EMT Exam For Dummies with Online Practice

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About the Author

Art Hsieh, MA, NREMT-P, has been in the EMS profession since 1982 and has worked as a volunteer, line medic, educator, and chief officer in private, third-service, and fire-based EMS. He has directed both primary and EMS continuing education programs, and currently he is the Paramedic Program Director for the Public Safety Training Center at Santa Rosa Junior College in California. A past president of the National Association of EMS Educators, Art is a published textbook author and editorial columnist, and he has presented at conferences across the United States and internationally.

Dedication

The EMS family is filled with the most caring, compassionate people that I have the privilege of calling friends. Many have been my teachers and mentors. I have learned much from them and can only hope to continue to pay it forward. I am honored to be part of this family, and dedicate this work to them.

Even more important is my own family. Their love and sacrifice have allowed me to serve my profession in ways few EMS providers can imagine. To my wife, Veronica, no words can convey my deepest gratitude for your love and friendship. Thank you.

Author’s Acknowledgments

To paraphrase the saying, it takes a village to raise the village Dummy.

I was surprised and honored when I was asked to create a Dummies book for the EMT exam. This venerable series of how-to books is well known for breaking down complex information into easier-to-understand concepts and manageable chunks. However, when I started writing the content for this book, I felt like I was the dummy!

Fortunately, the good folks at John Wiley & Sons provided me the confidence to complete this book. Erin Calligan Mooney, acquisitions editor, paved the way to get me onboard with the project. Senior project editor Georgette Beatty’s expert editing, much-too-kind words, and gentle nudging of maintaining deadlines made the project much more straightforward and helped to calm my ever-present stress. Copy editor Christy Pingleton provided the extra pair of eyes in making sure what I wrote would make sense to the reader. My technical reviewer, colleague, and friend Lori Gallian had the thankless task of keeping me on the straight and narrow when keeping the facts straight. Kathryn Born’s artistic hand created the perfect set of simple but effective illustrations to highlight some of the key points in the text.

EMS is a small profession; those who teach others to save lives, smaller still. I’m blessed to call many of them my colleagues and close friends. Their willingness to share their mistakes and successes has helped shape my teaching practice and continues to influence it to this day.

Publisher’s Acknowledgments

Acquisitions Editor: Erin Calligan Mooney

Senior Project Editor: Georgette Beatty

Copy Editor: Christine Pingleton

Technical Editor: Lori Gallian

Art Coordinator: Alicia B. South

Project Coordinator: Sheree Montgomery

Illustrator: Kathryn Born, MA

Cover Image: ©iStock.com/lauradyoung

Chapter 1

Becoming an Emergency Medical Technician

In This Chapter

arrow Knowing what an EMT does

arrow Becoming a certified EMT

arrow Renewing your EMT certification

Welcome to the world of emergency medical services, or EMS! This is a noble profession. The training is challenging, the work unpredictable, and you won’t become rich performing the job. But you will have the privilege of helping people when they need it the most — when doing the right thing at the right time may very well save a life. Even in instances when the job isn’t that dramatic, the simple care, comfort, and words of reassurance you provide may be all someone needs to feel better.

This chapter gives you the basics on what EMTs do, how to become one, and how to maintain your certification.

Understanding What Being an EMT Means

An emergency medical technician, or EMT, provides a basic level of emergency and non-urgent patient care. Some EMTs are paid for their work, while others volunteer their time, especially in more rural parts of the United States. In most states, the EMT is the minimum level of training required to provide ambulance transportation or care for the patient in the ambulance. The following sections explain what EMTs do, where they work, and the value of EMT training.

Note: The profession is transitioning from using the older term EMT-Basic (EMT-B) to simply EMT. This book uses the term EMT, but you can assume that the two terms are interchangeable.

What does an EMT do?

The EMT is one component of an EMS system, which may use other trained prehospital professionals to care for patients as well. The four general levels of EMS providers in the United States are

  • Emergency medical responder (EMR): 48–60 hours of training. An EMR provides minimum, basic first aid. Lifeguards, police officers, and some firefighters are often required to have this certification.
  • Emergency medical technician (EMT): 120–180 hours of training. This level serves as the foundation for higher certification levels. An EMT provides basic emergency care, such as oxygen administration, spinal immobilization, and splinting. Many states require this certification as a minimum to work as a staff member on an emergency ambulance. Many firefighters and police officers also earn EMT certification so that they can perform basic emergency care as part of their duties.
  • Advanced emergency medical technician (AEMT): 160–300 hours of training beyond EMT. This training can vary quite widely from one state to the next. In addition to the skill set of the EMT, AEMTs may perform intravenous therapy, administer a limited set of medications, and manage a patient’s airway at a higher level than an EMT.
  • Paramedic: 1,100 hours or more of training beyond EMT. In addition to the skill set of the AEMT, the paramedic receives more information about human anatomy and physiology, the pathophysiology of disease, and trauma, and can administer a greater array of emergency medications. Paramedics can insert endotracheal tubes to help patients breathe and perform various types of electrical therapy to help heart rhythm disturbances.

In the majority of states, you have to be certified first as an EMT before taking on additional training to become an AEMT or paramedic. All EMS providers function under medical direction; usually a physician oversees the clinical practice of each level of responder.

An EMT does a patient assessment, which includes taking the patient’s history and vital signs, and performing a physical examination. The care an EMT provides includes oxygen administration, artificial ventilation, cardiopulmonary resuscitation (CPR), splinting of broken bones, and immobilization for spinal injuries. EMTs are trained to assist patients with specific types of emergency medication that are prescribed for them, such as nitroglycerin for chest pain, an inhaler for breathing difficulties, and an epinephrine autoinjector (EpiPen) for anaphylaxis, a severe, life-threatening allergic reaction. Some states permit EMTs to do more procedures, such as monitor oxygen levels in the blood (oximetry), test blood glucose levels (glucometry), and administer certain emergency drugs.

tip.eps Because the practice of the EMT isn’t consistent throughout all states, the test questions don’t evaluate your knowledge of things like glucometry. The questions assume only that you were taught to the foundational level as determined by the EMS National Scope of Practice, which is a federal document that describes what each level of EMS provider is permitted to perform. You can see this document at www.ems.gov/education/EMSScope.pdf.

Where do EMTs work?

EMTs traditionally work in ambulances, caring for and transporting patients from one location to the next: from a hospital bed to the person’s home, from an emergency care scene to a hospital, or even from one hospital to another.

In emergency response systems, an EMT may work alongside another EMT, or partner with a more advanced level provider such as an AEMT or paramedic. Firefighters and police officers who are EMT-certified may respond to an emergency call and arrive sooner than the ambulance that may be farther away.

You often find EMTs working as part of an emergency-department team or working at a clinic. It’s not unusual for the EMT to receive additional training in skills such as phlebotomy (blood draws) or recording a patient’s electrocardiogram (tracing of the heart’s electrical activity).

Wilderness and search-and-rescue teams often deploy EMTs because their skill set is ideal for providing care in remote areas. As in the hospital or clinic setting, EMTs may receive more training to better handle these conditions.

Can you use EMT training for other purposes?

Many students become EMTs to help prepare them for a career in the healthcare field. The information is valuable and serves as a foundation to build upon. EMTs go on to become AEMTs, paramedics, nurses, physician assistants, doctors, or other allied health professionals.

Even if you’re not planning to further your education or pursue a career as an EMT, the training you receive is invaluable. Learning to stay calm, manage a scene, and provide basic care in a medical emergency makes you a more valued member of society.

Walking through the Steps of Becoming an EMT

As you find out in the following sections, you need to complete a few steps before you can apply your skills and knowledge as an EMT. Note: Because emergency medical services are regulated at the state level, these steps can vary from one state to the next. Always check your state’s EMS website for the details.

Finding and completing a class

EMT classes are conducted by a wide variety of institutions. Your local community college may offer the class for college credit. Hospitals may also provide the training. The local EMS agency or fire department may offer the course, especially if it’s to help train volunteers. Private organizations provide the training as well.

tip.eps Searching online usually yields a list of classes closest to you. You can also check your state’s office of EMS to see whether it offers a listing of approved training programs. If you feel adventurous, try visiting your local EMS or fire station and introduce yourself to the EMTs on duty. Ask whether they have any suggestions or recommendations on where to take a course.

After you find a class that meets your needs, you complete your training program. This means passing all the tests your instructor provides, including all the practical examinations. Seems obvious, but you really can’t proceed to the next step without completing this one. Chapter 2 provides the scoop on finding a class and meeting its requirements.

Passing the National Registry Exam

A desire to pass the National Registry Exam may be the main reason you have this book. The National Registry of Emergency Medical Technicians (NREMT) is a nongovernmental organization that serves as the national EMS certification organization. The computer-based NREMT examination has been exhaustively evaluated for its ability to measure your EMT knowledge. Part of the NREMT examination is a practical exam, often given by your training program. Passing the NREMT exam means that you have a level of understanding that experts call “entry-level competent.” You discover more about the exam in Chapter 3.

Note: Although most states require you to pass the NREMT exam, not all do. States that don’t mandate the NREMT exam usually require you to complete a state-level examination. You can check the NREMT website (www.nremt.org/nremt/about/stateReciprocityMap.asp) to see whether your state requires the NREMT exam.

Finishing the process

Passing the NREMT exam doesn’t authorize you to function as an EMT. That responsibility resides with your state. You typically present your NREMT credentials to the state EMS office, complete an application, and pay a fee to become state-certified. Because EMTs enter people’s homes and businesses as part of the job, as well as solicit personal information about patients, many states require that you submit to a criminal background check.

To work as an EMT, an employer may require you to pass a medical examination and/or pass a test regarding the operation of an ambulance. You should check with these agencies to see what they require.

Maintaining Your EMT Certification

All states require you to renew your EMT certificate periodically. The time frame varies from one part of the country to the next, but many states have a two-year interval. Some states require you to use the NREMT renewal process to recertify. Other states have their own renewal process. You should consult your state EMS office for exact details.

If your state requires you to follow the NREMT renewal process, you need to do one of the following every two years:

  • Take a refresher course plus continuing education classes: This option requires you to complete a combination of an approved, 24-hour EMT refresher course and an additional 48 hours of ongoing continuing education classes.
    • EMT refresher class: The refresher class is exactly that — a course designed to refresh your original knowledge base and, in some cases, verify your skill competency. It’s designed to renew baseline knowledge that you may not have used or may have forgotten over your certification period. A written test is usually given at the end of the class to confirm that you possess the appropriate baseline knowledge and skill set for EMT practice (sometimes a practical test is also given).
    • Continuing education classes: Receiving your NREMT card doesn’t signal the end of your training; in fact, it’s really the beginning! Medicine is a continuously evolving science and art. New discoveries occur every day, and eventually some make it into the world of prehospital medicine.

      Continuing education classes help increase your body of EMT knowledge. They can be traditional, in-classroom courses; online courses; or a combination of the two, called a hybrid. Regardless of how the instruction is delivered, continuing education courses keep you up to speed in the world of prehospital medicine.

    Refresher and continuing education classes are offered by a variety of organizations, such as EMS agencies, fire departments, community colleges, and private education providers. You can search the web for organizations near you. Also, several providers provide online continuing education; you need to check whether the courses they teach are accepted in your state.

  • Retake the NREMT exam: This option gives you the ability to renew your registration by retaking the initial exam. This is a good choice if your state requires fewer continuing education hours than the NREMT renewal process, and you’d prefer to take only the minimum number of hours necessary to maintain your certification. You can find additional information at the NREMT website (www.nremt.org).

A valid CPR card is also necessary. In addition, you must be working as an EMS professional and have your skills verified by your agency’s training program director, director of operations, or physician medical director. Complete information can be found at www.nremt.org/nremt/about/reg_basic_history.asp#EMT_Recertification.

States that don’t require the NREMT renewal process have their own recertification process. Check with your state’s EMS office for details. A listing of state EMS offices can be found at www.nremt.org/nremt/about/emt_cand_state_offices.asp.

Chapter 2

Taking an EMT Course and Registering for the EMT Exam

In This Chapter

arrow Taking and passing an EMT course

arrow Signing up for the big test

It’s time to take that first step — undergoing the training you need to qualify to take the NREMT examination. Depending on where you live, finding a program that best fits your needs may be a bit confusing. Determining where to take the training is an individual choice. You may be a 19-year-old student taking the course for credit or a 45-year-old working professional looking to volunteer in your local community.

Regardless of your particular needs, some common thoughts and tips about locating and completing an EMT course apply. This chapter walks you through the process and then explains how to register for the EMT exam.

Enrolling in and Completing an EMT Course

You need to find and complete a course that prepares you properly, not just for the exam but also for real-world conditions. The following sections explain how to find and succeed in an EMT course.

Finding a course that fits your needs

You have several options for finding an EMT course in your neck of the woods:

  • Perhaps the easiest way to find a course is to perform a web search. Entering “EMT training” and the name of your town, city, or county in your browser of choice often brings up programs that are available in your area. Easy!
  • Every state has an office of EMS, which may provide a list of training organizations that are approved or authorized to provide EMT training. Do an online search for the name of your state plus “EMS office.”
  • EMT programs may advertise in the local community. For example, volunteer fire or EMS departments may conduct EMT training at little or no cost to students in an effort to attract new volunteers to the organization. You may find additional information on their websites, in local newspapers, or at community centers.
  • You may get a recommendation via word-of-mouth. Take a field trip down to the EMS or fire department to see whether the staff can recommend a particular training program.

remember.eps Before you sign up for the first course you come across, carefully consider what the course needs to have to maximize your chances of success:

  • Distance matters, of course. A training program that’s close by is easier to attend. If you have other priorities in life, such as work or family, a local program makes it simpler to travel between locations.
  • Cost is a consideration. Some courses require additional expenses beyond the tuition. These may include books, lab fees, uniforms, and medical equipment. Many programs offer the practical portion of the NREMT exam as part of their curriculum. Make sure you find out about all the costs upfront so you can budget ahead of time; this way, you won’t stress about a “sudden” cost that you didn’t anticipate. Also keep in mind that there may be additional costs beyond your training program, such as paying for the NREMT exam and your certification application.
  • What about the time commitment? Some courses meet weekends only, whereas others meet during the week. Day and evening options exist as well. Compare EMT course schedules to your own schedule for work and/or school, and see what matches up best. If you can’t find a course that fits your schedule exactly, consider what you can move around in your personal schedule. The bottom line is that you can’t miss too many class sessions — there is a lot to cover, and the program probably has a minimum attendance policy.
  • An increasing number of EMT courses are provided online. This option may be great for folks who have little time to attend a traditional face-to-face class or who work odd hours that conflict with class schedules. However, the majority require some type of hands-on labwork as part of the class; make sure you know exactly what the time commitments are. Note: Not everyone is cut out for an online class; you must be a highly motivated student who’s capable of independent learning in order to maximize your chance of success.
  • Being a good consumer of education can help you select the right course. Your state EMS office may have public data regarding how well graduates of various courses perform on the NREMT or state examination. You can also call the training organizations you’re considering and ask what their NREMT passing rates are, as well as their attrition rate (the percentage of students who don’t complete the training).

Being prepared for the course

If you haven’t been to a classroom in a while, the prospect of formal learning may intimidate you. Don’t worry — EMT education is very interactive and interesting, and it’ll be what you make of it. Be prepared to have fun and be challenged! On one hand, you get to discover how to do things such as administer oxygen, immobilize patients using long backboards, perform CPR, operate an automated external defibrillator (AED), and manage chaotic emergency scenes. On the other hand, you have to get a handle on basic anatomy and physiology, plus a few complex concepts related to serious medical conditions such as shock, anaphylaxis, and diabetes.

tip.eps A good rule of thumb is to set aside one to two hours of study time for each hour of instruction. For example, if the course meets six hours a week, plan to spend another six to twelve hours either reading, studying in groups, or practicing skills.

Create a study schedule that’s realistic and maximizes your learning. Maybe you can only spend an hour a day or two hours every other day studying. That’s fine, as long as you commit to focusing on your learning during those time periods. It’s better to be totally focused for one hour than to sit in front of your books for three hours while being distracted by the television, telephone, or social media.

Figure 2-1 shows an example of a class/study/life schedule.

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© John Wiley & Sons, Inc.

Figure 2-1: A sample class/study/life schedule.

In this sample, 16 hours of study time are set aside for 13 hours of classroom instruction. Free time is also set aside each day, as well as an evening off, to allow your brain to rest and recharge. Your schedule will probably be different, but the point is the same: Creating a schedule can help you stay on track and avoid falling behind in your studies.

remember.eps After you make your schedule, follow it religiously. Consider it as important as being on time for work, having dinner, or going to bed. You may need to give up some time with family and friends, or even reduce your work hours while attending the course. Whatever your sacrifice, know that it will be short-lived!

Create a positive study environment. Have a place in your home where you can minimize outside distractions. Have a good task light to read with and a table with a comfortable but supportive chair. (Beds and couches are more conducive to napping than studying.)

If you can’t make the space at home, look for other places where you can study. The campus or public library is one place. A nearby coffee shop is a favorite spot for many students, but you’ll want to know whether the shop charges for Internet access or requires minimum purchases for “parking” to study.

Speaking of Internet access, many courses use online resources to supplement what’s taught in the classroom. If that’s true of the course you’re taking, you’ll need to have reliable access to the web. A tablet may be adequate, but a smartphone may be too small to view the videos or readings that may be required. Check with the instructor before the course begins regarding the technology requirements.

tip.eps Understand how you learn! For example, you may not be a strong textbook reader, but instead, you may pick up a lot of information from listening to someone talk about the subject matter. You may benefit from recording the instructor’s lectures and playing them back when you’re in the car or at home. Several different learning-style assessments are free to use online. One example can be found at www.edutopia.org/multiple-intelligences-learning-styles-quiz.

Meeting the course requirements

Besides the classroom portion, most EMT courses also have a clinical component, where you may observe on an ambulance or fire engine, in an emergency department, or in a combination of locations. You may need to provide proof of vaccinations and immunizations in order to participate in clinical “ride-alongs.”

These clinical hours are important. You’ll see real patients and perhaps have the opportunity to practice your skills under the watchful eye of an experienced EMS provider. It’s crucial that you don’t miss these sessions; your instructor will certainly consider these hours to be just as important as your classroom sessions.

EMT courses typically have a series of exams and practical skills tests that you have to successfully pass. The exams may be done in the classroom, using pencil and paper; others may be done through a website; and others may even be done outside the classroom. Check with the instructor at the beginning of the course as to the requirements for completion. The course syllabus should contain that information, along with other requirements and guidelines for the course.

The final exam is a comprehensive test that evaluates your overall knowledge of the course. Usually this is a test created by the instructor; it’s not the NREMT or state exam. Passing the final exam doesn’t certify you as an EMT; only the state’s process of using either the NREMT or its own exam can perform that function. However, you have to successfully pass the course in order to qualify for the certification exam.

If your state requires the NREMT exam as part of the certification process (and it probably does if you’re reading this book!), the practical skills exam portion is likely to be conducted in your course. The hands-on portion tests your ability to perform the skills listed in Chapter 3.

Getting the most out of your instructors

The majority of EMT instructors are interested in your success as a student. That said, you are your own best advocate when it comes to your learning. Introduce yourself to the instructor on the first day of the course. Ask questions that are appropriate to the subject being taught. If you’re challenged by a specific concept or skill, don’t hesitate to ask for clarification or additional information. Most instructors appreciate enthusiasm and a desire to learn.

tip.eps Many instructors are also EMS providers, actively working in the field. Besides the instruction they provide, instructors can also help you gain employment, from passing along information about job opportunities to providing interview tips and recommendations about your performance as a student. When the opportunity arises, take the time to find out more about your instructor’s background and see whether he or she may be able to provide job placement assistance.

Signing Up for the EMT Exam

After you complete your training, you’re ready to focus on passing the certification exam. First, determine whether your state has its own examination process. Chances are, your instructor knows this and may have already provided you with information on how to register for the state exam.

If you’re taking the NREMT exam, you must fulfill the following minimum requirements:

  • Be 18 years of age or older
  • Successfully complete an EMT training program that meets or exceeds the National EMS Education Standards for the EMT
  • Complete that course within two years of taking the exam
  • Have a current CPR certificate at the healthcare-provider level
  • Successfully pass a state-approved practical examination (your final practical test)

If your state requires the NREMT examination (and if you’re reading this book, I assume it does), you’ll need to set up a testing account, which is easy to do. Begin by going to the website at www.nremt.org. Toward the upper left of the home page, click on the link “Create New Account” (Figure 2-2 shows you the exact location). Fill out the requested information. You’re requesting to use your new login as a “nationally certified EMS professional.”

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Courtesy of the National Registry of Emergency Medical Technicians

Figure 2-2: Create a new account on the NREMT website.

warning.eps After you complete the first page, you’ll be required to respond to statements related to licensing action and felony statements. Do not hide any criminal convictions that you may have. Like most states, the NREMT has certain criteria for who they allow to take the exam. Although very serious convictions may keep some people from taking the exam, most incidences are evaluated on a case-by-case basis. The fastest, easiest way to be barred from taking the exam is to try to hide any past criminal record.

After you submit your information, an account will be created. Your training program will be notified through the website that you have registered an account, and the course director will be asked to verify that you have successfully completed your training and have a current CPR healthcare-provider-level card.

Once that’s done, your account will show that you’re ready to register for an examination. You’ll pay the exam fee of $70 via the website, or follow the instructions to print a money order tracking slip for mailing your money order to the NREMT.

After your application has been verified and approved, and you’ve paid your fee, your NREMT account will show that you’ve received an authorization to test (ATT), allowing you to determine the date and location of the exam you want to take. This step takes you to the Pearson VUE website (www.vue.com), which allows you to schedule your exam. Chapter 3 provides more information.