nobody forgot BSI/Scene Safety. 
Backboarding-- again, I had trouble reading whether candidates passed or not. I see that the time offered to examine and prep equipment is invaluable, two of the candidates messed up because straps were in the wrong place, another because a buckle was missing. If they had pointed that out before starting, it would have been fine, but because they missed it, they were docked points. I wondered if the examiner had stuck the broken strap in to see if it would be caught.  Being KED boarded is an interesting experience, I forgot how "restrictive" it is. 
Pt Evaluation-- this is where I saw candidates REALLY mess up. To me, it seems simple enough to memorize steps and adapt them to the situation. Recently, I have had a lot of practice with assessment, and that may be why I am so critical. The candidates are given two fairly simple scenarios--one a trauma (Y/A thrown 20 feet from a MVA, the second, medical, is an elderly man with emphysema with difficulty breathing. 
On both of the scenarios, the candidates did their work completely out of order, causing them to miss big things and include unnecessary elements (like checking for tramatic bleeding on the medical pt, or forgetting both c-spine stabilization and baseline vitals on the trauma pt). 

I do worry that some of these candidates passed (is that wrong?) I guess it's wishful thinking, but I thought I could have done better under the circumstances. Is this the trend for state exams? Are candidates always this inept? Am I judging them too harshly? Please weigh in, I am curious. 

DES


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## Ridryder911 (May 5, 2007)

Very good points, I always suggested if possible for students to observe testing and the lack of details. 

I have to admit I am an honest but firm examiner. It amazes me candidates that fail to really assess the patient. Very rarely, I see students assess the 4 quadrants properly never assessing the abdomen with the pads of the fingers, and rarely if ever below the belt line. The same as assessing the anterior and posterior of extremities. 

One of my favorite scenarios is a person that was a former assailant that police had to shoot. The GSW is is the axilla (armpit) and very few locate it. The results is a SCW, in which most rarely find, to seal it. 

One time, to prove a point that candidates go through the motion and not really perform the skills I did an experiment. I placed a live gold fish in an IV bag on the IV station. Out of the 20 candidates only 3 seen the fish. Of course, all of them the said the memorization of "I would check the IV for clarity, date of expiration, etc.. but lacked to really perform it. After their attempt, I asked them if they noted any discrepancy in the IV, in which they said no. I would ask, if they would start an IV with a fish in it ? Point being .. they only performed in memory, not actually knowing and performing the skill. 

The same as in trauma assessment. Everyone can recite, "scene safe, BSI" which is great, but lack the understanding of truly being able to "assess" a patient. I routinely have a patient that is conscious and alert, this makes them have to ask the patient Hx. and intervene with the patient. The patient deteriorates during assessment and I observe their intervention or lack of. 

Skill testing, is designed to evaluate the minimal allowable for patient safety and performance. It is not designed to "fail" but one can determine easily for those that have practiced and mastered the skill and those that just have memorized the skill sheet. 

R/r 911


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## fm_emt (May 6, 2007)

Ridryder911 said:


> I placed a live gold fish in an IV bag on the IV station. Out of the 20 candidates only 3 seen the fish.



How could you look at a bag and not notice a FISH in it?!


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## Sophie (May 29, 2007)

How did you even get the fish in it?


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## disassociative (May 30, 2007)

The trick is to volunteer to be a patient at another location. 
Then you can see how things go.


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## Ridryder911 (May 30, 2007)

Sophie said:


> How did you even get the fish in it?



I used a scalpel and slit about 1" opening and slid them in (goldfish do squeeze through), then sealed with silicone. The opening really did hide well. 

Amazing, that test will go down in history, something some will never forget!

R/r 9111


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## Amack (Jun 20, 2007)

Ridryder911 said:


> I used a scalpel and slit about 1" opening and slid them in (goldfish do squeeze through), then sealed with silicone. The opening really did hide well.
> 
> Amazing, that test will go down in history, something some will never forget!
> 
> R/r 9111


:lol: That's awesome!


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## medicdan (Jun 21, 2007)

Since this topic was brought out of oblivion by someone else, I want to take this  moment to recommend on my initial comments. 

I finished my class about three weeks ago, and am taking my state practical in about a week. Earlier this week, I went into class for a student-organized review session. While only four students out of 25 showed up, I think the majority of the class is well prepared for the state exam. I have to say, it was nice to be able to rehearse the skills again-- I haven't thought about them in three weeks. 

After formally learning the skills needed for the exam, it is harder and harder for me to understand how the students messed up so much when I was a patient. The stations are really very straightforward. We can use the state skill sheets as much as we want before the day of the test, and students are given virtually unlimited use of the equipment in the month before the test to practice. 

I really hope I am not as oblivious and unprepared as the students I saw two months ago-- as has been remarked here, it boils down to lack of attention to detail. 

I thank all members of this community for your guidance... you have truly helped me enormously.

Although the postings of "I PASSED" annoy me on principal, I will post to this topic the results of my exam as soon as I know.

Thanks again,
DES


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## Artique (Jun 23, 2007)

Thats bizzare. Why would you puruse this carrer path if you wanted to be a mindless drone going by the motions of memory and not thought or skill. Might as well work at a retail store as a stockroom clerk.


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## Thanach (Jun 24, 2007)

emt-student said:


> forgetting both c-spine stabilization and baseline vitals on the trauma pt
> 
> I do worry that some of these candidates passed (is that wrong?) I guess it's wishful thinking, but I thought I could have done better under the circumstances. Is this the trend for state exams? Are candidates always this inept? Am I judging them too harshly? Please weigh in, I am curious.
> 
> DES



In Mass forgetting to mention c-spine at all on the assessments is a critical fail point, you forget that, even if you do everything else perfect, you still fail that station.


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## emtd29 (Nov 24, 2007)

Sophie said:


> How did you even get the fish in it?





Yeah, Rid!!  Enquiring minds want to know!!!!


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## Ridryder911 (Nov 25, 2007)

emtd29 said:


> Yeah, Rid!!  Enquiring minds want to know!!!!



Simple. Drain saline, make a slit on the back of the bag-with a scalpel about 1/2" long(fish can slide into small opening), fill with water, insert fish, seal with clear silicone caulking.

I usually place only one, two is too obvious. However; it is a lifelong teaching point!

R/r 911


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## Flight-LP (Nov 25, 2007)

Ridryder911 said:


> Simple. Drain saline, make a slit on the back of the bag-with a scalpel about 1/2" long(fish can slide into small opening), fill with water, insert fish, seal with clear silicone caulking.
> 
> I usually place only one, two is too obvious. However; it is a lifelong teaching point!
> 
> R/r 911



Thats a good one!

Personally, I am against any student participating in an activity where they can view a testing session. Every student going into NREMT testing has a clear outline of what standards are required to satisfactorily complete the registration process. What I am looking for is application, or better yet, correlation of knowledge. When one sits in on a testing session or views various "gouges" found online, all they are accomplishing is rote memorization. If you cannot apply basic aquisition of knowledge in a simplistic testing environment, then how can you remotely expect yourself to be proficient in applying and coorelating this knowledge on a day to day basis? This is why I change scenerios for every testing session. I can immediately tell who is trying to BS their way through and who actually took the time to study. 

I think it is suffice to say that the one's BS'ing get to see me more than once!


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