BSI. Scene Safe!

     Almost two Saturdays ago I took the Oregon EMT practical exam. My fellow candidates and I had to prove our ability to perform six skills in a competent manner. These skills were medical and trauma assessments (if you want to know what this looks like, here's an example of a Trauma Assessment), providing spinal immobilization for a supine patient (getting a patient onto a long spine board), providing CPR and using an AED (see my PSA below), ventilating a patient with a Bag-Valve Mask and inserting a supraglottic airway, and then a random skill that was either caring for a bleeding wound and shock (what everyone wanted to get because it takes 30 seconds to do) or splinting a long bone (the skill I ended up doing -an easy skill that's made difficult by the 5 minute time limit). Everyone had done the skills so often in class that we all knew how to do them, and do them well. However, nerves are tricky things, and there's a lot of waiting that goes on at the state exam so you have plenty of time to agonize over mistakes you think you've made or all the ways you could mess up the next skill. Plus, the proctors aren't allowed to give you any indication of how you've done, so you often leave a station convinced you'd done something wrong, and since you can't talk to anyone about the exam, you sit there and go over everything over and over in your head. Then you just try to figure out if it was a critical fail or not. Luckily for everyone in our class, we eventually realized that our instructor had held us to a much higher standard than the state exam and I think almost all of us passed. We went to a place down the street to celebrate, talk about how we'd done, and cheer each new victorious compatriot as they joined us. It was a great way to end the class.

Guess I'm going to need to get one of these. ; )

     The final step to becoming an EMT was to take the national exam, which I did last week. That exam is cognitive rather than psychomotor and thus tests you on your knowledge, and not on your ability to perform skills. Like the state exam though, this one also plays with your head. It's an adaptive test, so if you get a question right the next question will be harder, but easier if you get the question wrong. The computer keeps asking you questions on a particular topic until it's clear whether you should pass or not, and then it moves on to the next section. You can be doing really well, but still fail half the questions because you keep getting harder and harder questions, which is a bit unnerving. Also, the test doesn't tell you when it's switching to a new section, so you might get some easy questions all of a sudden and think you must be doing poorly, when really you're just starting a new section. Oy. Anywho, I got out in about an hour, but then had to wait four days to find out how I'd done when I received the official results in the mail because they forgot to email me my results the next day like they were supposed to. It doesn't matter though because I passed and come Jan. 1 I'll be a licensed EMT!!

How hypothermic was he when he was unfrozen? Question for the ages.

     Now that the class and whole process is over, I've certainly enjoyed having more time to focus on work and prepping for PA school interviews, but I'll admit that there are things I miss. I miss debates about whether or not Han Solo was profoundly or only mildly hypothermic when he was thawed from the block of carbonite (I hold to "mildly" since I don't think he was mentally altered). I miss hearing about real calls and how responding to a patient with ruptured esophageal varices is pretty much just sloshing through blood to check a pulse and confirm death (I would gladly explain what happens, but I don't think everyone would enjoy the details as much as I do, so look it up if you're interested). I miss quizzes where questions such as "what should you do with bystanders at the scene of a motor vehicle accident" have possible answers like "lay them in the road to act as human traffic cones" or "douse them with gasoline and tell them to light flares." I miss the bad jokes the other students would tell when we were loopy from sitting around for hours waiting to perform skills for our practical exam. All said though, I'm glad to move on to the next step and start using my new skills. First though, I have a couple Public Service Announcements.

You really should.

PSA 1: If you find yourself a bystander at the scene of an accident, here are three things you should not do: a) run up to the ambulance (running people are considered panicked/unstable and no one will exit the vehicle until you calm down), b) frantically wave us to where you think we should park/get angry if we don't park there (it's usually fairly obvious where the accident is and there are regulations about the best places to park to avoid hazards), and c) assume the EMT is an idiot. The last one may need some explaining. Often EMTs and paramedicswill do things that may seem stupid to bystanders, but only because the bystanders don't know the reasons behind the actions. For instance, my instructor was once at a motor vehicle accident where the driver was severely injured. When he first came up to the patient he asked them if they knew their name, where they were, what had happened, and if they hurt anywhere. One bystander became infuriated at this because it was obvious that the patient's leg, and pretty much everything else, was very broken and needed immediate care. What the bystander didn't understand was that the paramedic was collecting important clues that would determine care. From these questions he could determine if the patient was alert (altered mental status would increase the patient's priority), oriented (and to what degree), and whether there was any cause to suspect severe spinal cord injury (if the patient didn't feel pain, this would clearly be a problem). So, as in any area of life, don't assume that you know or understand all the reasons behind someone else's actions. 

This is all you need to do. Smiling not required.

PSA 2: CPR. It's important. Sadly, few people learn how to do it, and even fewer perform it when it's needed. I have two things to say about it. First of all: just do it! CPR cannot, by itself, restart someone's heart and save their life (that's why you need a defibrillator aka an AED), but it causes the blood and oxygen to circulate so that the other cells of the body are still alive when you restart the heart. CPR classes take just a few hours, and the skills you learn are vital. You can find a course here: AHA CPR Classes. Even if you have never taken a class, you can still perform CPR. Lay people are now taught "compressions only CPR" which just means that all you do is the compressions -the pounding on the chest, rib-breaking part. There's no need to count or give breaths. It's simple. Scary, but simple. Basically, the compressions are the most important part of CPR, so please just do them until EMS can arrive. This podcast includes a discussion of the effectiveness of CPR: PodMed. In class we watched a real video of a guy who had a heart attack in his office and it took FIVE MINUTES before anyone began CPR, even though his wife arrived just as his attack was beginning. This should not be. My second tidbit about CPR is a slight modification to the first: definitely do CPR, but make sure the patient actually needs CPR first. This means you shake them and shout in their face, then if they don't respond you check for breathing and a pulse. If they have no pulse start CPR immediately. If they aren't breathing but have a pulse, you need to breathe for them. If they are both breathing and have a pulse chill out. They probably just fainted. Call 9-1-1 but don't go breaking their ribs. Our instructor told us about an old man who fainted while waiting in line at the bank and then woke up when "Rescue Ricky" immediately began CPR and broke his ribs. "Ricky" thought he'd saved the guy's life when really he just caused him agonizing pain. Or there was the group of "rescuers" who told the paramedic that a surfer had collapsed when walking back from the beach on a hot day, but was resisting their efforts to perform CPR. The poor surfer was merely overheated, and these people were trying to hold his arms down so he would stop fighting them as they tried do CPR. Please do CPR when needed, but don't let these latter stories be you.

P.S. -The title of this post comes from all the skills we perform as EMTs. The first two things you have to do when performing any skill is state that you have taken appropriate precautions by using body substance isolation (gloves, glasses, anything that prevents contact with bodily fluids) and that you have determined the scene is safe. We said "BSI, scene safe" so often that it almost became a single word we spat out without even thinking. That's good, because if you forgot to say either of the two phrases, you automatically failed the skill, even if you did everything else correctly. 

We all started doing jazz hands whenever we said BSI to represent the imaginary gloves we had one. Then we started doing it without realizing it. Our instructor enjoyed mocking us for it.