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 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

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

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

Approaching the CAT is a little like jumping a high bar. The bar is set at a certain height for the EMT exam, and you need a certain amount of speed and skill to make it over the first time. If you do, the next time you jump, the bar may be set higher. On the other hand, if you don’t make the first jump, the bar may be adjusted a little lower before you try again. A CAT exam begins like the first high bar setting. You see a couple of multiple-choice questions, in a content area like EMS operations, that have been judged to be of medium or medium-easy difficulty. Say that you’re Mr. or Ms. Smarty Pants, and you answer these questions correctly. The computer records the information and sets a more difficult question in front of you. You, being as smart as you are, answer that question correctly too. The computer records that result and adds it to the previous results. It then continues to give you increasingly difficult questions to answer until statistically you’ve proven you know your stuff in this area. The computer then switches to another content area, say medical and obstetrics/gynecology, and begins the process all over again. If you correctly and consistently answer a majority of questions that are above a set minimum standard, the test abruptly stops, and you’re done. If you’re really prepared and knowledgeable about all things EMT, you may only have to answer as few as 70 questions for the computer to decide that you’re ready to go. If this happens to you, you may think, “Wow, I must have passed since the test shut off after 70 questions.” But that’s not necessarily the case. Imagine the same scenario, but this time, say you miss the first couple questions of medium difficulty. The computer records this, just as before. But now it shows you a question that’s easier. You end up missing that one too. The computer records your result and adds it to the others. If you continue to miss similarly easy questions, eventually you demonstrate that you don’t know the material. The computer switches to the next content area and repeats the same process, until you’ve demonstrated that you’re not ready to go. This may also take as few as 70 questions. The result? If your test shuts off after 70 or so questions, you either did really great or really poorly. And to add insult to injury, you may not know how you did. Because the test adapts the difficulty of each question to your level of ability, every question will appear to be difficult. Many EMT students report how uncertain they feel about how they did after an NREMT exam. The two preceding scenarios represent the extremes. The fact is, most people need to answer somewhere between 70 and 120 questions before the computer decides statistically that they’re either at or above the standard or below it. For example, say you do just fabulous on the EMS operations section, but when it comes to medical and obstetrics/gynecology, you flub a question that’s considered medium in difficulty. The computer then asks you a similar question at a lower level of difficulty. You answer that question correctly. The computer then asks a more difficult question related to the same topic and continues to do so until you show that you are at or above the standard. Then it moves on to the next section. As a result of a few ups and downs, you have to answer more questions to show that you have enough understanding compared to someone who has a better level of comprehension. The number of questions you have to answer doesn’t matter though; as long as you meet or exceed the standard in all sections, you pass the exam. That’s what matters, which brings to mind a joke: What do you call someone who graduates from an EMT program at the bottom of the class? An EMT. In other words, passing the NREMT exam means that your understanding of being an EMT is enough for you to be a safe, beginning practitioner. Educators utilize a concept known as classical test theory to create a paper-based exam. Classical test theory basically says that by asking a few well-constructed and well-chosen questions about a particular topic area, your performance on those questions can predict how well you’d do if you were asked every possible question about the same topic. Writing good test questions and choosing the right ones to ask is challenging. A computer adaptive test, on the other hand, uses item response theory as a basis for choosing its questions. Item response theory says that how well you do on a question is based upon how good your knowledge base is and how difficult the question is. CAT, combined with item response theory, delivers a much more targeted exam process that’s highly accurate in determining your readiness level.

Article / Updated 03-26-2016

After you read an NREMT test item, you may be very tempted to look at the answers and choose the one that seems correct. This strategy may work in many cases, but it can also work against you, if more than one answer appears correct. Many of the NREMT exam items are challenging for exactly this reason. A stem should be written well enough so that you should be able to answer it without looking at the responses. Doing so gets you to slow down and consider exactly what the question is asking. You may have to draw certain conclusions about the patient’s status or condition, based on the information provided in the stem, before answering the question. After you have the answer in your head, compare it to the four choices that are presented. If you’re spot on, the best answer should immediately be apparent. If none of the choices appear to match what you thought the answer should be, move to the next step. Take a look at the following example. First, read the stem and tell yourself what you think the answer is. A 62-year-old female is experiencing chest pain that began at rest. She describes the pain as “sharp,” and points to the right side of her chest when you ask her to locate where the discomfort is. Her heart rate is 90, her blood pressure is 130/70, and her respiratory rate is 16 and nonlabored. Her oxygen saturation level is 97 percent. You should (A)administer high-flow oxygen using a nonrebreather mask. (B)transport immediately. (C)question her further about the chief complaint. (D)place her in a supine position. Based only on the information provided — before you even look at answer choices — you should understand that the patient is not in a serious or critical state that requires a major intervention to airway, breathing, or circulation. Given that her oxygen saturation level is normal, supplemental oxygen isn’t indicated either. Although you can say that the discomfort doesn’t appear to be cardiac in nature, you still need to investigate further. With this information in mind, you’re ready to consider the answer choices. Choice (A) isn’t indicated because her saturation level is normal and she’s not in respiratory distress. Choice (B) is not correct; none of the information given indicates that she needs to be rushed to an emergency department. Her blood pressure is normal and there are no signs of shock, making Choice (D) incorrect. The leaves Choice (C) as the best answer; you want to know more about the chief complaint. NREMT exam items rarely test you on simple “recall” performance. The test assumes that you possess basic knowledge contained within the EMT curriculum. The questions build upon your knowledge and test your ability to use it in a scenario or to deduce certain conclusions about a patient.