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NREMT Exam

 

AEMT Cognitive Exam Content

 

The cognitive portion of the NREMT exam for the AEMT is constructed to administer test questions from five areas of content. These content areas are EMS Operations, Trauma, Cardiology and Resuscitation, Airway; Respiration and Ventilation, and Medical/ Obstetrics/ Gynecology.

 

For all areas of content, any patient care questions will focus on 85% elderly and adult and 15% pediatric content.

 

The goal of the National Registry of EMT exam is to determine if candidates are able to apply book learning and course knowledge to real life patient care and field experience. The EMT test is designed to create situations and tasks that an entry-level EMS professional will need to respond to.

 

Wrong answers on the EMT test can reflect wrong choices in the field that may ultimately lead to incorrect assessment or treatments of patients.

 

The AEMT Cognitive Exam content is organized using a test plan which is approved by the National Registry of EMT Board. The test plan is a blue-print that communicates with the computer testing software and tells it how to build each candidate’s exam.

 

According to the test plan each Advanced EMT test will focus:

 

11% – 15% of EMT test on EMS Operations.
14% – 18% of EMT test on Trauma.
21% – 25% of the NREMT exam on Cardiology and Resuscitation.
18% – 22% of the EMT test on Airway; Respiration & Ventilation
26% – 30% of the EMT test on Medical; Obstetrics & Gynecology

 

These areas of content cover Emergency Medical Services (EMS) care. The standard for passing each section of the NREMT exam is providing safe and effective entry-level emergency medical care.

NREMT Psychomotor Exam AEMT

 

The NREMT Advanced EMT psychomotor exam is not a written exam, but rather the candidate will have to show proficiency with a hands-on scenario-type demonstration of NREMT skills. 

 

All NREMT exam skills are developed in accordance with the U.S. Department of Transportation National EMS Education Standards for either Emergency Medical Technician (EMT) or Advanced Emergency Medical Technician (AEMT).

 

The NREMT exam skills are also designed in accordance with the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC), and the US Dept. of Health and Human Services Centers for Disease Control Prevention National Trauma Triage Protocol.

 

This means studying the AHA CPR & ECC Guidelines, etc can help candidates get a strong knowledge and skill foundation for the NREMT exam.

 

The AEMT psychomotor exam consists of ten skills which will be presented in scenario type formats. Candidate will need to negotiate each station in order to pass, and will need to determine which assessment to perform based on the scenario presented.

 

Quick Tip: Pay attention to the name of the stations for clues on what will be tested and expected in the National Registry of EMT psychomotor exam. For example the “Cardiac Arrest” station should clue you in to be ready for your Cardiac Arrest/AED scenario. 

 

The best way to study for the psychomotor EMT test is with hands on practice using the National Registry of EMT advanced skill sheets. These NREMT advanced skill sheets are similar to the skill sheets used in EMT school and should be familiar to candidates.

 

Here are some examples of skill stations that candidates will need to complete to show competency in for the Advanced National Registry of EMT psychomotor exam. (These skills are from the 2016 National Registry of EMT skill sheets):

 

Station 1 – Candidate will perform a hands on, head to toe physical assessment while voicing treatments for a simulated patient. This scenario includes:

1. Scene size-up 2. Initial Assessment/Resuscitation 3. Focused History and Physical Exam- Rapid Trauma Assessment 4. Detailed Physical Examination.

1. Patient Assessment – 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).
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 ventilations
  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)

HISTORY TAKING
N. Obtain or direct assistant to get Baseline vital signs
O. Attempt to get a SAMPLE history.
SECONDARY ASSESSMENT

P. Head:
   a. Inspect and palpate the patient’s scalp and ears
   b. Assess eyes for PERRL
   c. Inspect mouth, nose and facial area
Q. Neck – Check position of trachea, check jugular veins and palpate 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. Reassess the patient.

Station 2 – Candidate will perform a hands-on, head to toe physical assessment while verbally voicing the treatments for a simulated patient. This scenario includes:

1. Scene size-up 2. Initial Assessment/Resuscitation 3. Focused History and Physical Exam- Rapid Trauma Assessment 4. On-Going Assessment.

2. Patient Assessment – 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

G. Verbalize general impression of the patient
H. Determine responsiveness/level of consciousness

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 AND SECONDARY ASSESSMENT
M. Taking History of present illness:
a. Onset, Provocation, Quality, Radiation, Severity, Time
   b. Clarifying 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
O. Perform Secondary assessment [Assess affected body part/systems, if indicated completes rapid assessment] – Cardiovascular, Pulmonary, Neurological, Musculoskeletal, Integumentary, GI/GU, Reproductive and Pyschological/Social.


P. Vital Signs: Blood Pressure, Pulse, Respiratory Rate and quality, AVPU
Q. Diagnostics: Must include applying ECG for dyspnea and chest pain
R. State field impression of the patient

S. Verbalize the proper treatment plan and interventions for the patient
T. Re-evaluate transport decision

REASSESSMENT
U. Repeat primary survey
V. Repeat vital signs
W. Evaluate patient response to treatments
X. Repeat secondary assessment regarding patient complaints or injuries

Station 3Ventilatory Management (NREMT Exam)
Candidates will be monitored and tested while demonstrating two ventilatory management scenarios. The first relates to an Apneic Adult and tests the Supraglottic Airway Device skill.

The first scenario is: Having just found an apneic adult patient with a palpable carotid pulse, the candidate must demonstrate immediate management of the patient using simple airway maneuvers and adjuncts, bag-valve-mask device, and supplemental oxygen, followed by the placement of a supraglottic airway device (King®,Combitube®, etc.).

3. Supraglottic Airway Device

A. Take or verbalize appropriate PPE precautions
B. Open the airway manually
C. Elevate tongue, insert oropharyngeal or nasopharyngeal airway [simple adjunct] (Examiner will verbalize no gag reflex is present and the patient accepts airway)
D. Ventilate patient immediately with bag valve mask (BVM) device unattached to oxygen
E. Ventilate patient with room air (Examiner will inform candidate that ventilation is being performed without difficulty and pulse oximetry indicates the patient’s blood oxygen saturation is 85%)
F. Attach oxygen reservoir to bag valve mask (BVM) device and connect to high-flow oxygen regulator at a rate of 12 – 15 L/minute
G. Ventilate patient at a rate of 10 – 12 L/minute (1 ventilation every 5 – 6 seconds) with correct volumes (After 30 seconds, examiner auscultates and reports breath sounds are present and equal bilaterally and medical direction has ordered insertion of a supraglottic airway. The examiner will now take over ventilation.)
H. Check and prepare supraglottic airway devices
I. Lubricate or verbalize lubricating distal tip of the device (Examiner will remove OPA when candidate is prepared to insert device.)
J. Position head properly
K. Perform a tongue-jaw lift
L. Insert device to proper depth
M. Secure device in patient [inflate cuffs with proper volumes and immediately removes syringe or secure strap]
N. Ventilate patient and confirm proper ventilation [correct lumen and proper insertion depth] by auscultation bilaterally over lungs and over the epigastrium
O. 
Adjust ventilation as necessary [ventilate through additional lumen or slightly withdraw tube until ventilation is optimized]

P. Verify proper tube placement by secondary confirmation such as capnography, capnometry, EDD or colorimetric device (The examiner will ask the candidate, “How would you know if you are delivering appropriate volumes with each ventilation?”)
Q. Secure device or confirm that the device remains properly secured
R. Ventilate patient at proper rate and volume while observing capnography/capnometry and pulse oximeter

The second scenario involves an infant in respiratory distress and will test Pediatric Respiratory Compromise skills. The candidate must demonstrate immediate management of the patient using simple airway maneuvers, adjuncts, and supplemental oxygen. You will then be required to demonstrate bag-valve-mask ventilation as the patient progresses from respiratory distress to respiratory failure.

 

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