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NREMT Survival Guide

Posted: January 30, 2014 in Health
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After 16 grueling weeks, 2 days a week, 4 hours a night, I finally passed my EMT recommendation class as well as the NREMT exam..

As with many successes, there are often sacrifices and lessons learned. I hope I can help sway some of the questions and fears about the process.

Expense

The process can be costly, depending how you do it… I would assume the cheap way would be to go to a community college but I chose to go to an actual trade school for several reasons (will discuss later).

You can expect the tuition to be comparable to an 8 unit college class, for me that was $995, which included tuition and the book.

The school I went to had VERY high standards (EMS Training Institute, in Simi Valley, CA) not only on the grading (you must sustain a 75% or you are out), but also dress and appearance. For that reason, we all had to be in uniform at all times which will run you another 100-200 bucks.

So roughly 1300 bucks will get you in a class and graduate.

Then come the extras

Exam fees ($125)
Drug Tests ($75)
Livescan Fees ($75)
Credential Fees ($125)
Ambulance License Fee ($90)
and lastly liability insurance ($120-200/year)

So… Not for the feint at heart, and not a journey you want to take unless you REALLY want to be in the field… Therefore, if you want to learn about Health, take a nutrition class, this is not for you if you are looking for a survey class.

School

The school is very important for several reasons.. Quality of teachers being the most important but quality of direction, lecture, demonstration, resources to get you clinical hours and lastly, professionals IN THE FIELD.

Going to a school with a lone instructor and some assistants will get you nowhere. The place I went was owned by a paramedic, staffed by EMT’s and paramedics and was VERY highly regarded in the EMS as well as the hospital community.

When choosing a school, ignore the ones that guarantee 100% passing.. Go to the tough ones with prestige, as you will not only learn the information but retain it.

My school was VERY good… We had lecture 4 hours a week, followed by 4 hours of hands on (NREMT skill sheets). If you couldn’t grasp a concept in the lecture or the reading, the hands on REALLY helped.

Studying

This is NOT a path that you can wing and get by… Even after 8 hours of class time a week, I found myself studying at LEAST 8 more hours a week. Concepts are sequential where if you don’t understand topics like respiration, you can’t wing it by doing well on cardiac.. You MUST know it all… Remember, you are preparing to administer help to citizens as well as their children and parents.. You need to understand the trust people put in your hands, and to abuse it by just being average is not going to cut it.

Study… and when you are done, study again…

The “Adaptive” NREMT Test

The test itself is a roller coaster ride and this is how it works..

First, the test is computerized. Each question is a screen with a single question and 4 multiple choice answers that you bubble in with a mouse and then hit NEXT>. There is no <BACK button. This means there is no going back.. You put your answer in and that’s it next question, you better know your shit.

Secondly, the NREMT is what is called an ‘adaptive’ test which means it learns from how you answer, reason why there is no BACK button. The test will ask you a medium question, one that 50% or more respondents get correct. Lets assume it is an OB question, and If you get it right, it moves on, to maybe another OB question, or maybe another branch of the test. If you get it wrong, it will select another question from the pool of equal or slightly more difficult challenge (maybe one that is historically answered 40%). If you get that right, it moves on again.. if you get that one wrong, then you are in trouble, and the system thinks you are circling the drain, and it attempts to beat you down… The next question will be a 30%, then a 20%, then maybe a 10%… So if you get to that point, and you keep getting OB questions that appear more difficult, know that you better take a breath, get it together and prove to the system the previous responses were just screw ups.

Thirdly, the number of questions on the test are variable, from 75 to 125 questions, and no matter what, you only have 2 hours to complete the test.

At the end of the time period, the test will STOP and log you out.. You are done.

If the test feels, at 75 you have proven you are competent, it will STOP and log you out.. You are done.

If you are circling the drain, the system will keep asking you questions until it deems you competent or incompetent, and will eventually STOP and log you out.. You are done.

If the test logs you out at 75, there are only two answers (much like an AED), either you did VERY well, your you did VERY bad (terrible). Everyone I know who has taken the test and finished at 75 has passed.

Nonetheless, I had a friend that got to 124 questions and also passed.

Preparing for the Test

As far as what to study for, this is my suggestion.

You want to ABSOLUTELY have firm in your head the following:

  • Cardiac
  • Respiratory
  • Trauma Assessment
  • Medical Assessment
  • Obstetrics
  • Vitals
  • Perfusion

There are some NIMS questions as well as a handful on shock (i had a question on compensated and decompensated shock).

Most importantly, almost ALL the questions are scenario based and will look like this:

You approach the scene of a 55 year old woman who complains of dizziness. Her vitals are BP: 84/40, Respiration: 14, Pulse 120. Which of the following is she being affected by:

  • Neurogenic Shock
  • Hypovolemic Shock
  • Cardiogenic Shock
  • Hemorrhagic Shock

So this is a double banger. Not only must you know what the different symptoms and causes are, but you also need to interpret vitals. You better know both!

Then there are easier ones:

You respond to a scene where a 14 year old girl has fallen off her bike is sitting on the sidewalk, and has a laceration on her forehead. What do you do?

  • Apply direct pressure to the laceration
  • Assess scene safety.
  • Apply oxygen via nasal cannula in a supine position.
  • Apply manual inline immobilization of the head.

These are questions about protocols. All the answers are right, but what is the most important?

Study Aids

Very simply, if you have taken a class or have gone to a trade school DO NOT BUY STUDY AIDS like exam-pass or whatever they are called. I personally purchased several and they blew my confidence and almost made me quit.

There are several reasons why I say this, with no disrespect to the authors of these tools:

  1. Schools are rated on how many people pass, not how many good EMTs they make (unless you are the school I went to where reputation precedes credentials of its students). Because of this, the curriculum schools have are proven, and accredited to pass you… They have to apply to teach the content, prove the curriculum is correct, get it approved, and show results. Any process other than that does not meet the standards of the national registry and should be avoided.
  2. Secondly, many of these tools are NOT NREMT certified. They are made by anyone from plagiarists to seasoned professionals based on their experience. With the advent of android and iPhone apps, there are a LOT of options to choose from… Ignore them all unless you are failing the class, in which case this is your last hope, but if you pass the class, you should be qualified to pass the test.
  3. Thirdly, well really 2.5ish, and this is the trap I landed in, many of these aids hire expertise from ‘professionals in the field’ which 99% of the time are paramedics. The result is a test bank of questions that are beyond the scope and expertise of what is required for the NREMT. So what happened to me? Well being the perfection freak, i get one of these tests, take the 120 question quiz and score a…… 61… WTF?!?! 61/120 is an F. This destroyed my confidence and after some rebuilding from my school mates and professionals I hang out with, it became pretty apparent that these aids did far more damage than good.. STAY AWAY FROM THEM, and trust you instructor.

The After-Test

Very lastly you will have noticed that at the end of the test, it doesn’t tell you if you pass or fail. You actually finish the test and your results are mailed to you via snail mail, but there is a way to get a quick answer, which ill describe later.

This test as I said before is adaptive, and some of the questions have answers which are all right and you choose the BEST or actually all WRONG and you choose the most realistic. The test is not testing your ability to memorize information but the ability to think and use reason.

You will leave the test, thinking you have FAILED…

Let me repeat this…

When you finish, you will NOT have a feeling of “I did great” or “I did horribly”.. You will leave the test feeling like you FAILED.

I sure did.. I finished at 75 points and thought, oh crap, i really had to think on some of those questions…

This is the nature of the test… In high school we took tests that went something like:

What color is the sky on a normal day:

  • Red
  • Black
  • Blue
  • Orange

Unless you are from another planet or the moon, you will answer Blue and feel confident with it, but because this test is assessing your decision making skills, very few questions will give you a warm and fuzzy that you got it right.

So what happened to me? I finished, I left the building, paralyzed with fear that I not only failed but I was going to embarrass my family and my teacher. After all.. I was the valedictorian. I played all the possible outcomes of what my future would be, the worst of which was my lecture instructor pounding on the next class about how important studying was and that she had a student that did well, but failed the test..

I went home pissed, upset, angry, embarrassed and almost crying.. I didn’t sleep that night and woke up in the morning with a ‘If i fail, this isn’t the path for me’.

DON’T freak out.

On the good side, 76% of candidates pass the test on the first try. On the bad side, if you fail, you have 2 more chances… If you fail those two, you have to take the 24-hour refresher class, and then you get another 3 tries… If you fail those 3 (for a total of 6), then you can go back to thinking this isn’t for you. Until that happens though, consider yourself to have passed the test and hang in there.

Did I Pass?

Ok so there is only one way you are notified, by USPS snail mail, even though you have your email address in NREMT.org

if you want to find out if you passed, there are two ways.

The first way, and the most obvious, is to log in to NREMT.org and go to My Credentials. If you passed it will actually display the number of days left on your credential (692 or less) and little blocks for the CE units you have completed. You will also have an option to print out your EMT card.

If it says something along the lines of (there is no current certification), you can do this:

Go to the left side and ‘submit an application’ for testing.

If the tool comes back and says you can’t, you have either passed or your results are not in yet.

If the tool comes back and ALLOWS you to fill out another application, you have failed and it is assuming you want to retake the exam.

Conclusion

I am glad I did this… It was a wonderful journey and not only did I prove a 44-year old dog can still learn new tricks, but I am now empowered to help people, which was my ultimate goal.

I strongly encourage you to be a first responder of some sort, even if it is EMS-1 (First Responder).

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Why are our kids Obese?

Posted: June 19, 2013 in Health, Opinions

It is truly disheartening what capitalism (or maybe call it imperialism) has done to human culture.

First, let me state that I am a big fan of free markets.. They provide jobs, drive technology, and force commercialization. What I don’t like is that the American lifestyle compared to other countries has obsoleted our work force for ones that are far cheaper and automated in third world countries… For those that have an iphone, google Foxconn and explain to me how your iPhone is such a boon to your life, while the people who make it are committing suicide because they hate their jobs and can’t find anything better.

Enter obesity, one of my pet peeves of why Americans are sensation addicts. Corporate American is driving MORE people to their restaurants (i.e. McDonalds, on the guise of cheap affordable food). What they don’t tell you is that the food is as close to an ’empty calorie food” as a stalk of celery. Yes this stuff will fill you up, but it will not satisfy you (salts and phosphates). Yes it is cheap, but it will NOT nourish you (you will need to eat an order of magnitude more volume of fast food to get a fraction of the nutrients fresh food will offer you).

So yes, to save money, junk food looks very attractive, and in the picture above, a buck for a hamburger yields far more calories than a salad, but will starve your body of nutrients to make it grow… Is it a suprise why our kids are growing horizontally and not vertically? Not to me.