NREMT-I Practical Exam

So I took my practical (hands on) exam for my upgrade to Nationally Registered Emergency Medical Technician-Intermediate. This practical is one of the two culminating events that finalize everything I learned in my EMT-I class over the last 4 months. National Registry is a strange animal, I have already passed the course work at the Community College for EMT-I. As far as they are concerned I am done,however to actually work as an EMT-I I have to pass the national registry practical and written test. So I was a little nervous. I haven't taken a hands on test in about 4 years or since I took my practical exam for my EMT-Basic.

Last Thursday the instructor who taught our class was actually working with me at the Ambulance Service so she ran me through all the possible test stations (Thanks Mary). I wasn't totally confident though as test conditions are always different. On Friday night, before the test, I watched a bunch of youtube videos that showed other people going through National Registry stations. I woke up Saturday morning and as soon as I was conscious the test steps started running through my head, I guess I was a little tense. Anyway I took a shower, got dressed and made the 30 minute drive to the University of Iowa Hospitals and Clinics. 

When I walked into the testing area, I saw that there where about 60 people taking the practical that day. Most of these though were from the latest Paramedic class and they had different stations than the EMT-I's. There were about 10 of us testing for EMT-I. I checked in with the proctor and sat next to a few of the guys I had been in class with. I looked through the test steps again but I could definitely feel the old rush that I always feel when I take a hands on test. From the Basic Training Skills test to the Military Freefall Jumpmaster Personnel Inspection and all the others in between I would feel a mixture of nervousness and adrenaline. Eventually the National Registry representaive came out and handed everyone there test paperwork. We filled it out as she read the rules and procedures for the test. We then got in line to start the test.

How the test was organized for the EMT-I was we had to pass a trauma assessment station, airway management, intravenous cannulization, and a random basic skill. We would get in line and be given a plastic card that told us what station to go to next. So when I was at the head of the line the first card I got was the trauma station. This was the go hard or go home moment for me. This was the station with the most points,most opportunity for failure and the most leeway for the evaluator to be subjective. It was also the station I dreaded the most since when I took my EMT-B test I failed it the first time around and had to retest.

So I made my way down the hall hoping that I wouldn't blow the very first station of the day. I entered the room and the evaluator read me the instructions for the station. The scenario was a young lady who was a victim of domestic violence and I was to do a trauma assessment and treat and transport appropriately. What made it difficult was she was unresponsive and all moulaged up with several injuries to the face,abdomen and left arm. I started my assessment and interventions, I made sure I verbalized everything I was doing and asked the evaluator for any information such as vital signs or changes as I went along. I was in the zone and had tunnel vision on the victim, I was trying so hard not to miss anything. At one point my mind went totally blank, I started to panic a little not sure where I was at in my assessment or what the next step was. However, I took a breathe and suddenly my mind started working again. At the conclusion the evaluator asked me if there was anything else I wanted to say. I realized I had not called for additional help which was critical fail criteria. I blurted out " Advanced life support is in route since I never called them off!" The evaluator asked if I was done and I said yes. I left the room feeling pretty good about that station.

So trauma was the turning point and I got it out of the way early. I went through the next three stations fairly easily as they followed the check list in my mind. No subjectivity on the evaluators part you either did each step or you did not. Airway management was accomplished using a Combi Tube which is a blind insertion away device. The Combi is a tube you insert into the trachea to keep a patient's airway open. The basic random skill was the application of the Kendrick Extrication Device. The KED is a short semi-rigid backboard that is used to maintain spine control on a patient that may be seated in a vehicle or chair. My last station was the IV station which due to all the cross training I had in the military gave me absolutely no anxiety. When I was all finished  I went back out to the lobby and waited for my results. I looked over the criteria for each station again and unless I was totally wrong I felt I had passed them all. Eventually the National Registry representative called me and asked if I had any issues with the test. While she was asking me this she had a little smile on her face. When I said no she informed me I had passed. I felt this enormous sense of relief as all the self induced stress just left my body. I thanked her, informed my classmates I had passed and walked out of the Hospital on cloud nine. I will be taking my written test next week and then I will be a Nationally registered EMT-I. That day was a good day.