Today was our final practical exams, a requirement for graduation from the EMT course. Designed to test our knowledge and understanding of all things EMT, covering medical and trauma assessments along with key skills including airway management, bandaging and splinting, CPR and AED usage, and pharmacological interventions such as EPI-Pen and Nitroglycerin administration.

And although the final practical exams were designed to test the skills I have gained over the past 4 months, in the end it taught me perhaps the most important lesson of all -- a reminder that being humble and keeping an open mind may just be the most important EMT skills I can master.

While the EMT course has been challenging, especially for someone who has been out of the day-to-day experience of classes, studying, and test taking for almost 30 years, I felt that I had done pretty well for myself. My quiz and exam grades were always high, and while there was a lot of memorization to accomplish, my own life experiences often helped to put class material in context and perspective.  Eighteen months as a driver for the squad gave me an additional sense of how to interact with patients, and the experience of having observed other squad EMTs actually putting some of these skills in action in the course of our calls might have even offered me an edge in some scenarios.

Through the class, the practical exams had gone extremely well, with several instructors telling my that I appeared to have that special quality that would make me a good EMT. I passed through all the practical exams without requiring remediation or a second (and final) attempt to demonstrate a critical skill.

And then there was today. Final exams. And on the fourth and final skill station, I made a huge mistake, one that I won't quickly or easily forget.

Having just wrapped up the third exam, it feels like a great weight has been lifted from my shoulders. With a little more than a 40 hours remaining (a month of weekends, in my case), the end of the EMT coursework is within sight.

Most of our remaining classes are really going to be review, helping us to fine tune our skills at patient assessment and interventions for both trauma and medical emergencies. In talking with some of my fellow students, everyone seems to be more comfortable than we were just a few weeks ago, having recognized that by breaking down how to approach patient care in to a logical and consistent manner, we've grown both comfortable and confident in our own skills and ability to handle many different situations.

Of course, the instructors aren't going to just make it easy for us. The scenarios and situations they're starting to give us are more complex, often involving a mix of injuries and medical conditions, and requiring us to build upon our index of suspicion skills and determine which are serious life threats to be dealt with quickly, and which ones could have little or nothing to do with the situation at hand.

For example, just because a patient presents with high blood pressure and is known to be diabetic doesn't necessarily mean that either of these two conditions are linked to an underlying issue that we must treat.  Where our initial scenarios were clearly set up so we could demonstrate an understanding of diabetic emergencies (and associated treatment options), instructors now want us to be able to treat our patients holistically, and not get overly focused on one specific piece of information at the expense of something more critical.

And I got a real-life lesson in this just the other week....

Well, actually... don't!

There's no doubt that we've got to master the signs and symptoms, and associated interventions, of both respiratory and cardiac emergencies. Every situation we face starts with assessing the ABC"s -- Airway, Breathing, and Circulation -- as these represent true emergencies, where it really can be a matter of life-or-death.

Respiratory and cardiac emergencies are very closely related, as issues in one area can have a detrimental, even fatal, impact to the other.

While the heart is responsible for pumping blood through the lungs for oxygenation, and then moving the oxygenated blood itself to the tissues and organs throughout the body, it is itself a muscle that also requires oxygenated blood to effectively pump. So any disruption in how the body is obtaining and utilizing air through the upper and lower airways (including the lungs) can cause issues for the heart as well.

And things roll downhill quickly from there on... Because having to perform CPR means that someone is having a really, really, really bad day....

With the first set of EMT written and practical tests behind us (Ashley, our Cadet member, and myself both scored very well...thanks to all who offered their well wishes!), our classwork moves on to a more focused set of lectures on medical emergencies, and their associated care and treatment options. 

While we are told not to diagnose underlying causes of illness, in practice, EMTs play a very key role in uncovering critical signs and symptoms of those underlying medical issues through our history-taking activities (the aforementioned "million questions"), which we provide to medics and hospital staff as part of our transfer of patient care. The questions also guide us in developing an index of suspicion for what may be happening with our patient, allowing us to be more aware of the risks for cardiac, respiratory or neurological issues that may develop while we are in transport.

Classwork this week focused on the various causes of respiratory distress.  If you love to read a good detective story, this set of coursework is for you.  The textbook almost reads like a good mystery novel, filled with similar signs and symptoms for many different potential causes of dyspnea (or shortness of breath).

And only by combining the practical lung sound skills we're learning to listen for, with other vital signs (including pulse rate and blood pressure), key medical history, and signs and symptoms from our observations and the patients own behaviors and expressed issues, can we reach a clear index of suspicion on key underlying possibilities to be aware of.