EMT PRACTICE

–EMT PRACTICAL SKILLS EXAM–

in reporting to each station so that we may complete If you feel either occurred, you must contact me
this examination within a reasonable time period. immediately to initiate the complaint process. You
must submit the complaint in writing. The examina-
Failure of three or fewer skill stations entitles tion coordinator and the medical director will review
you to a same-day retest of those skills failed. Failure your concerns.
of four or more skill stations constitutes a failure of
the entire practical examination, requiring a retest of I am here today to assure you that fair, objective,
the entire practical examination. Failure of a same-day and impartial evaluations occur in accordance with
retest entitles you to a retest of those skills failed. This the guidelines contained in this guide. If you have any
retest must be accomplished at a different site with a concerns, notify me immediately to discuss your con-
different examiner. Failure of the retest at the different cerns. I will be visiting all skill stations throughout the
site constitutes a complete failure of the practical examination to verify adherence to these guidelines.
examination, and you will be required to retest the Please remember that if you do not voice your con-
entire practical examination. cerns or complaints today before you leave this site or
before I inform you of your results, your complaints
The results of the examination are reported as will not be accepted.
pass/fail of the skill station. You will not receive a
detailed critique of your performance on any skill. The skill station examiner does not know or play
Please remember that today’s examination is a formal a role in the establishment of pass/fail criteria, but he
verification process and was not designed to assist with or she is merely an observer and recorder of your
teaching or learning. The purpose of this examination actions in the skill station. This is an examination
is to verify achievement of the minimal DOT competen- experience, not a teaching or learning experience.
cies after the educational component has been com-
pleted. Identifying errors would be contrary to the Does anyone have any questions concerning the
principle of this type of examination and could result in practical examination at this time?
the candidate “learning” the examination while still not
being competent in the necessary skill. It is recommended Points to Remember
that you contact your teaching institution for remedial 1. Follow instructions from the staff.
training if you are unsuccessful in a skill station. 2. During the examination, move only to areas
directed by the staff.
If you feel you have a complaint concerning the 3. Give your name as you arrive at each station.
practical examination, a formal complaint procedure 4. Listen carefully as the testing scenario is
does exist. You must initiate any complaint with me explained at each station.
today. Complaints will not be valid after today and will 5. Ask questions if the instructions are not clear.
not be accepted if they are issued after you learn of 6. During the examination, do not talk about the
your results or leave this site. You may file a complaint examination with anyone other than the skill
for only two reasons: station examiner, programmed patient, and
when applicable, the EMT assistant.
1. You feel you have been discriminated against. 7. Be aware of the time limit, but do not sacrifice
Any situation that can be documented in which quality performance for speed.
you feel an unfair evaluation of your abilities 8. Equipment will be provided. Select and use
occurred may be considered discriminatory. only what is necessary to care for your patient
adequately.
2. There was an equipment problem or malfunc-
tion in your station.

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–EMT PRACTICAL SKILLS EXAM–

Patient Assessment/ Trauma Situation #1:
Management—Trauma Patient Assessment/Management

Instructions to the Candidate Mechanism of Injury
You are called to the scene of a motor vehicle crash,
Minimum Score: 33 where you find a victim who was thrown from a car.
This station is designed to test your ability to You find severe damage to the front end of the car.
The victim is found lying in a field 30 feet from the
perform a patient assessment of a victim of multisys- upright car.
tems trauma and “voice” treat all conditions and inju-
ries discovered. You must conduct your assessment as Injuries
you would in the field, including communicating with The patient will present with the following injuries.
your patient. You may remove the patient’s clothing All injuries will be moulaged. Each examiner should
down to shorts or swimsuit if you feel it is necessary. program the patient to respond appropriately
As you conduct your assessment, you should state throughout the assessment and assure the victim has
everything you are assessing. Clinical information not read the “Instructions to Simulated Trauma Victim”
obtainable by visual or physical inspection will be that have been provided.
given to you after you demonstrate how you would
normally gain that information. You may assume that 1. unresponsive
you have two EMTs working with you and that they 2. left side flail chest
are correctly carrying out the verbal treatments you 3. decreased breath sounds, left side
indicate. You have ten minutes to complete this skill 4. cool, clammy skin; no distal pulses
station. Do you have any questions? 5. distended abdomen
6. pupils equal
Sample Trauma Scenario 7. neck veins flat
The following is an example of an acceptable scenario 8. pelvis stable
for this station. It is not intended to be the only pos- 9. open injury of the left femur with capillary
sible scenario for this station. Variations of the sce-
nario are possible and should be used to reduce the bleeding
possibility of future candidates knowing the scenario
before entering the station. If the scenario is changed, Vital Signs
the following four guidelines must be used. 1. Initial vital signs—BP, 72/60; P, 140; RR, 28
2. Upon recheck—if appropriate treatment:
1. A clearly defined mechanism of injury must be BP, 86/74; P, 120; RR, 22
included. The mechanism of injury must indi- 3. Upon recheck—if inappropriate treatment:
cate the need for the candidate to perform a BP, 64/48; P, 138; RR, 44
rapid trauma assessment.

2. There must be a minimum of an airway,
breathing, and circulatory problem.

3. There must be an additional associated soft-
tissue or musculoskeletal injury.

4. Vital signs must be given for the initial check
and one recheck.

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–EMT PRACTICAL SKILLS EXAM–

Patient Assessment/ When assessing the signs and symptoms of the
Management—Medical patient, the candidate must gather the appropriate infor-
mation by asking the questions listed on the skill sheet.
Instructions to the Candidate
Each candidate is required to complete a full
Minimum Score: 33 patient assessment. The candidate choosing to trans-
This station is designed to test your ability to perform port the victim immediately after the initial assess-
a patient assessment of a patient with a chief com- ment must be instructed to continue the focused
plaint of a medical nature and “voice” treat all condi- history, physical examination, and ongoing assess-
tions discovered. You must conduct your assessment ment en route to the hospital.
as you would in the field, including communicating
with your patient. You may remove the patient’s cloth- NOTE: The preferred method to evaluate a can-
ing down to shorts or swimsuit if you feel it is neces- didate is to write the exact sequence the candidate fol-
sary. As you conduct your assessment, you should lows during the station as it is performed.You may then
state everything you are assessing. Clinical informa- use this documentation to fill out the evaluation instru-
tion not obtainable by visual or physical inspection ment after the candidate completes the station. This
will be given to you after you demonstrate how you documentation may then be used to validate the score
would normally gain that information. You may on the evaluation instrument if questions arise later.
assume that you have two EMTs working with you and
that they are correctly carrying out the verbal treat-
ments you indicate. You have 15 minutes to complete
this skill station. Do you have any questions?

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–EMT PRACTICAL SKILLS EXAM–

Sample Medical Scenarios Interventions: “I haven’t done anything but
call you guys. I know she took
ALTERED MENTAL STATUS Seizures: her insulin this morning.”
Fever:
When you arrive on the scene, you meet a 37-year-old Allergies: None
male who says his wife is a diabetic and isn’t acting Medications:
normally. Past Medical Low-grade fever

Initial Assessment History: Penicillin
Last Meal:
Chief Complaint: “My wife just isn’t acting right. Insulin
I can’t get her to stay awake. Events Leading to
She only opens her eyes, then Illness: Insulin-dependent diabetic
goes right back to sleep.” since 21 years of age
Focused Physical
Apparent Life Depressed central nervous Examination: “My wife ate breakfast this
Threats: system, respiratory compromise morning.”
Vitals:
Level of Opens eyes in response to “My wife has had the flu and
been vomiting for the past
Responsiveness: being shaken 24 hours.”

Airway: Patent Complete a rapid assessment to
rule out trauma.
Breathing: 14 and shallow
RR, 14; P, 120; BP, 110/72

Circulation: 120 and weak ALLERGIC REACTION

Transport Decision: Immediate You arrive to find a 37-year-old male who reports eat-
ing cookies he purchased at a bake sale. He has audible
Focused History and Physical Examination wheezing and is scratching red, blotchy areas on his
abdomen, chest, and arms.
Description of “My wife took her insulin this
Episode: morning like any other morn-
ing, but she has had the flu and
has been vomiting.” Initial Assessment

Onset: “It happened so quickly. She was Chief Complaint: “I’m having an allergic reaction
just talking to me and then she to those cookies I ate.”
just went to sleep. I haven’t really
been able to wake her up since.” Apparent Life Respiratory and circulatory
Threats: compromise

Duration: “She’s been this way for about Level of Awake, very anxious, and
15 minutes now. I called you
right away. I was really scared.” Responsiveness: restless

Airway: Patent

Associated “The only thing that I can Breathing: 26, wheezing, and deep
Symptoms: think of is that she was vomiting
last night and this morning.” Circulation: No bleeding, pulse 120 and
weak, cold and clammy skin

Evidence of Trauma: “She didn’t fall. She was just sit- Transport Decision: Immediate
ting on the couch and fell asleep.
I haven’t tried to move her.”

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–EMT PRACTICAL SKILLS EXAM–

Focused History and Physical Examination Level of Responds slowly to verbal

History of Allergies: “Yes. I’m allergic to peanuts.” Responsiveness: commands

When Ingested: “I ate cookies about 20 min- Airway: Patent
utes ago and began itching all
over about five minutes later.” Breathing: 18 and deep

Circulation: 120 and strong

How Much Ingested: “I ate only two cookies.” Transport Decision: Immediate

Effects: “I’m having trouble breathing,
and I feel lightheaded and dizzy.”
Focused History and Physical Examination

Progression: “My wheezing is worse. Now Substance: “My baby took sleeping pills. I
I’m sweating really badly.” don’t know what kind they are.
They just help me sleep at night.”
Interventions: “I have my epi-pen upstairs,
but I’m afraid to stick myself.”
When Ingested: “I think she must have got them
about an hour ago when I was in
Allergies: Peanuts and penicillin the shower. Her older sister was
supposed to be watching her.”
Medications: None

Past Medical “I had to spend two days in How Much “My prescription was almost
History: the hospital the last time this Ingested: empty. There couldn’t have
happened.” been more than four or five
pills left. Now they’re all gone.
Last Meal: “The last thing I ate were those Please do something.”
cookies.”

Events Leading to “None, except I ate those Effects: “She just isn’t acting like herself.
She’s usually running around
Illness: cookies.” and getting into everything.”

Focused Physical Not indicated (award point)
Examination:
Allergies: None

Vitals: RR, 26; P, 120; BP, 90/60 Medications: None

POISONING/OVERDOSE Past Medical None
History:
You arrive on the scene where a 3-year-old female is
sitting on her mother’s lap. The child appears very Last Meal: “She ate breakfast this morning.”
sleepy and doesn’t look at you as you approach.
Events Leading to “She just swallowed the pills.”
Illness:

Initial Assessment Focused Physical Complete a rapid trauma
Examination: assessment to rule out trauma.
Chief Complaint: “I think my baby has swal-
lowed some of my sleeping
pills. Please don’t let her die!” Vitals: RR, 18; P, 120; BP, 90/64

Apparent Life Depressed central nervous
Threats: system and respiratory
compromise

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–EMT PRACTICAL SKILLS EXAM–

ENVIRONMENTAL EMERGENCIES Past Medical None
History:
You arrive on the scene as rescuers are pulling a “I ate lunch at school three
16-year-old female from an ice-covered creek. The Last Meal: hours ago.”
teenager has been moved out of the creek onto dry “I thought the ice would
land, is completely soaked, and appears drowsy. Events Leading to hold me.”
Illness: Complete a rapid assessment
Initial Assessment to rule out trauma.
Focused Physical RR, 26; P, 110 and strong;
Chief Complaint: “I saw something in the water Examination: BP, 120/80
below the ice. When I tried to
get it out, the ice broke.” Vitals:

Apparent Life Generalized hypothermia
Threats:
OBSTETRICS
Level of Responsive, but slow to speak
You arrive on the scene where a 26-year-old female is
Responsiveness: lying on the couch saying, “The baby is coming and
the pain is killing me!”
Airway: Patent

Breathing: 26 and shallow Initial Assessment

Circulation: No bleeding; pulse, 110 and Chief Complaint: “I’m nine months pregnant
strong; pale, wet skin still and the baby is coming soon.”
covered in wet clothing

Transport Decision: Immediate Apparent Life None
Threats:

Focused History and Physical Examination Level of Awake and alert

Source: “I fell in the creek when the ice Responsiveness:
broke. I tried to get out, but the
current was too strong.” Airway: Patent

Breathing: Panting, rapid breathing
during contractions
Environment: “The water was up to my neck.
I could stand up, but I couldn’t
get out of the water.” Circulation: No bleeding, pulse 120, skin
is pale

Duration: “I think I was in the water for Transport Decision: Unknown
ten minutes before they pulled
me out. It felt like an hour.” Focused History and Physical Examination

Loss of “I feel sick, but I never Are You Pregnant: See chief complaint (award
point if mentioned in general
Consciousness: passed out.” impression).

Effects: Lowered body temperature,
slow speech patterns, “I can’t
stop shivering.” How Long See chief complaint (award
Pregnant: point if mentioned in general
impression).
Allergies: None

Medications: None

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–EMT PRACTICAL SKILLS EXAM–

Pain or “My pain is every two to three Airway: Patent
minutes,
Contractions: and it lasts two to three Breathing: 16 and effortless
minutes.”
Bleeding or None Circulation: No bleeding, pulse 100, warm
Discharge: skin, and red nose
“Yes, every time the pain
Do You Feel the begins.” Transport Decision: Delayed
Need to Push: Present (award point if identi-
fied in focused physical exam) Focused History and Physical Examination
Crowning: None
None How Do You Feel: “I’m a little sick, otherwise,
Allergies: “This is my third baby.” I just want to go to sleep.”
Medications:
Past Medical “I ate breakfast today.” Suicidal Tendencies: “No, I ain’t going to kill
“The contractions started a few myself.”
History: hours ago and have not
Last Meal: stopped.” Threat to Others: “Hey man, I ain’t never hurt
Events Leading to Assess for crowning, bleeding, anyone in my life.”
and discharge.
Illness: RR, 40 during contractions; Is There a Medical “My wife says I’m an alcoholic,
P, 120; BP, 140/80
Focused Physical Problem: but what does she know?”
Examination:
Interventions: “Yeah, I took three aspirins
Vitals: because I know I’m going to
have one heck of a headache in
the morning.”

Allergies: None

Medications: None

BEHAVIORAL Past Medical “I’ve been in the hospital four
History: times with those DTs.”
You arrive on the scene, where you find a 45-year-old
male in the custody of the police. He is unable to stand Last Meal: “Man, I haven’t eaten since
and smells of beer. He appears to be dirty, and you yesterday.”
notice numerous rips and tears in his clothes.
Events Leading to “I don’t care what these cops
Illness: say, I didn’t fall down. I was
just taking a nap before going
Initial Assessment home.”

Chief Complaint: “Nothing is wrong with me Focused Physical Complete a rapid assessment
except these cops won’t leave me Examination: to rule out trauma.
alone. I only drank two beers.”
Vitals: RR, 16; P, 100; BP, 90/60

Apparent Life None
Threats:

Level of Responds slowly with slurred

Responsiveness: speech to verbal questions

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–EMT PRACTICAL SKILLS EXAM–

Cardiac Arrest Management instruct him or her. As you arrive on the scene, you
will encounter a patient in cardiac arrest. A first
Instructions to the Candidate responder will be present performing single-rescuer
CPR. You must immediately establish control of the
Minimum Score: 14 scene and begin resuscitation of the patient with an
This station is designed to test your ability to manage AED. At the appropriate time, the patient’s airway
a prehospital cardiac arrest by integrating CPR skills, must be controlled, and you must ventilate or direct
defibrillation, airway adjuncts, and patient/scene the ventilation of the patient using adjunctive equip-
management skills. There will be an EMT assistant in ment. You may use any of the supplies available in this
this station. The EMT assistant will only do as you room. You have ten minutes to complete this skill sta-
tion. Do you have any questions?

Airway, Oxygen, Ventilation ventilation has not been initiated. The only patient
Skills/Bag Valve Mask— management required is airway management and
Apneic with Pulse ventilatory support. You must initially ventilate the
patient for a minimum of 30 seconds. You will be
Instructions to the Candidate evaluated on the appropriateness of ventilator vol-
umes. I will then inform you that a second rescuer has
Minimum Score: 13 arrived and will instruct you that you must control the
This station is designed to test your ability to ventilate airway and the mask seal while the second rescuer
a patient using a bag valve mask. As you enter the sta- provides ventilation. You may use only the equipment
tion, you will find an apneic patient with a palpable available in this room. You have five minutes to com-
central pulse. There are no bystanders, and artificial plete this station. Do you have any questions?

252

–EMT PRACTICAL SKILLS EXAM–

Spinal Immobilization— the patient’s vital signs remain stable. You are required
Supine Patient to treat the specific problem of an unstable spine using
a long spine immobilization device. When moving the
Instructions to the Candidate patient to the device, you should use the help of the
assistant EMT and the evaluator. The assistant EMT
Minimum Score: 11 should control the head and cervical spine of the
This station is designed to test your ability to provide patient while you and the evaluator move the patient
spinal immobilization on a patient using a long spine to the immobilization device. You are responsible for
immobilization device. You arrive on the scene with the direction and subsequent action of the EMT assis-
an EMT assistant. The assistant EMT has completed tant. You may use any equipment available in this
the scene size-up as well as the initial assessment, and room. You have ten minutes to complete this skill sta-
no critical condition was found that would require tion. Do you have any questions?
intervention. For the purpose of this testing station,

Spinal Immobilization– EMT has completed the initial assessment, and no
Seated Patient critical condition requiring intervention was found.
For the purpose of this station, the patient’s vital signs
Instructions to the Candidate remain stable. You are required to treat the specific,
isolated problem of an unstable spine using a half-
Minimum Score: 9 spine immobilization device. You are responsible for
This station is designed to test your ability to provide the direction and subsequent actions of the EMT
spinal immobilization of a patient using a half-spine assistant. Transferring and immobilizing the patient to
immobilization device. You and an EMT assistant the long spine board should be accomplished verbally.
arrive on the scene of an automobile crash. The scene You have ten minutes to complete this skill station. Do
is safe, and there is only one patient. The assistant you have any questions?

253

–EMT PRACTICAL SKILLS EXAM–

Immobilization Skills— injury to the extremity. The scene size-up and initial
Long Bone assessment have been completed, and during the
focused assessment, a closed, nonangulated injury of
Instructions to the Candidate the ______ (radius, ulna, tibia, fibula) was detected.
Ongoing assessment of the patient’s airway, breathing,
Minimum Score: 8 and central circulation is not necessary. You may use
This station is designed to test your ability to properly any equipment available in this room. You have five
immobilize a closed, nonangulated long bone injury. minutes to complete this skill station. Do you have any
You are required to treat only the specific, isolated questions?

Immobilization Skills— to the shoulder. The scene size-up and initial assess-
Joint Injury ment have been accomplished on the victim, and dur-
ing the focused assessment, a shoulder injury was
Instructions to the Candidate detected. Ongoing assessment of the patient’s airway,
breathing, and central circulation is not necessary.
Minimum Score: 7 You may use any equipment available in this room.
This station is designed to test your ability to properly You have five minutes to complete this skill station.
immobilize a noncomplicated shoulder injury. You Do you have any questions?
are required to treat only the specific, isolated injury

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–EMT PRACTICAL SKILLS EXAM–

Bleeding Control/Shock questions about the actual steps of the procedures to be
Management performed. You may use any of the supplies and equip-
ment available in this room. You have ten minutes to
Instructions to the Candidate complete this skill station. Do you have any questions?

Minimum Score: 5 Scenario (Sample) Bleeding Control/
This station is designed to test your ability to control Shock Management
hemorrhage. This is a scenario-based testing station. As You respond to a stabbing and find a 25-year-old
you progress throughout the scenario, you will be given male victim. Upon examination, you find a two-inch
various signs and symptoms appropriate for the stab wound to the inside of the right arm at the ante-
patient’s condition. You will be required to manage the rior elbow crease (antecubital fascia). Bright-red
patient based on these signs and symptoms. A scenario blood is spurting from the wound. The scene is safe,
will be read aloud to you, and you will be given an and the patient is responsive and alert. His airway is
opportunity to ask clarifying questions about the open, and he is breathing adequately. Do you have
scenario; however, you will not receive answers to any any questions?

Airway, Oxygen, Ventilation isolated skills test. You will be required to assemble an
Skills/Supplemental oxygen tank and a regulator and administer oxygen to
a patient using a nonrebreather mask. You may use
Oxygen Administration only the equipment available in this room. You have
five minutes to complete this station. Do you have any
Instructions to the Candidate questions?

Minimum Score: 8
This station is designed to test your ability to correctly
assemble the equipment needed to administer supple-
mental oxygen in the prehospital setting. This is an

255