A Good Run for Your Money – Part 3

Author © Scott D. Zachary

Leaning into the sixth and final written exam, I again scheduled vacation days for the prior Thursday and Friday. As I did for the fourth exam, I ramped up all the way for this last one which would comprehensively cover all 1,505 pages of our textbook. Between Wednesday after class and Sunday at noon when Ryan arrived, I studied determinedly for fifty hours. That’s not counting the eight hours on the previous weekend when Bobbie battered me with intense quizzing. To wrap up my marathon review, I pummeled Ryan on Sunday afternoon with seven hours of non-stop interrogation. We then practiced our trauma and medical assessment skills for another two hours. Ryan thanked me for sharing my acronyms and for teaming up with him to study. He said he might have dropped out of the class, otherwise.

Tension etched the faces of many students as the instructors handed out the final written exam on Wednesday evening. This 200-question test could mean failure for many of the students. Several of the firefighter trainees were taking the class for their second time (some for their third) as most fire departments now require an EMT license as well as firefighting certification. Their dreams were on the line.

I felt much better upon completion of this sixth exam than I did the fourth one, but would it be good enough to beat Scott?

Kathy’s face revealed no clues as everyone reassembled in the classroom. Kathy suddenly looked straight into my eyes and lit up. “Top score was Scott Zachary with a 91!”

       The class applauded resoundingly.

       Kathy continued, “…followed closely by Scott with a 90,” prompting a straggle of half-hearted claps. “Those are two very good scores of which you should be proud.”

       Kathy zeroed in her attention on Scott Paramedic. “He gave you a good run for your money, didn’t he?!”

       Kathy proceeded to address the class as a whole. “You’ll notice that there are several more vacant seats around you. Out of the original thirty-six, the class has nineteen students left. Those of you still here have passed the written exams. Give yourselves a hand!”

We cheered!

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Our two remaining four-hour classes are the last chance to get signed off on our skills. I still had to prove my proficiency in seven skills, including the medical and trauma assessment. Failing is not an option in my book. My gracious lady Bobbie patiently listened to my determined babble over the phone for dozens of hours as I recited my insanely ridiculous acronyms over and over and over.

       “How many hours did you spend listening to me rehearse my skills?” I later asked.

“Long enough that I could probably pass the skills testing,” she declared.

* * * * * * * * * * * * * * * * * * * * * *

I rolled into my class with my determination stoking a full head of steam on Monday evening. Failure on the skills testing is unthinkable after having devoted all of my free time to this course for five months, and especially after having shown out on the written exams. Bustling into the room, I went straight to Kathy and asked her if she would evaluate me on the medical assessment first thing.

       After a few announcements, I followed Kathy to a corner of the classroom. Several other students gathered around us. One of them volunteered to be my patient. I handed Kathy my skills worksheet booklet, took several deep breaths, and began asking Kathy pertinent questions to color in the patient’s situation. Kathy snappily checked off the blocks on my proficiency form. Nine out of the forty steps in this skill were critical. Overlooking one of those nine would result in failure. The instructor would determine how many of the non-critical steps we could omit and still pass.

I was on a roll. My questions prompted Kathy to inform me that my patient was wheezing and displaying symptoms of a severe allergic reaction. Her scenario specified that the patient revealed an epinephrine auto-injector. Kathy handed me the disabled injector that we used in class. I had already been signed off on the skill that involved the application of an auto-injector; however, I only verbalized jabbing the injector into that patient’s thigh without actually going through the motions. Further, I didn’t know that the injector was supposed to click when released. Worse yet—I applied it upside-down!

“The injector failed to activate,” stated Kathy.

“The patient happens to have another EpiPen,” I improvised, “which I’m applying.” I jabbed it into my patient’s thigh.

“The injector still did not activate,” pronounced Kathy.

Using Kathy’s vernacular, “I load the patient into the ambulance and PUHA (pick up and haul ass) to the emergency room!”

“Good job, Scott, except that you killed your patient. Next time, try using the correct end of the EpiPen.”

Devastation! I went for a long smoke break to rally my fervor. More determined than ever, I barreled back into the classroom. A runaway freight train with a sparkle in its eye and one eyebrow cocked caricatures my demeanor squarely. I gamely asked Kathy if she would again evaluate me on the medical assessment skill. She said three girls were ahead of me and welcomed me to join their group down in the hallway.

The three young female firefighter trainees sighed conspicuously as they spotted me accompanying Kathy, declaring their extreme aversion to having me watch them. We had to complete each skill within a precise time limit, and that time didn’t allow for their constant hemming and hawing. I listened to the first two girls trying desperately to remember the multitude of steps and was thrilled that the idea of using acronyms had occurred to me.

Absolute trepidation defined the third girl’s countenance as she froze after having seen her two friends fail miserably. Kathy waited for a few moments, and when the girl didn’t voice her desire to be tested, Kathy looked at me. “Let’s give Scott a shot—he’s raring to go.” I could see the glaring disappointment in that third girl’s eyes. Kathy compounded the girl’s agony by appointing her as my cardiac patient. In the process of assessment and administering sublingual nitroglycerin (the most complex medical assessment), I nailed that skill to the wall with perfection!

“Fantastic, Scott!” Kathy cheered. “You got every single point!”

I had six more skills to go, including trauma assessment. I walked back into the classroom and looked around at the flurry of activity. There sat Joe all by himself in the far corner of the room. Sitting slumped, his head in his hands, he stared down at his desk. Joe’s posture signaled his acceptance of defeat. I strutted over to him. “Let’s go! Let’s do it!” I coached. “Let’s get some of the little ones knocked out—get our numbers down!”

Joe looked as though I had slapped him hard.

I snapped my fingers at one of the part-time instructors and abruptly motioned for him to join us. I asked the instructor to demonstrate the immobilization skills for long bone and joint injury. Joe and I got signed off on those in a matter of minutes. Joe expressed his doubt about the medical and trauma assessments. I shared my acronyms with him and his mental sails filled with a gust. Somehow, he and I both got all the skills signed off with no time to spare. Whew!!!

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Saturday morning, 6:30—time to go! I reached for the car door handle and saw a yellow sticky note. It read: “Good luck Scott! – Aaron & Rebecca.” My good friends’ encouragement gave me the OOMPH I needed to triumph over the monumental challenge looming ahead of me today—EMT skills proficiency certification.

The breakfast banquet in the kitchen at St. Matthews Fire Department was fantastic. Kathy had asked each student to bring in an entrée. I contributed two large fruit trays. What a feast! I nibbled throughout the day, but my nerves bypassed my stomach. This day vexed a blur of stress!

My trauma assessment evaluation is unforgettable. My patient (an EMT trainee from another school) was a voluptuous young lady with monumental breasts. I’m confident that if I hadn’t had my acronyms to keep me on track, the process of palpating (examining by touch—exploring by palpation) my unconscious patient’s chest for potential injuries would’ve thoroughly stymied me.

Besides the acronyms that I invented, there are other well-known acronyms used by EMTs and paramedics. One such acronym is used to guide a responder through the prescribed order of securing a patient to the longboard with straps for transport: “My Baby Looks Hot Tonight” (Middle, Bottom, Legs, Head, Top). I couldn’t help but chuckle when I got to that part of my trauma assessment.

“What’s so funny?” the male evaluator sternly rebuked.

“My baby looks hot tonight!” I said.

My evaluator snickered, and my patient briefly revived with a giggle.

I returned to my seat in the classroom after completing the trauma assessment. Directly behind me sat a man who contracted EMTs for positions around the world, including some jobs in war zones such as Afghanistan. I overheard Kathy and this man, Robby Said, talking. The prospects that he described immediately magnetized me, especially Afghanistan! My wanderlust and adventurous spirit raptured!

“The positions in Afghanistan,” Robby explained to me, “are combat EMT slots that also require infantry skills.”

“I served four years in Security Police—the Air Force’s infantry—guarding high-priority weapons,” I proudly replied.

“You’d be ideally suited, Scott, if you can survive the demanding physical training.”

“I ran six half marathons in the past year.”

Robby handed me his card. “Give me a call, Scott.”

I had a tough decision to make. The typical pay of $120,000 a year interested me; however, the adventure and the three four-week vacations per year with travel costs covered tantalized me. I could travel to a lot of places like Bangladesh and Myanmar doing Christian medical missions under those circumstances!

Our certification skills testing included: trauma and medical assessments, ventilatory management, and three randomly chosen skills. I walked into the screening room adjacent to the fire engine bay to begin the ventilatory management skill test. The evaluator told me to close the door, look over my equipment, and start when I was ready. The numerous steps in this procedure are:

1)    Open the patient’s airway

2)    Insert an airway adjunct into the mannequin patient

3)    Ventilate the patient at the proper rate as I breathe through my ventilation mask while the evaluator monitors my performance for 30 seconds

4)    Connect the reservoir to the oxygen tank

5)    Adjust the oxygen liter flow gauge

6)    Ventilate the patient with high-pressure oxygen

7)    Direct my assistant to pre-oxygenate the patient while I prepare the blindly inserted King airway device

8)    Lubricate the device

9)    Position the patient’s head and perform a tongue-jaw lift

10)  Properly insert the device into the patient’s airway

11)  Inflate the pharyngeal cuff with the proper volume and remove the syringe

12)  Attach the BVM (Bag Valve Mask)

13) Squeeze the bag while withdrawing the tube until the rise and fall of the chest is evident

14) Confirm placement and ventilation by observing chest rise, auscultation (examination made either by use of the stethoscope or by direct application of the ear to the body—in this case by stethoscope) over the epigastrium (to ensure that the inflow of air is not improperly diverted into the stomach) and bilaterally over each lung

15)      Secure the device

I don’t think I could’ve improved on my rendition of the ventilatory skill. My thoughts were seconded by Kathy as I opened the door and walked out of that room. “I was listening through the door, Scott, and you were nailing that one!” she boasted.

“Thanks, Kathy.”

Scott Paramedic pleasantly surprised me as I walked away from Kathy. “Way to go, Scott!” he cheered, his voice braided with respect.

My next skill was a medical assessment. The evaluator described my patient as having an allergic reaction. I held the EpiPen right-side-up this time, and I did not kill my patient!

We were not informed about our results on any of the skills evaluations until we had completed all of them. Upon completion, Joe Welsh, the President of Life-Savers Inc., pulled us aside individually to give us our weighty news. I don’t think I have ever been more relieved as I walked out of the hallway where Mr. Welsh told me that I am now a certified Emergency Medical Technician. I walked back into the classroom. Kathy had to have recognized the overwhelming relief on my face and gave me a big congratulatory hug.

* * * * * * * * * * * * * * * * * * * * * *

Kentucky also requires passing the National Registry examination to be licensed as an EMT. I had decided to forego this last hurdle since I had no intention whatsoever of working as an EMT. But after all I had endured, I was not going to settle for merely having passed the Emergency Medical Technician course.

Kathy had described the National Registry Exam as a computer program that becomes increasingly more challenging with each correct answer. And it did! I went to a company that administers various types of certification tests to take this exam. Sitting at the computer terminal punching the keyboard, I squirmed. This test is like the fourth exam, but worse! Much worse!! Most of the cases presented a complicated scenario ending in a question with multiple correct answers from which to choose. This multiple-choice exam surmounted into multiple-mayhem! I would’ve given 3-to-1 odds on my failure. I waited for the young lady to process my score on her computer terminal and wondered: How many people put themselves through this wringer without any intention whatsoever of working as an EMT?!

“You passed,” the lady said.

Woohoo! Another big adventure tale pinned on the donkey.

* * * * * * * * * * * * * * * * * * * * * *

I’ve learned from many excellent instructors in the Air Force and in college; however, Kathy Dorman outshined them all. She wrote the following letter of recommendation:

April 21, 2012

To Whom It May Concern:

I am writing in regards to Mr. Scott Zachary. It has been our extreme pleasure to have Mr. Zachary as a student in an Emergency Medical Technician course held at St Matthews Fire Dept from November 2011 through April 2012.

Scott was an exceptional student – remaining in the top two scores of a very difficult course, out of 36 students! His enthusiasm for learning was unquenchable, and his study habits were outstanding! He skillfully adapted to our ever-changing EMS world and worked well with all other students. He even came up with his own system of acronyms to help himself and others pass the rigidly structured skills testing.

I have no doubt in my mind Mr. Zachary will be highly successful in whatever medical field he may decide to enter. I strongly recommend him for any position he is striving to obtain!

If you have any questions regarding Mr. Zachary, please don’t hesitate to contact me.

Sincerely,

   Kathleen D. Dorman

Kathleen D. Dorman, Instructor

Vice President, Life-savers, Inc.

Lead Instructor, St Matthews Fire Dept. EMT Course