1Scene Size-up and Safety17.2%
Everything that happens before you touch the patient: using dispatch information to plan, spotting hazards, choosing protective equipment, working out how many patients there are, triaging when there are several, and calling for the right help early.
- 1.1Plan before arrival, using dispatch and all other available information, so the response is safe and effective.
- 1.2Protect yourself, other responders, the patient, bystanders, and the scene from current and potential hazards.
- 1.3Choose and put on personal protective equipment that matches the known hazards.
- 1.4Survey the scene to work out whether there are patients and how many.
- 1.5Triage multiple patients so that care goes where it does the most good.
- 1.6Call for the right additional resources based on the hazards present and the patients' conditions.
Where people lose points: Starting care on an unsafe scene. If the scenario mentions traffic, a weapon, a downed wire, fumes or an agitated bystander and one option deals with it, that option comes before any patient care. In multiple-patient questions, the trap is treating the first or the loudest patient: triage sends care where it does the most good.
2Primary Assessment41.4%
The largest domain by a wide margin. Know the primary assessment as a fixed sequence and be able to say what you are looking for at each step: general impression, level of consciousness, airway, breathing, circulation, the chief complaint and any life threats, baseline vital signs, and then the decision about priority, rapid transport and extra resources.
- 2.1Build rapport by communicating with the patient and bystanders.
- 2.2Form a general impression of the patient.
- 2.3Assess the patient's level of consciousness.
- 2.4Assess whether the patient's airway is open and clear.
- 2.5Assess how well the patient is breathing.
- 2.6Assess the patient's circulation.
- 2.7Identify the chief complaint and any immediate life threats.
- 2.8Obtain baseline vital signs and the results of diagnostic tests.
- 2.9Decide whether the patient needs rapid treatment, rapid transport, or additional resources.
Where people lose points: Skipping ahead. The classic question lists four things you would all do for this patient and asks which comes next; the answer is the earliest step in the sequence that has not been done, or the life threat that has just been found. Taking a detailed history from a patient whose airway is not secure is the wrong answer however good the history would be. Also judge breathing by adequacy, not by rate alone: a patient can be breathing and still need ventilating.
3Secondary Assessment7.1%
The smallest domain: the focused physical exam, the patient interview and past medical history, and reassessment. Be able to choose the exam and the questions that fit the complaint, and to say what you would recheck after an intervention and how often.
- 3.1Use a focused physical exam, patient interview, and past medical history to understand the patient's condition and shape the ongoing treatment plan.
- 3.2Reassess earlier findings and interventions to detect any change in the patient's condition.
Where people lose points: Forgetting reassessment. After you give oxygen, a medication or a splint, the next step is to check whether it worked. Questions also describe a change in vital signs over time and ask what it means; read the trend, not the single reading.
4Patient Treatment and Transport22.2%
What you actually do for the patient: open and maintain an airway, ventilate and oxygenate, control bleeding and manage shock, restrict motion of an injured limb or spine, give the medications an EMT may give, adapt care for pediatric, obstetric and geriatric patients, move the patient and choose the destination, and hand over to the receiving team.
- 4.1Manage the patient's airway, ventilation, and oxygenation.
- 4.2Manage cardiovascular and circulatory problems, including bleeding and shock.
- 4.3Restrict motion of injured parts of the musculoskeletal system, including the spine.
- 4.4Administer medications within the EMT scope of practice.
- 4.5Provide interventions specific to special populations, such as pediatric, obstetric, and geriatric patients.
- 4.6Manage patient transport, including moving the patient and choosing the destination.
- 4.7Communicate relevant patient information to the receiving team and other providers.
Where people lose points: Options beyond EMT scope. An advanced intervention can look like the best care for the patient described and still be wrong, because it is not something an EMT does. The Registry reviews every question for scope of practice and points candidates to national standards, so answer from those and not from a local protocol. The other pattern is choosing a complicated intervention when a simple one has not been tried: a head tilt or jaw thrust before an airway adjunct, direct pressure before a tourniquet where pressure can work.
5Operations12.1%
The work around the call: checking that equipment functions, keeping medications and supplies stocked, documenting properly, and looking after your own and your crew's well-being.
- 5.1Check that equipment is in proper working order.
- 5.2Keep enough medications and patient-care supplies in stock.
- 5.3Complete the required documentation properly.
- 5.4Look after the well-being of yourself and other responders.
Where people lose points: Treating it as common sense and not studying it. Operations is 10 to 14% of the exam, more than Secondary Assessment, and its questions have specific right answers about what a patient care report must contain and how equipment readiness is checked. Documentation questions reward what is objective and complete over what is brief.