How to Master your Psychomotor Exam (EMT)
The psychomotor exams are one of the most nerve wracking performances of EMT school for potential EMTs. This is where all the hard work accumulated over the course of the program is tested, well that and the National Registry cognitive computer based testing. Without passing this testing portion, you may not continue further in the process of obtaining your certification.
So what do the EMT psychomotor exams entail? First, there are currently 8 testable skills per National Registry. These include the Medical Patient Assessment, the Trauma Patient Assessment, BVM Ventilation of an Apenic Adult Patient, Oxygen Administration via Non-Rebreather Mask, Bleeding Control/Shock Management, Cardiac Arrest Management/AED, Joint Immobilization, and Long Bone Immobilization. Each skill will be proctored and if you look at the skill sheets available on the national registry website (https://www.nremt.org/rwd/public/document/psychomotor-exam), there are critical fails that you must not execute. Even if you nail the rest of your exam, if you hit a critical fail, you fail the rest of the psychomotor exam. If you hit a critical fail, most proctors will not tell you that you did unless they’re extremely short on time. You will finish the rest of your exam and be notified later if you pass or fail.
Each of the skills all have their own set of critical fails but all have some fails in common. The first and foremost critical fail in all skills testing is failing to identify that the scene is safe and you are taking all Body Substance Isolation/Personal Protective Equipment (BSI/PPE) precautions appropriately. Failing to verbalize something to the effect of “BSI/Scene Safety, is my scene safe?” at the beginning of your sim is an automatic fail. The reason for this is to ensure there are no unseen hazards within the scene you are entering. Since this is a simulation and not all institutions have the resources to create a realistic scenario, it is important to establish the safety of your scene and that you are protected with the most minimum equipment (gloves, eye protection, mask since the Covid-19 outbreak).
The rest of the scene size-up block (https://content.nremt.org/static/documents/skills/E202_NREMT.pdf) ensures recognition of whether the patient is a medical patient or a trauma patient, the number of patients, if other resources are necessary (including ALS), and acknowledgement of necessary spinal precautions. Lack of recognition for spinal precautions/immobilization during your scene size up will also cost you a critical fail. This is due to the fact that potential spinal injuries should be taken very seriously and treated right away. A simple acronym used for the scene-size up block is PENMAN. Repeating this to yourself is a sure safe way for not hitting any critical fails. It stands for
PPE/BSI
Environmental hazards
Number of patients
MOI/NOI (mechanism of injury vs. nature of illness)
Additional resources (ALS, Fire, Law Enforcement, etc.)
Need for c-spine
Another common critical fail we observe a lot is failing to determine any life threats. This could be as simple as confirming with the proctor “I do not see any life threats at this time, is that correct?”. During your medical and trauma assessment, you put your skills to the test. If you are able to manage your ABCs appropriately and efficiently, there should be no question of how to navigate through the simulation if there are life-threats present.
Another extremely common critical fail we see is failing to obtain PMS before AND after applying any sort of immobilization. This includes cervical collars. PMS determines the effectiveness of the application as well as any changes in patient status. It is pertinent to remember this. An easy 4 step process to any immobilization skill is as follows:
BSI/Scene Safety
Assess PMS
Apply immobilization correctly
Re-assess PMS
Aside from PMS, you must obtain vital signs prior to treatment for any medical patient. This does not include treating ABCs or applying a cervical collar but to treat a patient with any medications such as nitroglycerin, it is imperative you get a baseline set of vitals prior to administration. Know your national and local parameters for treatment and for the love of pearl, make sure to ask the patient if they’ve had any sexual enhancement/pulmonary hypertension medications in the last 48 hours and know their names!
Lastly, our criteria is observing that you manage your patient as a competent EMT. The fact that this is the final performance to exhibit you are able to go out into the world and treat life-threatening emergencies, you must be competent. You must know your equipment, know your parameters, and manage your patient appropriately. Every criteria is taught in the curriculum and available on the nremt website. With excessive practice and exuded confidence, you will pass your psychomotor exam.
Try to get a flow or script going and check out our upcoming guide on EMT assessment blocks for an easier break down!
