7. Spinal Immobilization (Supine Patient):
A. Use or verbalize the use of Personal Protective Equipment (PPE)
B. Instruct assistant to place and maintain head in the neutral, in-line position
C. Instruct assistant to maintain manually stabilizing the head and reassess circulatory, motor, and sensory functions in each extremity
D. Apply appropriate size extrication collar and position the immobilization device correctly
E. Direct the movement of patient onto the device without compromising the integrity of the spine
F. Apply padding to void between patient torso and device as needed
G. Immobilize the patient’s torso to the device
H. Evaluate the pads behind the patient’s head as needed and immobilize the patient’s head to the device
I. Secure the patient’s legs to the device and then secure the patient’s arms to the device
J. Reassess circulatory, motor, and sensory functions in each extremity.
8. BVM Ventilation of an Apneic Adult Patient:
A. Take or verbalize appropriate PPE precautions
B. Check responsiveness of patient and request additional EMS assistance
C. Check pulse and respirations simultaneously (The examiner will inform the candidate that patient is unresponsive, apneic, and has a weak pulse of 60)
D. Open airway properly (Examiner will verbalize the patient’s mouth is full of secretions and vomitus)
E. Prepare rigid suction catheter
F. Turn power on to suction device OR retrieve a manual suction device
G. Insert rigid suction catheter without applying any suction
H. Suction the mouth and oropharynx (Examiner will inform the candidate the mouth and oropharynx are clear)
I. Open the airway manually and insert the oropharyngeal airway (Examiner will verbalize that no gag reflex is present and the patient accepts the airway adjunct)
J. Immediately ventilate the patient Bag Valve Mask (BVM) device not attached to oxygen (Examiner will verbalize that ventilation is being given properly without difficulty)
K. Recheck the patient’s pulse for 10 seconds or less
L. Attach the bag valve mask (BVM) assembly [Bag, Mask, and Reservoir] to oxygen at 15L/minute
M. Ventilate the patient adequately with correct volume to cause a visible chest rise and the proper rate of 10 – 12 breaths per minute, around 1 ventilation every 5-6 seconds. (Examiner will ask candidate how will you know if you are delivering the correct volume with each ventilation and candidate will need to answer out loud.)
9. Patient Assessment / Management – Trauma:
A. Take or verbalize appropriate PPE precautions
SCENE SIZE UP
B. Determine that the scene and situation is safe
C. Determine the mechanism of injury or nature of illness
D. Determine the number of patients
E. Request additional EMS assistance if needed
F. Consider stabilizing the spine
PRIMARY SURVEY/RESUSCITATION
G. Verbalize general impression of the patient
H. Determine responsiveness / level of consciousness (LOC) of the patient
I. Determine apparent life-threats / chief complaint
J. Airway: Open and assess airway and insert adjuncts as needed
K. Breathing:
a. Assess breathing and assure adequate ventilation
b. Initiate oxygen therapy as needed and manage any injury which compromises airway/ventilation.
L. Circulation:
a. Check pulse and assess skin for color, temperature or condition
b. Assess for major bleeding and control if found
c. Initiate shock management [position patient, conserve body heat]
M. Identify patient priority and make treatment/transport decision based on calculated Glasgow Coma Scale (GCS)
N. Obtain Baseline vital signs – Blood pressure, pulse and respirations
O. Attempt to get a SAMPLE history.
SECONDARY ASSESSMENT
P. Head – a. Inspect and palpate the patient’s scalp and ears b. Assess eyes c. Inspect mouth, nose and facial area
Q. Neck – Check position of trachea, check jugular veins and palpate the cervical spine
R. Chest – Inspect, palpate and auscultate chest
S. Abdomen/Pelvis:
a. Inspect and palpate the abdomen
b. Assess pelvis and verbalize assessment of genitalia/perineum as needed
T. Lower Extremities – Inspect, palpate and assess motor, sensory and distal circulatory functions
U. Upper Extremities – Inspect, palpate and assess motor, sensory and distal circulatory functions
V. Posterior thorax, lumbar and buttocks:
a. Inspect and palpate posterior thorax
b. Inspect and palpate lumbar and buttocks areas
W. Manage secondary injuries and wounds as needed
X. Demonstrate how and when to reassess the patient.
10. Patient Assessment/ Management – Medical:
A. Take or verbalize appropriate PPE precautions
SCENE SIZE UP
B. Determine that scene and situation is safe
C. Determine mechanism of injury or nature of illness
D. Determine number of patients
E. Request additional EMS assistance if appropriate
F. Consider stabilization of the spine
PRIMARY SURVEY / RESUSCITATION
G. Verbalize general impression of the patient
H. Determine responsiveness/level of consciousness (AVPU)
I. Determine apparent life-threats/chief complaint
J. Assess Airway and Breathing:
a. Assessment
b. Assure adequate ventilation
c. Initiate oxygen therapy as appropriate
K. Assess Circulation:
a. Assess and control any major bleeding
b. Check pulse
c. Assess skin for color, temperature or condition
L. Identify patient priority and make treatment/transport decision.
HISTORY TAKING
M. Taking History of present illness:
a. Onset, Provocation, Quality, Radiation, Severity, Time
b. Clarify questions of signs and symptoms associated with OPQRST.
N. Past Medical History – Allergies, Medications, Past pertinent history, Last oral intake, and events leading up to present illness
SECONDARY ASSESSMENT
O. Assess affected body part/systems – Cardiovascular, Pulmonary, Neurological, Musculoskeletal, Integumentary, GI/GU, Reproductive and Pyschological/Social.
VITAL SIGNS
P. Blood Pressure, Pulse, and Respiratory Rate and quality
Q. State field impression of the patient
R. Interventions [verbalize the proper treatments and interventions for the patient]
S. Demonstrate how and when to reassess the patient to determine any changes in condition
T. Provide an accurate verbal report to the arriving EMS unit.
NREMT Exam Critical Criteria
Each psychomotor skill test has a set of “Critical Criteria” which can be found listed at the bottom of the National Registry of EMT skill sheet. These NREMT skill sheets can be found by going to the National Registry of EMT website and clicking EMT, then under the heading EMS Certification click EMT again. From there, the NREMT skill sheets can be found under the psychomotor Exam tab.
The critical criteria must be done correctly to pass the skill. If a candidate fails to do any of these criteria they will fail the skill station, regardless of how well they do completing the rest of the skill.
Basically, these are actions the candidate takes that have the potential to cause the patient injury or puts the patient’s life at risk.
Here are some examples of common Critical Criteria:
• Failure to take or verbalize PPE precautions.
• Failure to make establish scene safety.
• Failure to manage the patient as a competent EMT.
• Exhibits unacceptable affect with patient or other personnel.
• Uses or orders a dangerous or inappropriate intervention.
• Failure to suction airway before ventilating the patient.
• Failure to assess/provide adequate ventilation.
• Failure to initiate or call for transport in expected time limit.
NREMT Advanced
The National Registry of EMT cognitive exam for the Advanced Emergency Medical Technician is a linear computer based test (CBT). A linear computer based EMT test has a fixed length, with a set amount of questions. Linear computer based tests are a similar experience to taking a test with pencil and paper, but they are administered via computer. Also, there is no penalty for guessing on questions with a linear test. Linear tests allow candidates to go back and change answers, skip questions and mark questions for review.
The NREMT advance cognitive exam is 135 questions long and each candidate has up to 2 hours to answer all the questions. The Advanced EMT test has 35 “Pilot Questions” which are questions being tested for a future NREMT exam and do not count towards the candidates final score.
This means that only 100 of the 135 questions actually count towards your final score so don’t panic if you feel like you don’t know the answer to a lot of questions, maybe they are the pilot questions. Unfortunately, it’s impossible to know which questions are the pilot questions so each EMT test question should be taken seriously.
