I Recert You Long Time

Hey – nobody take offense at the post title; I just got done watching Full Metal Jacket the other night.

My, but time does fly, and it became time for DTs to recertify his NREMT-P this month.

Now, generally we know what we’re doing here in EMS-land. But doing things “the street way” and doing them “the NREMT way” are sometimes different in expression, if not action. The NREMT written test is sometimes a little vague in their questioning:

“You find a patient struck by a light aircraft, breathing 14 times a minute with shallow respirations, spurting blood from a thigh wound and showing four feet of eviscerated bowel wrapped around a pair of chopsticks. The patient has a DNR bracelet and a necklace stating he is diabetic. The patient states he has an allergy to seafood, and a lobster tail is partially dangling from his left nostril. What do you do? What DO you do?” a) begin BVM respirations; b) call for medivac; c) verify the patients identity; d) run in circles, scream and shout.

“Well, shit,” you think, “What I want to do is not a listed option.”

And here, because that’s the way they roll, one should note the key word is “shallow” – shallow respirations require positive pressure ventilation (PPV), with a bag-valve mask (BVM). That’s the answer they want.

Yeah.

Now, at this time, the NREMT allows you to take the recert test ONCE, for a $110 fee.. If one doesn’t pass, it is REQUIRED that one complete a paramedic refresher course, and that costs big dineros I’m sure. It seemed prudent to invest in some small-ticket items to prep for the test.

A++ Would Read Again:

Stephen J Rahm’s Paramedic Review Manual for National Certification ($29.95 at Amazon)

This contains gobs of questions and multiple-choice answers. Each answer is backed by a short paragraph explaining why it, of all the choices, is the correct answer. There are also sections which give hints for prepping for the practical examinations.

I spent a weekend typing in the entire book to a free Palm program called Anki, which lets one build flash cards. Anki allows you to associate a pile of information in each “record” and then build on-screen flashcards on-the-fly. I told it to put the question, and each possible answer on one side of the card, the correct answer and rationalization on the other. Running the program I could select categories (Trauma, Airway, Medical, etc), or the whole shebang, or just those items I marked (either as “wrong” when last I took the test, or those I checked the little “Mark” box for further review/study). The book itself is very good without all that PDA prep stuff, though. If anyone wants it I’d be glad to provide the Anki database, but you’ll need Rahm’s permission of course.

A-, Would Recommend

Building on that it was time to subscribe to the Pearson / Prentice Hall / Brady online Paramedic review ($32.00 from Brady)

One logs in to their web site and is given four practice tests, Content Area tests in Airway and Breathing, Cardiology, Trauma, Medical, OB/Peds, and Operations; a set of Practice Quizzes in same, and something called “Resources” – “Thousands of media-rich learning resources such as photos, illustrations, animations, and video.” I sure didn’t see any media-rich learning resources..

Clicking Resources gives you a Tutorial section (how to use the online test prep), Helpful Links to the Brady Catalogue of Stuff You Can Buy, and the Results Reporter – this is where your quiz and test taking is scored. Right answers are listed, along with the rationale behind them.

It’s a good resource, but I have a major bone to pick with Brady.

There is no way to contact them via web or email, concerning this product. And SOME OF THE INFORMATION IS WRONG. Correcting it would be simple and quick, if one had a way to point it out to them.

“Airway & Breathing. When performing tracheobronchial suctioning, you do not want to insert the catheter past the carina. Which of the following methods would be most appropriate to guide the insertion of the suction catheter?”

Brady lists the correct answer as “Measure from the mouth, around the ear, to the xiphoid process.” Hey Brady – that’s an NG tube. Take a look at where your xiphoid process is – several inches below the carina. Somebody somewhere is going to scrape a catheter tip across the bottom lobe of a lung if they listen to Brady.

As well, sometimes a question will deliberately misspell a possible answer (I’m making this one up): “What is the name of the bone connecting the forearm to the shoulder?” a) arm bone; b) funny bone; c) humerous; d) humerus

And the answer here would be D, because C is misspelled. That’s legitimate.

But when Brady insists that the most dire patient in my trauma scene is the one with the “scaffold abdomen” when they clearly mean “scaphoid abdomen”… well.

Anyway, the loveliest phrase in the English language (that can be uttered by the NREMT): “CONGRATULATIONS! You have successfully demonstrated continued cognitive competency by examination.”

In EMSish: “You passed.”

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