Arthur Hsieh

Cheat Sheet / Updated 02-18-2022

This Cheat Sheet is a quick summary of facts you should know about becoming a certified emergency medical technician (EMT), including certification steps, computer adaptive testing, and exam preparation.

Article / Updated 03-26-2016

The requirements for becoming a certified emergency medical technician (EMT) vary from state to state. However, several steps are common to the EMT certification process. They include the following steps: Enroll in an EMT course. Search on the web or go to your local emergency medical services (EMS) or fire station to find out where reputable EMT training programs are offered. Talk to the program coordinator or main instructor to find out when the course meets, how long it lasts, what costs are involved, and other factors you want to know before deciding which one to enroll in. Complete the EMT course. EMT training programs are fairly intensive, taking at least 150 hours to complete. Review the course syllabus and understand what it takes to successfully complete the program. Pass the NREMT or state exam. Most states now use the National Registry of Emergency Medical Technicians (NREMT) exam as the qualifying test for state certification; your instructor will let you know whether another state exam is being used. You'll want to prep a bit for either exam after you complete your EMT course. Apply for state certification. You complete an application and turn it in to the state EMS office, along with a fee. Some states require proof of successful course completion, and other states may require a criminal background check. You'll want to check the state's EMS website and talk to your instructor about the process. Maintain your EMT certificate. All states require you to attend continuing education classes in order to stay up-to-date on changes in practice. Several states require you to attend refresher courses each time you renew your EMT certificate, usually every two to three years. Your state's EMS office likely has this information on its official website.

Article / Updated 03-26-2016

The National Registry of Emergency Medical Technicians (NREMT) began using computer adaptive testing (CAT) in January 2007. Prior to then, NREMT exams were paper based; an NREMT representative had to administer the test to a group of candidates. Answers were recorded by test-takers onto Scantron forms, which were collected by the NREMT representative and mailed to the NREMT. As you can imagine, this all took time to process and candidates had to wait a couple weeks for their results. With CAT, the computer you use for the emergency medical technician (EMT) exam knows immediately whether your performance meets the minimum standard necessary to practice as an EMT. That information is transmitted to the NREMT, where staff confirm that you have completed all aspects of the application process. Your results are then posted to your online account. The result is that you often know within 24 to 36 hours whether you passed the exam; many candidates report knowing their results on the same day they take the exam! While the reduced waiting time is great, what's even more important is the level of precision CAT has when evaluating your abilities. After you answer a test question of a specific difficulty level, the computer determines whether you answered it correctly. It then provides another question that is similar, higher, or lower in difficulty, depending on your response to the previous question. It continues this process as you go through the exam, constantly reevaluating your performance with each question. The NREMT's CAT question bank contains thousands of questions that the computer can select from during your exam. It picks questions for content and difficulty based only on your performance. The questions become tailored to you; your test isn't likely to be exactly the same as another person's exam. You may wonder how different tests for different people can be consistently judged by the computer. A testing principle called item response theory is the basis for CAT. By testing the candidate's answering ability per question, rather than per test, the computer can rapidly identify performance on the fly rather than waiting for the whole test to be run through. Over time, the computer develops a statistical projection as to whether you'll continue to pass questions that meet minimum standards or fail them. When it reaches that point, there's no reason to continue answering questions, as the outcome will likely remain the same. This results in a test that is typically shorter than the original, paper-based exams, yet has more confidence in identifying whether your knowledge base is above standard. For most students, the length of the exam ranges between 70 and 120 questions.

Article / Updated 03-26-2016

One responsibility that you have as an emergency medical technician (EMT) is to document your assessment and management of the patient. Such documentation can take time to complete if you write out everything that you found and performed. Medical abbreviations can help speed up the process. You can use literally dozens of abbreviations; here are ten (or so) that are commonly used when documenting your assessment and care, plus a few symbols that you can use as shorthand for common words. A/Ox3 (or x4): Alert and oriented to person, place, and time (if using x4, also event). Normally, people can tell you who they are, where they are at the moment, and at what point in time, such as day, date, or time of the day. This awareness is known as orientation. A change in mental status causes the orientation to change. For example, a patient may become disoriented and not remember the time or date. He would be A/Ox2 because he's oriented to person and place only. CC or C/O: Chief complaint or complains of. This is the patient's reason for requesting emergency medical services. It may not always be the actual, true cause. For example, the patient may tell you that she's having trouble breathing; however, the real problem may be that her blood pressure is very low due to internal bleeding, and her respiratory system is compensating by making more oxygen available to the remaining red blood cells. OPQRST: This common mnemonic helps you to remember questions related to the complaint: Onset: What were you doing when the problem began? Provocation/Palliation: Does anything make it worse or better? Quality: Can you describe what you are feeling — for example, does your discomfort feel like pressure, like squeezing, or sharp? Related/Radiation: Is there anything else bothering you? Does the pain go anywhere? Severity: On a scale of 1(hardly bothersome) to 10 (really bad pain or discomfort), can you rate the feeling you have? Time: How long has this been going on for? Does it come and go, or is it constant? AMPL: This is another mnemonic that provides information about the patient's past medical history: Allergies: Are you allergic to any prescribed medications, over-the-counter (OTC) medications, or herbal supplements? Allergies may also be related to common environmental sources, such as food, stinging insects, or pollen. Medications: Are you supposed to be taking any prescribed or over-the-counter (OTC) medications? Be specific when asking this question. If you ask Are you on any medications?, the patient who is non-compliant with his medication may say no. Past medical history (PMH): Do you have any past medical history, such as hypertension, diabetes, or a heart problem? A patient's PMH may be the source of the current presentation or related to it. Additionally, very common and problematic medications such as those for hypertension or diabetes can complicate the patient's chief complaint and make it harder for the patient to compensate. Last oral intake: When did you last have something to eat or drink? This information can be valuable in determining a possible cause of nausea, vomiting or diarrhea, abdominal discomfort, or allergic reactions. DCAP BTLS: This is a mnemonic for remembering injuries associated with trauma: Deformities: Broken bones, dislocated joints Contusions: Bruising, bleeding under the skin Abrasions: Scrapes along the top of the skin Punctures: Small openings made by something sharp, such as a nail, knife, or bullet Burns: Soft tissue damage from heat, chemicals, or electrical or radioactive materials Tenderness: Pain upon palpation Lacerations: Openings in the skin; may be from blunt force that "cracks" the skin or a sharp object Swelling: Soft tissue injury after a strain or sprain; may also be blood collecting under the skin, creating a hematoma N/V/D: Nausea, vomiting, and/or diarrhea. These are common complaints that, if severe, can lead to dehydration and shock. Nausea can arise from a wide variety of reasons, ranging from food poisoning to medication reactions, heart attacks, and simply anxiety or fear. Vomiting is the body's way of trying to quickly eliminate something it doesn't want; it often occurs because of nausea, although patients may vomit without warning. Diarrhea is another "quick release" mechanism for something the body doesn't want. Food poisoning, infections, and certain types of medications are a few reasons for diarrhea. NKA: No known allergies. A simple abbreviation to record when a patient denies being allergic to medications. RUQ, RLQ, LUQ, LLQ: These point to different parts of the abdomen: right upper quadrant, right lower quadrant, left upper quadrant, left lower quadrant. Each quadrant contains a specific set of organs and structures that can cause discomfort if affected by an illness or condition. Great to use when describing where abdominal pain is located — for example, "Patient C/O RUQ pain" means that the patient is complaining of pain in the right upper quadrant. PEARL: Pupils that are equal in size and reactive to light. Alternative abbreviations include PERRL (pupils equal, round, and reactive to light) and PERRLA (pupils equal, round, reactive, and light accommodating.) Eye pupils are very reflective of brain function. A penlight is used to shine light into one eye; normal pupils are PEARL. If the brain is affected by a lack of oxygen, experiencing unusually high pressure, or altered by specific medications or drugs, it may malfunction, causing the pupils to act abnormally. They may become dilated (bigger than normal), constricted (smaller than normal), unequal in size, or slow to react to light. MVC: Motor vehicle crash. An older term is MVA — motor vehicle accident. The word "accident" implies that nothing could have been done to avoid the event; most crashes are, in fact, preventable. Other trauma mechanisms can also have shorthand documentation, such as auto-ped (automobile versus pedestrian). L, R, +, –: Left, right, positive findings, negative findings. These symbols can be used as shorthand for common words.

Article / Updated 03-26-2016

Don't take the National Registry of Emergency Medical Technicians (NREMT) exam lightly. Prepare for the cognitive (computerized) portion of the emergency medical technician (EMT) exam by taking the following actions: Create a study schedule and follow it. Study in a place that promotes learning and retention. Have all of your study materials at your side. Use tools like flashcards and study with friends to enhance your studying. Along with your knowledge, build your testing skills by taking practice tests. This in turn will build your confidence — another essential part of successful test-taking. The practical portion of the EMT exam is the hands-on part. You'll be tested on your ability to demonstrate various EMT skills, such as airway management, spinal immobilization, and splinting. The exam varies by state and is usually conducted at the end of the EMT course. Prepare for it by doing the following: Practice, practice, practice. Skills like splinting and spinal immobilization require repetitious practice to become second nature. Follow your skill sheets closely, especially when you're first learning a new skill. You want to learn it right the first time rather than have to unlearn mistakes later on in the course. Practice with classmates. You'll need help with many of the skills. More importantly, other people can tell you what you're doing right — or wrong — while you go through the steps.

Article / Updated 03-26-2016

The cognitive portion of the National Registry of Emergency Medical Technicians (NREMT) exam is a computer adaptive test (CAT) that continuously evaluates your performance as you answer each question. Here are a few things to keep in mind before you take the emergency medical technician (EMT) exam: As you take the exam, the computer constantly evaluates how you respond to each question and shows you questions at a level of difficulty that matches your ability to answer them. In other words, the exam "pushes you" to see where your performance lies — above or below the minimum standard of difficulty. Therefore, the questions seem difficult, no matter whether you are doing well or poorly. CAT asks you questions on a specific topic until it knows you are either above or below the standard. It then shifts to another section and repeats the process until all five sections are checked: Airway, Respiration, and Ventilation; Cardiology and Resuscitation; Medical and Obstetrics/Gynecology; Trauma; and EMS Operations. Because of this behavior, no two tests are ever alike. It may take as few as 70 questions or as many as 120 or more for the computer to calculate the statistical likelihood of your being above or below the standard. After you finish the exam, your answers are scored by the computer and sent to the NREMT. After your results are reviewed and approved by NREMT staff, they are posted to your online account. NREMT exams are delivered at Pearson VUE testing centers. These are offices that promote a secure, comfortable testing environment for many types of certification exams. You can schedule an exam at your convenience after your application is complete. Go to the NREMT website for more information.

Article / Updated 03-26-2016

As an emergency medical technician (EMT), you often need to tell the difference between one medical condition and another, known as the differential process or differentiating the medical complaint. This can be a challenge when the presenting signs and symptoms are very similar. Here's an example: A 54-year-old male presents with breathing difficulty and says his chest feels "tight." In this brief scenario, conditions that can cause that presentation include diseases such as asthma, chronic obstructive pulmonary disease (COPD), pulmonary embolus, and a heart attack, just to name a few. To narrow down the field of possible causes to a few probable ones, you have to play the medical detective — pulling information together through your assessment and coming to some conclusions based on your findings. You gather this information through two general approaches: Asking patients about what's happening is called history taking. You want to know what's happening right now, known as the history of the present illness (HPI). A mnemonic, OPQRST, begins a line of questions that describes the circumstances of the patient's complaint. (OPQRST stands for Onset, Provocation/Palliation, Quality, Related/Radiation, Severity, and Time.) Then, you record information about the patient's past medical history (PMH). Another mnemonic, AMPL, provides background information that may be related to the patient's HPI. (AMPL stands for Allergies, Medications, Past medical history, and Last oral intake.) Your attention is also focused on the physical examination. This is a hands-on evaluation of parts of the patient's body, feeling for bumps, masses, tenderness, and other physical findings. What specific findings you look for depends on what the complaint is. In the previous example of shortness of breath, you want to know what the patient's lung sounds are, whether there is any accessory muscle use, in what body position the patient presents, whether the patient's feet appear to be swelling, and whether the patient has a medical alert bracelet that indicates a medical problem. You also obtain a set of vital signs — the patient's blood pressure, pulse and respiratory rate, and skin signs. This information provides baseline knowledge on how well the body is maintaining itself while having a problem. You combine your findings from the history taking and physical examination into one pile. As you piece it all together, consider which medical conditions can cause the greatest number of the findings that you uncovered during your assessment. The more a particular condition fits, the higher the likelihood that it is the cause.

Article / Updated 03-26-2016

On the NREMT exam, you should make efforts to eliminate answer choices to narrow down your options. If you end up having to select between two options, try these tips: Reread the stem once more just to make sure that you didn’t miss any subtle clues. Sometimes the best answer is the longest one or the one that has the most specificity. This is not likely to happen with the NREMT exam because they check for such item-writing “errors,” but you never know. A test item may ask you a sequencing question — what you should do next, for example. If you’re trying to choose between two answers, look to see whether there’s an order to how things should happen. For example, does Choice (A) happen before Choice (B)? You can apply a “true-false” test to the answer choices. Reread the stem with each answer and ask yourself whether it sounds true or false. Your intuition is your subconscious mind speaking to you. You may have learned the information, but it may not be coming to the surface. Rereading the stem and answer together may allow your subconscious to match a learned nugget that you’re unable to recall at the moment. If more than one answer rings true, check to see whether there’s a sequencing component. Sometimes two of the four choices are opposites of each other. If so, there’s a good chance that one of them is correct. A 19-year-old male has been shot in the chest. He has an open wound to the left anterior chest wall that is oozing blood. He responds incomprehensibly to verbal stimulus. His respiration rate is 8, with shallow breathing. His pulse rate is 110, and his skin is cool, pale, and diaphoretic. What should you do first? (A)Insert an oropharyngeal airway. (B)Ventilate with a bag-valve mask (BVM). (C)Apply gauze to the open chest wound. (D)Administer high-flow oxygen with a nonrebreather mask. You might want to select Choice (D) because it’s the longest answer, and it certainly seems that the patient requires oxygen. However, his breathing rate is slow, and his tidal volume is shallow. These facts point more to Choice (B) as a better answer. While he is altered, he does respond to a verbal stimulus, which may mean he has a gag reflex. This consideration makes Choice (A) less of a good answer. If Choice (C) were to apply an occlusive dressing to the chest wound, that would make it a very good answer. But applying gauze alone makes this a poor choice as air could still pass through the wound. If you follow these tips, you’re making an educated guess on questions to which the answer isn’t clear. This tactic is very different from performing a WAG — a wild-&#!ed guess. WAGs are simply playing the odds and hoping that you end up choosing the best answer. Educated guessing is really applying the skill of deduction, which increases your chances of being correct.

Article / Updated 03-26-2016

On the EMT Exam, you will be faced with multiple choice questions. A multiple-choice question, or item, is made of several parts: the stem, distractors, and the correct answer. Each part plays a specific role. The stem The stem is the “question” part of the item. It’s the first part that sets up the situation for you to respond to, providing only the information necessary for you to answer the item correctly. The stem ends in the form of a question, for example, “What should you do next?” or asks you to complete a statement, such as “You suspect the underlying condition to be… .” Here’s an example of a stem: “An adult male is unresponsive on the floor of a restaurant. Patrons report the patient was having lunch when he suddenly grabbed his throat and collapsed. He is cyanotic, with agonal breaths. What should you do next?” Distractors and the answer The choices that are provided after the stem come in two flavors, answers and distractors. The answer is the best choice, given the stem. A distractor is exactly that — it’s designed to draw your attention away from the answer. Note the importance of high-quality distractors Where a multiple-choice question shines is in the quality of the distractors. Good distractors look like they could be right answers. In fact, they often are; however, in such cases the stem asks for the best answer, not the right one. This means that you really have to choose which “right” answer is the best one. On the other hand, bad distractors are obviously incorrect. Bad distractors don’t test your knowledge base or your ability to reason. Here’s a simple example. You look up and see a small animal with wings flying overhead. As it does, you can hear it make a “quack quack quack” sound. You suspect it is (A)a cow. (B)a dog. (C)a duck. (D)a brick. Unless you’ve been partaking in some sort of mind-altering substance, you immediately recognize that Choices (A), (B), and (D) aren’t even remotely described by the stem. This question really doesn’t evaluate knowledge — the distractors are so off the mark that Choice (C) is the only possible answer. What if the choices were these instead? (A)an American Black Duck. (B)a Tufted Duck. (C)a Ruddy Duck. (D)a Steller’s Eider. Unless you’re a duck aficionado, this question is much more difficult to answer. All the distractors are of the duck variety. Three of the choices include the word “duck.” You’d need to know something about ducks to answer this question correctly. (And in case you want to really know, it’s the American Black Duck; the others don’t quack. For example, the Tufted Duck makes a “kar kar” sound, and the Ruddy Duck makes a low belching sound — quite rude, those Ruddy Ducks. But you get the point: You need to know this information to answer the question.) Aim for the best answer The NREMT exam asks you to select the best answer from the choices. Don’t mistake “best” with “right.” On the exam, more than one of the distractors may be right. The more right answers you have to select from, the harder the question is to answer. An adult male is unresponsive on the floor of a restaurant. Patrons report the patient was having lunch when he suddenly grabbed his throat and collapsed. He is cyanotic, with agonal breaths. What should you do next? (A)Perform abdominal thrusts. (B)Perform chest compressions. (C)Roll him onto his side. (D)Ventilate with a pocket mask. Given the situation described in the scenario, most of these answers are correct. But, the stem is asking for what to do next. Here are some factors you need to consider: Cyanosis with agonal breathing makes you conclude that the patient is in cardiac arrest, which requires chest compressions, Choice (B), as soon as possible. You need to recognize that abdominal thrusts, Choice (A), are performed only if a patient is conscious and obstructed, not when he’s unconscious. Ventilation, Choice (D), comes after chest compressions. Rolling the patient onto his side, Choice (C), won’t change the state of the patient. So, although Choices (B) and (D) are both appropriate in cardiac arrest, the best choice is (B). You may be thinking, “Wait! There’s no information about whether the patient has a pulse. How do I know that he’s in cardiac arrest?” The step of checking for a carotid pulse isn’t a choice. You need to know that agonal respirations set in at the beginning of cardiac arrest. Answering NREMT exam items is similar to the real-life decision-making you’ll do in the field. Based on limited findings and your knowledge base, you’ll need to make some conclusions about the patient and then use those to decide what to do about the situation.

Article / Updated 03-26-2016

Begin by discarding answers that are clearly incorrect. On the NREMT exam, answers that are obviously wrong may not appear often, but when they do, make the most of it and get rid of them. It’s better to make an educated guess when you have three possibilities rather than four! If you’re not lucky enough to remove an obvious incorrect answer, read each choice carefully. Consider whether what you read has some relationship to the stem and make a mental judgment as to how likely that answer is to be the best one. You may grade the choice as “very unlikely,” “maybe,” or “very likely.” Repeat this process for each choice. When you’re done, sort the responses according to how likely they are to be the best answer. The one that comes to the top of your list is likely your best answer. A 20-year-old female was struck in the chest with a bat during a fight. She complains of chest pain and trouble breathing. There is tenderness when you palpate the left anterior chest wall, in the area of T3 and T4. Lung sounds are clear and equal on inspiration. She is alert and breathing 20 times per minute. Her pulse rate is 90. Which of the following injuries is most likely? (A)Tension pneumothorax (B)Rib fractures (C)Pneumothorax (D)Pulmonary contusion Given the mechanism of injury, any of the choices could be correct. However, you would expect to see additional findings in the stem for most of the responses. For example, you’d expect to see tachycardia, hypotension, altered mental status, and jugular venous distension for Choice (A), which makes it very unlikely. While Choice (C) is possible, you’d expect a faster breathing rate and/or a difference in lung sounds on the affected side, making this choice less likely. You’d also expect tachypnea with Choice (D). This line of thinking leaves Choice (B) as the most likely answer. The following are common mistakes test-writers make that good test-takers recognize, sometimes unconsciously. However, the writers of the NREMT exam work really hard to eliminate these issues; as a result, the vast majority of the test items really test your knowledge and not your test-taking abilities. If the answer contains absolute words, such as never and always, it’s not likely to be correct. Virtually no situations are so clear-cut. If the answer doesn’t grammatically key into the stem, it’s probably not right. The correct choice may be the longest one. That’s because the test-writer provides an explanation or extra details to make it the best answer. Sometimes a word or phrase appears in the stem and is repeated within an answer. If so, it may point to the correct response. Remember that these are not hard and fast rules. For example, the test-writer may intentionally put the same word in both the stem and in a wrong answer, just to mislead you.