Nationals Skills Testing, Part II: The Rematch
Following my defeat from my last National Skills Testing, and after some remediation, I was ready for Round 2. The testing, unfortunately, was in another town nearly 45 minutes away. When I arrived, the mooing in the distance confirmed I was in a small, SMALL town. The K-12 school was a pretty good indication too.
The test worked the same as last time, just on a smaller scale. There were only about a dozen of us this time. The stations were the same, but there were less of them (there were 2 of each Trauma and Medical Assessments, instead of 3, and 1 Long Spine Board, instead of 2). As with last time, we were to wait in a staging area and take the index cards to our stations, and come back when we were done. The turn-around time between the stations went pretty fast. You really didn’t have time to think about what you did wrong, just gear up for the next skill. It made it seem more fast-paced, much like EMS.
My first station was Medical Assessment. The trick I learned with Medical Assessment (after volunteering to be a patient) is they try to lead you somewhere; you just have to figure out where. There are five medications they teach us about (other than oxygen), which are nitroglycerin, aspirin, epi-pen, metered dose inhaler (MDI), oral glucose. It usually boils down to using one of these medications; you just have to use a Q&A session to eliminate/promote possibilities.
The scenario was an elderly man (I think the age was 56) complaining of difficulty breathing. The difficulty breathing could be all of them, so that’s no help. In the allergies question I found out he was allergic to aspirin, so strike that out. There also wasn’t anything in his allergies (or breathing) that would indicate it would be an allergic reaction, so that removed the epi-pen. There were no symptoms of low blood sugar, so that gets rid of the oral glucose. The prescribed medications question is what sealed it: he was prescribed an MDI, which I saw in his hand, but I thought I’d eliminate everything else first. I started adding up the indications (things that make it okay to give a medications) and things were looking good. Then I started looking for contraindications (things that make it unsafe to give medications) and then something happened.
In addition to leading you somewhere, they also put in pitfalls. These are things that will make you fail. They don’t do this so you’ll fail, but to make sure you’re paying attention. I hit such a pitfall. After asking to look at the MDI, for the 5 Rights, the evaluator stated, “You notice this medication has expired.” I auscultated his lungs again to look for improvement (I had first put him on oxygen to help clear up breathing), no change. I informed the evaluator that I have exhausted all my possibilities. And due to the cyanotic nature of the patient’s skin and the fact there has been no improvement in breathing, I would transport this patient without further intervention. I gave my arrival report and was done.
Frankly, I felt like I lost. Did I miss something? Nothing I really did there helping anything and I just felt… defeated. Was I not supposed to win this time? But I couldn’t think about it long because it was AED time.
The machines were different from last time, so I tried to choose the one that was the closest to the one I was familiar with. The CPR dummy was different, so it threw my compression rate off. The ones at school you hear a clicking sound when you’ve reached the right depth. This dummy it was just like you were squeezing the air out of a bag (which is probably exactly what I was doing).
When the AED arrived, I click the power button… nothing. Again, I clicked it… still nothing. Shit… The evaluator said I had to hold the button, so I did that… it turned on and off. After the fourth attempt, I got it to turn on. Apply the pads before attaching the line to the AED I reminded myself. After that, it was all downhill.
The evaluator must have caught on to my compression rate problem because he asked, “What is the proper rate of compressions?” In my confusion, I replied, “30 and 2.” He repeated rate of compressions, not compressions-to-breaths. I told him, “100 beats per minute.” That seemed to satisfy him, because he declared I was done.
I zoomed through Non-Rebreather Mask and Bag Valve Mask without problem. The next station was Trauma Assessment. Treat all life-threats immediately, keep moving and don’t get hung up on the points on the sheet, and the body is my roadmap. I kept reminding myself.
The scenario was a call to a bar for a stabbing. There were no visible injuries on my first impression. After assessing the ABCs, and having one of my partner’s monitor them. That’s a trick my remediator taught me. That way if something goes bad, the evaluator HAS to tell me. When I cut away her clothes (the trauma patients always wear cut-away clothes over their normal clothes) I smiled, at least internally. I had found a pitfall. The woman had a piece of exposed intestines (which the makeup was done VERY well), which I immediately treated that life-threat.
When I did my primary assessment I made sure to avoid the area, but verbally recognized the injury. When I was checking vitals, and starting the blood pressure, I was told I had 1 minute left (the assessments are timed; you have 15 minutes each to complete the stations). So I did the blood pressure, and verbalized I would recheck the patient every 5 minutes due to them being a high priority. While I was looking them over for things I missed, the evaluator called time.
The Random Skill was next. And it was, no surprise, Bleeding and Shock. I made sure to treat the correct arm, and verify it was the injured arm. I didn’t have any problems with the station after that. I also made sure to say I would transport in a position of comfort.
Long Spine Board was the last station. This threw me off because I still couldn’t figure out what I did wrong. So I rolled the dice and did it similar to the way I did previously. The only thing I changed was I purposely didn’t center the patient on the board. This was so I could demonstrate the proper way to move a patient on the board. When the station was done, and I was helping clean up, I noticed he was writing something on my evaluation sheet.
The final results took a lot less time than last time. The head evaluator said I did, “markedly better this time.” I passed them all but Long Spine Board. I just can’t win with this one. I looked over the skill sheet, and I hit that thing point for point.
I decided to seek out the guidance of my remediator (who was there running a separate skill station). I went over the station with him, and he suggested checking CSM while I’m having my partner hold c-spine. That seemed silly to me, but I’d do it. I told him I think he marked me for a critical error (which is an auto failure), so we tooled on that. He asked me how I put on the c-collar, I told him. He gave me a different way to try. We guessed it might have been excessive spine movement, due to the way I put on the collar.
Now for the second attempt with Long Spine Board. I did the steps my remediator suggested and checked CSM while the partner held c-spine. When I put on the c-collar, I held the patient’s neck in my hand, while I slipped the collar behind her, brought it around and locked it into place in the front (which looks A LOT like choking them), and locked it into place.
The results came back quicker this time. I did notice the Long Spine Board volunteer was packing her things and getting ready to leave. Always a good sign. The head evaluator met with me again and I passed. I guess it was excessive spine movement after all.
Now just to pass the written exam and I’m certified as an EMT.