Now that the National Registry paramedic candidate has started the call, don’t forget to address anything you would need to deal with in the field. This means scene safety, which door you can get equipment through, is it a residence/apartment/etc., where is patient located in home.
These are all questions you will need to ask the proctor. For example, you can say:
“I’m driving up on scene. What kind of residence is it? Are there stairs?” “is there a crowd?” or you can generalize with a question like “Are there issues related to ingress or egress or any reason to believe I will need additional resources?”
Based on the proctor’s answers, the candidate can tell the proctor they will be using the appropriate PPE and entering the home. Once again the candidate should feel comfortable asking for any information related to scene that will clarify safety and equipment needed.
“Does the stretcher fit through the front door? Where is the patient located in the home? Am I able to access the patient with my equipment?”
It’s important the candidate uses the question and answer format to get a clear picture of what the scene looks like. You can ask:
“Are there any other family member or onlookers? Are there any pets I need to worry about?”
Saying I pull up on scene and bring in the stretcher might not work if the patient is on the fifth floor of an apartment complex with only stair access. The paramedic candidate needs to specify:
“We will place the patient in Reeves stretcher and then transfer to ambulance stretcher.”
This type of testing process can be difficult for individuals like me, who have a difficult time imaging a scene, a patient, and imagining providing care. For these paramedic candidates, taking good notes can be an important tool to help you get a “visual” of your full patient scenario.
An important factor with oral stations is that there is no rush to actually provide patient care and interventions.
The paramedic candidate can gather as much information as they need and ask as many questions as necessary before starting treatments. (As long as you stay aware of the 15 minute time limit.)
Taking organized notes can help the paramedic to “visualize” the next required step and verbalize it to the proctor.
A candidate should verbalize why they are taking an action, or why they have decided not to do something. Stating your reasoning can help the proctor better understand that a paramedic candidate is using critical thinking.
For example, a National Registry paramedic candidate may get a patient who is unconscious and can state:
“Normally I would gather a SAMPLE history from the patient, however due to the patient’s level of consciousness I am not able to. Is there someone on scene who can provide me with this information?”
Asking this gives the proctor a good idea of where a candidate’s head is at.
The National Registry paramedic candidate should remember to consistently verbalize vital signs and reassess after interventions like they would in the field.
For example, if you gave a patient with hypoglycemia 25 grams of D50 IV, it’s important to remember to verbalize a recheck of the blood glucose level.
If the candidate is concerned about forgetting vitals throughout the scenario, they can make a generalized statement like:
“My parter will take a set of vital now and repeat them every 5 minutes and after any interventions.”
This allows the paramedic candidate to ask the proctor what the latest set of vitals are throughout the scenario.
It’s also a good idea to talk through how and when the patient’s family members will be included in the scenario. If it’s a pediatric case, make sure to verbalize having the parent hold and calm the child.
The family members can be assets for information and parents can be valuable to help control, calm and instruct children.
As you can see, being familiar with the process and generalizing questions as needed can be a helpful tool during both the Oral Station Scenarios. You can help organize your thoughts and increase the chance of success by writing some notes on the piece of paper after you sit down, but before beginning the Oral Station.
With practice these notes can help keep you on track during the scenario and trigger your memory so you don’t forget anything important.
Here is an example of how to set up the page for success by writing mnemonics for SAMPLE, ABC, and OPQRST on your notes. Leave room to fill in each letter with patient notes and use other parts of the page for prompts to remind you about important test requirements.
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Personalize the page set up to your liking, but make sure to include major points like the Field Impression in case you get nervous and forget them during the test. This can help organize your thoughts before reporting the field impression to the proctor.
Quick Tip: State transport priority early in the call. If the candidate stays on scene for too long, the patient scenario can change for the worse.
Once the National Registry paramedic candidate feels they have a good grasp of the patient situation, have provided the necessary interventions, and gotten the expected results, they will be expected to report their field impression to the proctor.
The candidate should be ready to report their field impression of the patient and why they came to that conclusion. For example, the candidate could say:
“My field impression is that this patient is hypoglycemic and I base this on the fact that he was unresponsive on arrival with a blood sugar level of 50. After I administered 25mg of D50 IV the patients blood sugar was 100 and his level of consciousness improved significantly.”
Obviously this is a simplified example but it should give you an idea of what to expect when reporting field impression. It can be a good idea for the paramedic candidates to take a few moments to stop and review their before beginning the field impression report.
Don’t feel pressured to talk the whole test, the proctor will let you take as much time you need to organize your thoughts. In fact, if at any point in the Oral Station scenario you feel lost, stuck or frustrated. Stop. Review your notes and try to picture what you would do in the field with this type of patient.
Candidates can ask questions like:
“ I have found shoulder tenderness and a swollen left wrist, am I missing anything else as I examine my patient from head to toe?” to see if you are missing anything.
After the National Registry paramedic candidate completes the field impression they should be transporting and will need to give a verbal report to the receiving facility, which will likely be a mock Emergency Department radio report.
The verbal report must include chief complaint, interventions, current patient condition, and ETA.
Overall the Oral Stations A & B will cover everything from scene safety, unit type, additional resources, plan for patient transport, scene size-up, transport times, transport decisions, assessments, determining patient problem, proper diagnosis, correct treatment regimen chosen, field impression report, field impression rational, and verbal report.
In order to pass the paramedic candidate needs to mentally orchestrate the entire call and demonstrate competency along with determining the proper diagnosis and completing treatment interventions successfully.
Integrated Out Of Hospital Scenario (IOOH)
The National Registry Paramedic Integrated Out Of Hospital Scenario (IOOH) is a hands on fully immersive patient care experience.
The IOOH will require caring for either a pediatric, adult or geriatric patient. During the out of hospital scenario the paramedic candidate will be provided with a professional paramedic partner who you can delegate skills to during the call.
The paramedic test scenario will last for a total of 20 minutes and will include two components: On Scene Treatment and the Transport Phase.
The out of hospital scenario will evaluate the National Registry paramedic candidate on the ability to lead a team, manage a call, effectively communicate, and maintain professionalism during the entire simulated patient encounter.
Check out this video from the National Registry of EMT for a detailed overview of the Integrated out of hospital scenario.
Time – The National Registry paramedic IOOH scenario will last for exactly 20 minutes. This means no matter what is going on in the scenario, the call will end at 20 minutes.
Even if the paramedic candidate fails in the first minute of testing, the IOOH scenario will continue for another 19 minutes.
Timing is relevant because if the candidate has a load and go mentality, they will be stuck in the transport phase, without a professional partner for most of the call.
The two components of the scenario are on scene treatment and the transport phase. The transport phase is the time spent in the back of the ambulance with the patient on a stretcher and your professional partner driving the ambulance.
The amount of time spent in transport is decided by subtracting the On Scene Treatment time from 20 minutes. For example, if you spend 9 minutes performing the on scene treatment phase, then the transport time will be 11 minutes.
Obviously, the candidate shouldn’t stall on scene, but don’t rush through the assessment either. Spend the appropriate amount of time doing a good assessment and any necessary interventions; utilize the time well, and then begin transport.
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