Try and get a copy of the scoring sheet. Work out what items are critical fails, and what items will add up to a fail. Typical critical fails are often things like:
- not checking scene safety
- not verbalising BSI (or whatever it's called now)
- not taking C-spine control
- not placing an OPA
- not ventilating a patient that needs ventilation
- not doing CPR on a patient that needs CPR
- not controlling deadly bleeding
- not checking the back (or incomplete physical exam, e.g. not checking lung sounds)
- not verbalising that a patient is critical, or that you are leaving scene (often, if you haven't said it, you haven't done it).
- failing to decompress a tension pneumothorax
- decompressing a simple pneumothorax
- not checking neurovascular function before and after splinting
- starting IVs on scene on critical trauma
- not fluid resuscitating closed head injuries to an acceptable MAP
- giving any medication without checking for allergies
- giving an inappropriate medication
- not checking blood glucose prior to advanced airway
- placing an airway device without primary confirmation
- placing an airway device without capnography (**** should be a fail if in your scope of practice)
- not re-confirming tube placement periodically / after movement.
- decompressing a mainstem intubation
- giving drugs to intubate a patient who doesn't need them to be intubated
Usually, it's pretty hard to fail unless you do one of the above. So just be careful to verbalise everything, especially things like "I am leaving scene now".
The testing system is rigid, and often feels like a silly game of Dungeons & Dragons. But if you develop a systematic approach and accept that it's not realistic, and it's not real life, it will serve you well.
If you find yourself getting confused, it's usually ok to ask the examiner what you've done so far. And if you completely lose your train of thought, it's best to just go back to the ABCs. Because that's typically where you're going to fail.
With regards to keeping calm, I'd suggest the best thing is to practice as much as possible so that you're familiar with the testing critera. And just remember no one wants you to fail. Everyone there wants you to pass. So just work through things slowly and methodically. If you get stressed, slow down.
