EMS World recently polled its editorial advisory board about the most difficult test questions we’ve encountered during our careers in this industry. This survey reminded me how much I dislike written EMS exams. They make me nervous. I start worrying about them six months before I have to take them, and I think about worrying about them for three months before that. I’m afraid of being unlucky; that some bug-ridden test generator will feed me all the questions about Venturi masks.
I know the material—well, most of it—by exam day. Cardiology, pharmacology, the other -ologies—no problem. I’m less sure of details that have little or nothing to do with real-world practice—landmark papers and legislation, for example. Do I really need to memorize their titles and dates? I can’t imagine saying to a patient born in 1973, “What a coincidence! Landmark legislation was enacted that very same year!” Yes, I had to look that up.
I’m also not fond of questions about names and numbers of body parts. What are the chances a trauma victim will want to know how many bones he didn’t break or the name of the muscle the steak knife is sticking out of? Then there are those hospital-based nurses whose opinions of us as colleagues inexplicably seem to nosedive the more we try to use anatomically correct lingo. You know what I mean: the eye roll followed by a look of disdain when you present a patient with “a compound fracture of the tibia.” I know, I know, there’s always a chance the bone sticking out of your patient’s shin is someone else’s scapula, but why teach us and test us on skeletal structures if everyone feels better when we just say “broken leg”? I’d have no problem leaving more detailed diagnoses to doctors; I’d keep just as many patients alive even if I didn’t know metacarpal from Metamucil.
Some exam questions are just plain tricky. Try this one:
Ambulance calls begin with:
I picked B. Dispatch. How else would you know about a call you didn’t buff, stumble upon or prevision? This wasn’t an answer I agonized over.
The correct choice was D. Restocking. Calls begin with preparation, I was told. I argued that preparation shouldn’t wait for an alarm. I might have won that debate if I hadn’t prefaced my remarks with “Yes, but…” Among EMS instructors and police officers, yes overrides but every time.
What we need is a new class of relevant and enlightening test questions that probe our understanding of everyday challenges more significant than remembering the frequency range of the VLF band. Let’s replace interrogation about rads, rems and roentgens with scenarios concerning lifestyles of healthcare providers at home and at work. I’m sure holistic topics like partner management and household diplomacy would contribute more to our proficiency than mandated memorization of cranial nerves does. Consider the following sample question:
Your partner, Benny, hasn’t changed his uniform in a week—maybe longer. Cyanide and CO detectors activate spontaneously in his presence. Eating next to him makes your food taste funny. You try telling him his stench overpowers GI bleeds and makes it hard for you to smell smoke when the brakes lock up. How is Benny most likely to respond?
A. “I do change uniforms. I just don’t wash them.”
B. “This is my lucky shirt. I haven’t gotten another DWI since I put it on.”
C. “I wash all my summer clothes in September.”
D.“Dude, it’s the patient.”
Here’s another: You’re on your way home from a 48-hour shift when you realize St. Valentine’s Day came and went somewhere between the maternity at the movie theater and the dry cleaner high on naphtha. All the florists are closed, so you hustle to the local ManikMart, where they sell things that look like flowers. You settle for a red and white ashtray shaped like a hibiscus. Back home, as you present your gift to your spouse, you should say:
A. “Look, honey, this is even nicer than the ashtray I got you last year!”
B. “You must be so bored with real flowers by now.”
C. “I thought we could take up smoking together.”
D. “What’s for breakfast?”
On second thought, landmark legislation is easier.
Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World Magazine’s editorial advisory board. Contact him at firstname.lastname@example.org.