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armywifeemt

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So I am going to be helping a student going through EMT class study and catch up on things she missed while she was absent due to an illness in her family.. I know one thing she missed a lot of was practice for her practical exams, and I want to run through her skills sheets to make sure she is comfortable with them.

I was wondering if there were any good resources out there for trauma and medical scenarios that have already been put together.. As similar as possible to what you would be giving someone for a practical exam. I'm not experienced enough to be able to come up with a whole lot off the top of my head.. but I know that just reading skills sheets over and over is nowhere near as effective as practicing them as if it were a real test.

Any help would be appreciated.
 
Not that hard. Just use the skill sheet and make sure she hits all the points listed, especially the critical fails.

Trauma scenarios for NREMT almost always consist of one life-threatening injury that requires an intervention... ie: open pneumothorax, and one distracting injury such as a broken tib/fib. Just tell her she's at an MVA and tell her what she's finding as she goes along with the sheet. I let my students use the sheet as a reference at first, but I expect them to have it memorized pretty quickly and start taking them from them. Don't cut corners. Have her verbalize everything and physically do the full rapid trauma assessment.

Medical scenarios usually present with cardiac or respiratory symptoms.

There's something amiss if you're having trouble forming scenarios. All you have to do is be able to think up a problem one might encounter as an EMT (such as an MI, stroke, MVA, etc) and piece together the signs and symptoms someone might have related to the problem. It's good practice for you too, to remember what patient populations typically have what problems... what certain vital signs mean, etc.
 
However, if you really need some inspiration, I'm going to post a few scenarios posed as written assignments from my class.
 
Dispatch: You are responding to a 16 y/o male with difficulty breathing.

On Arrival: You find 16 y/o Bob sitting on a chair in the kitchen. He is leaning forward and bracing his arms on the table. He appears pale and you note he is using accessory muscles in his neck. His is awake but sleepy, and his mother is present.

Initial Assessment Findings
Mental Status—Awake, obeys commands
Airway—Open and clear
Breathing—RR 16, and extremely labored, unable to talk; lung sounds very faint and only heard in apices
Circulation—Skin pale, cool, and diaphoretic; his lips are dusky
Radial pulse rapid at 136 and irregular
BP 164/92

Chief Complaint—Difficulty breathing

Focused History
Events—Bob woke up with wheezing but took his inhaler and went to school. When he got home he was worse and now has no relief from inhaler.
Previous Illness—Asthma since early childhood
Current Health Status—Good
Allergies—Pollen, dust and cats
Medication—Beconase nasal inhaler, Albuterol inhaler
Last oral intake—normal lunch

Focused Physical Exam
Vital signs—Pulse 136, Blood pressure 168/92, Respiratory rate 16
Other Pertinent Findings—Cyanotic nail beds, pulse oximetry 82.
Diagnostic Tests – None performed
 
Remember your scenarios will usually start out stable and take a dive over time...especially if you are not moving quickly or performing improper tx.
Trauma is easy...check for pulse, quick assessment, call trauma alert, stop the bleeding, board them, get them to LZ or Helispot.
Medical can be a little more difficult but usually it will be resp, cardiac, or CVA.
 
Dispatch: 19:45 hrs; personal injury collision, 79 y/o male injured

On Arrival: You see three vehicles at odd angles to each other in an intersection and a SUV that has apparently run head-on into a tree. The SUV appears to have also been impacted on the driver’s side door and the rear bumper is severely damaged. Your patient is in the SUV. You find 79 y/o Sam, unrestrained, lying across the front seat. The steering wheel is bent.

Initial Assessment Findings
Mental Status—Responsive to voice, oriented to name only, occasionally follows commands
Airway—Open and clear
Breathing—RR 24, lung sounds are faint wheezes in both bases, clear in upper
lobes
Circulation—Skin pale, cold, dry
Radial pulse irregular at 70
Chief Complaint—No complaints at this time

Focused History
Events—Bystanders state the SUV ran a red light, was impacted on the driver’s side door and then rear ended by another vehicle and then jumped the curb and hit the tree.
Previous Illness—Hypertension, “heart problems”
Current Health Status—Good
Allergies—Penicillin
Medication—K-chlor, Theo-dur, glyburide, Lanoxin, Lasix and hydrochlorothiazide
Last oral intake—unknown
Focused Physical Exam
Current Set of VS—Pulse 70 and irregular, BP 114/84, Respiratory rate 24
Other Pertinent Findings—Complains of pain when left chest wall is palpated, no crepitus noted, ecchymosis to sternum: abdomen is soft and nontender to
palpation; pelvis intact; bilateral contusions to the patella, deformity of the right ankle; pulse oximetry is 78 percent
Diagnostic Tests—BS 40
 
I like your format Lucis...I am going to steal it

Dispatch: You are responding to a 70 yowf with aloc.

On Arrival: You find a 70 yowf sitting in a chair gazing to the left. Pt appears normal otherwise, but does have difficult time following commands. Family tells you they found her this way.

Initial Assessment Findings
Mental Status—Awake, tries to obey commands
Airway—Open and clear
Breathing—RR 16, and wnl, unable to talk,
Circulation—Skin pink and dry
Radial pulse rapid at 80 and irregular
BP 220/118
SaO2 98%
Blood glucose 142

Chief Complaint—ALOC

Focused History
Events—Margaret was found at 1400 sitting in her chair unable to speak or stand up. Last contact was night.
Previous Illness—Unsure
Current Health Status—Some cardiac, HTN, and Diabetic
Allergies—none
Medication—Beta blockers and insulin
Last oral intake—half eatten sandwich found on table beside chair and a broken glass of milk on kitchen floor.

Focused Physical Exam
Vital signs—Pulse 80, Blood pressure 220/118, Respiratory rate 16
Other Pertinent Findings—Pupils pinpoint


With this scenario focus on the ALOC, find your path. Check for Diabetic, CVA, Bleed, or Trauma. When you check Blood glucose it is normal. The neuro should give you a clue that this is a bleed because of the gazing and pinpoint pupils. Also remember you can not call a CVA alert even if you are unsure it is a bleed or not due to unknown start time of event. Focus on surroundings too. They can help the Dr. with tx...a half eatten sandwich may be a few hours since onset instead of last night and the broken glass could suggest the pt fell in the kitchen. But in the end a CT will be the determining factor if it is a bleed or just a cva. Have fun. Make the student think about every little factor and they will smoke the wonderful world of scenarios.
 
armywifeemt said:
So I am going to be helping a student going through EMT class study and catch up on things she missed while she was absent due to an illness in her family.. I know one thing she missed a lot of was practice for her practical exams, and I want to run through her skills sheets to make sure she is comfortable with them.

I was wondering if there were any good resources out there for trauma and medical scenarios that have already been put together.. As similar as possible to what you would be giving someone for a practical exam. I'm not experienced enough to be able to come up with a whole lot off the top of my head.. but I know that just reading skills sheets over and over is nowhere near as effective as practicing them as if it were a real test.

Any help would be appreciated.
Click to expand...

Don't your EMT classes have a 100% attendance policy? How can this student complete the class without attending every single class? Do you really want an EMT showing up to your door when you are having an MI and say "Oh, I missed that day in lecture because of XXX, but I reviewed it with someone...!"
 
emt.dan said:
Don't your EMT classes have a 100% attendance policy? How can this student complete the class without attending every single class? Do you really want an EMT showing up to your door when you are having an MI and say "Oh, I missed that day in lecture because of XXX, but I reviewed it with someone...!"
Click to expand...

I've not seen an EMT class the required 100% attendance. A majority, yes, but not every day.


Heck, I missed the OB/GYN lectures for Paramedic and it's my weakest subject... and I still did fine ^_^
 
emt.dan said:
Don't your EMT classes have a 100% attendance policy? How can this student complete the class without attending every single class? Do you really want an EMT showing up to your door when you are having an MI and say "Oh, I missed that day in lecture because of XXX, but I reviewed it with someone...!"
Click to expand...

I have *never* heard of an EMT class that required 100% attendance. I was allowed to miss up to 3 days of mine, and I missed them.. I had an injury that prevented me from going to one, and then the death of a friend with the memorial service at the same time as one of my classes. Unfortunately there are things that come up in life that prevent us from attending classes sometimes.

That said, no one expects an EMT to run a code solo on their first day. The class is meant to give you a strong foundation... Passing it proves that you have acquired that foundation. Once you start running with a department, you build on that foundation until you have the skills needed to manage the provision of care.


Missing a couple days of class isn't that big a deal in the long run. Especially not if you take the initiative to prepare yourself outside of class.
 
Scenarios

I got a book last summer to prep for my NREMT and it is full of scenarios including rationales and questions. I think it is helpful as a study tool when I am studying by myself.

EMT-Basic Review: a case based approach (cd included)
Mosby JEMS/Elsevier

I can't remember how much it was exactly, but I think it was somewhere around 20 bucks.
 
armywifeemt said:
I have *never* heard of an EMT class that required 100% attendance. I was allowed to miss up to 3 days of mine, and I missed them.. I had an injury that prevented me from going to one, and then the death of a friend with the memorial service at the same time as one of my classes. Unfortunately there are things that come up in life that prevent us from attending classes sometimes.

That said, no one expects an EMT to run a code solo on their first day. The class is meant to give you a strong foundation... Passing it proves that you have acquired that foundation. Once you start running with a department, you build on that foundation until you have the skills needed to manage the provision of care.


Missing a couple days of class isn't that big a deal in the long run. Especially not if you take the initiative to prepare yourself outside of class.
Click to expand...

Our class had a mandatory attendance policy. You were "allowed" two absences per term as long as they were pre arranged or called instructor atleast 2 hours prior to class to let him know you were sick or whatever...Also, if you were more than 15 minutes late to class you were considered absent. Period.

However, I had a classmate who's wife delivered their baby pre-maturely and was hospitalized out of town. He recieved an incomplete and was able to finish the course later. But, this all happened the 2nd to last week of our second term so it seemed like a circumstance that warranted an exception in my opinion.

We were expected to be in uniform all class days and treat the class as a job per se. If we wanted to have a profession in EMS we were to treat the class as such.
 
AngelEyes said:
We were expected to be in uniform all class days and treat the class as a job per se. If we wanted to have a profession in EMS we were to treat the class as such.
Click to expand...


The problem with this logic is that many of us in the EMS field are volunteers. I am professional while at the department, but this is not my profession. My profession is what pays the bills. If I have to pay to take a class, I should hope that if for some circumstance outside of my control I have to miss it, my instructor is going to understand that the class is not a job.

It is very important to attend classes, and I am certainly not suggesting that someone should be excused for repeatedly being late or absent with no reason.. but even a job is going to understand that if my mother is in the hospital with some sort of serious illness, I am going to be there with her, not at work. The same goes for school, and even more so because the instructor isn't paying me or relying on me to make his business/service function. I am paying him to teach me. If I have to miss out on that because of a valid unforeseen circumstance, it is on me to do what I can to make up for the learning I missed, but it is on him to understand that some things take precedence over work or school.
 
emt.dan said:
Don't your EMT classes have a 100% attendance policy? How can this student complete the class without attending every single class? Do you really want an EMT showing up to your door when you are having an MI and say "Oh, I missed that day in lecture because of XXX, but I reviewed it with someone...!"
Click to expand...

There's a certain bit of hyperbole there. Lecture isn't the only way to learn the material. Are physicians bad because a lot of medical students don't actually go and sit in the lecture hall because they fill it's not as helpful as studying on their own?
 
AngelEyes said:
We were expected to be in uniform all class days and treat the class as a job per se. If we wanted to have a profession in EMS we were to treat the class as such.
Click to expand...

A student wearing a uniform does not magically make them into a professional. In fact, I'd argue that if a student is unable to dress themselves for class without a protocol or procedure to do so, then I don't want them providing medical care.
 
JPINFV said:
A student wearing a uniform does not magically make them into a professional. In fact, I'd argue that if a student is unable to dress themselves for class without a protocol or procedure to do so, then I don't want them providing medical care.
Click to expand...

I didn't say that I agreed with the policy, rather quite contrary.
I agree with what you are saying JP, that was the complaint most of us had.
 
JPINFV said:
There's a certain bit of hyperbole there. Lecture isn't the only way to learn the material. Are physicians bad because a lot of medical students don't actually go and sit in the lecture hall because they fill it's not as helpful as studying on their own?
Click to expand...

I was being facetious in that statement, I hope you understood that. Clearly there are other ways of learning then classroom lecture (I am fully aware of the standard opinions on domains of learning, and even the work of Gardner on Multiple Intelligences), but frankly I dont trust EMT programs, or even the state exam (or NREMT) to test for competency, as they clearly test for basic competency. Although it will never be formally assessed, I'd like graduating EMTs to have some grasp over Type I and Type II Diabetes, and it's not clear that they are going to get that, if not from a lecture. Some practical days simply cannot be missed (such as airway/suctioning), again, they will likely not be assessed, but EMT students need to see an array of equipment, etc before hitting the streets.

The difference between EMT schools and Medical schools, as JP has pointed out in another post recently, is the depth of knowledge tested. The fact medical students are tested on material down to the biochemical level, and EMT students have vague test-bank multiple choice questions shows they are not comparable.

If EMT students cannot show the maturity or self-discipline to show up to (or make reasonable accommodations to make up) 100% of classes I'm not sure I have confidence as their work as EMTs.
 
Last edited by a moderator:
Wow... my simple question on training materials to *help* an EMT student catch up has been hijacked.

The fact that she is asking for outside help tells me that she realized that missing those days put her at a disadvantage and that she wants to catch up and will do everything in her power to do so.

So let's stop talking about EMT class attendance and uniform policies, please.

If you want to discuss the adequacy, or as you seem to feel, inadequacy of EMT classes, start another thread. I am sure there are plenty of people who will be happy to argue it out.
 
Believe it or not YOUTUBE has videos of the military doing there testing but it is almost the exact same look up emt-b assessment.
 
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