A paramedic has “been out of the field for a few years” and wants to get back in. Last week I asked subscribers what study guides, practice tests, web sites, training programs, and books they would recommend to this paramedic. These are the responses I received:

Review NREMT Requirements

John recommends starting with reviewing the NREMT requirements:

http://www.nremt.org/nremt/about/reg_para_history.asp
http://www.nremt.org/nremt/downloads/EMT_Instructions.pdf

Practice Tests

Sue encourages you to Google free practice tests. She gives her students a CD called “practice test for EMTP”. Barnes & Nobel also has a great sale (going out of business) on all EMT-P test/ review products.

Regional Resources

Ryan reminds us that it depends where you live. He writes, “In New York City I would recommend checking out the NYC REMSCO website for updated protocols.   I would also recommend the Brady series books.” Essentials of Paramedic Care (Amazon Affiliate Link)

How Long Has it Been?

Jim A. wants to know how long the question writer has been out of the field. He writes, “It would depend somewhat on how far ‘out’ he had been. Still an EMT? Did he keep his Medic license as a non-practioner? If he has totally lapsed all certification, there is probably no shortcut.  However, for national registry, I recommend Brady Pass Paramedic series which includes reviews and practice tests for written and DVD for practical stations.

Alphabet Courses

What are your tips, study guides, and resources for a paramedic that has been out of the field for several years that wants to get back into the field?

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This post was contributed by Micah Holmes of Code3Apps. Leave a comment about what makes a great EMS and you might get picked for a free EMT Tutor download code.

The EMT Tutor (iTunes link) is an educational development app for the EMT.  It was developed drawing from my knowledge and past experience, which includes training and developing yet to be nationally registered EMTs.  The app attempts to prepare EMTs for three things:

a) Passing EMT class

b) Passing the National Registry exam

c) Preparing for hands-on application of the material.

This is a difficult combination because many textbooks and EMT classes are geared to an older, recollection-of-material based assessment process; whereas the National Registry has moved to more of a scenario-based assessment, which values critical thinking.  This discrepancy has led to many students acing the class portion and then struggling on the National Registry Exam.  The EMT Tutor app attempts to prepare students for both while also transferring this knowledge and information to hands-on skills and critical, on-the-go, lights and sirens, real deal decision making.

About the App

The EMT Tutor app has four sections that are meant to assist EMTs of all backgrounds with the content required by the NREMT.

• Quizzes: almost 1000 multiple-choice based questions divided into sections including the newer Anatomy and Physiology and Pathophysiology.
• Flashcards: almost 1000 flashcards including terms, doses, skills, etc.
• Scenarios: over 60 different step-by-step scenarios, which can be used to prepare for the NREMT, discuss with an FI or just to review and hone skills.
• Toolbox: include all of the up-to-date NREMT skills stations, and some differential check-offs to aid in report writing and in reviewing calls.

Some additional features were added to make the app more useful, including bookmarking, randomization and explanations. Bookmarking allows the user to revisit trouble areas.  I found this to be essential for the user to be able to tailor the app however he or she needs.  It does not help to re-review 1000 flashcards before the NREMT if you’re only having trouble with 100 of them. Randomization of all potential answers in a question was included so that the user does not remember where the correct answer is, only WHAT the correct answer is.  This allows the user to reuse our material rather than consume it on one pass through.   Finally, explanations are included for all quiz questions to further assist the learning process.

As the writer and developer of the EMT Tutor, I of course have a special attachment to my application but I do realize that nothing great is created in a vacuum.  It is for this reason that I offer it up to some of the best and most experienced to evaluate.  One of the reasons that I started writing EMS apps is because of my involvement in another app developer’s project that I saw as less than comprehensive and not as concerned with the development of EMTs.  Questions were taken off of the Internet, or copied word for word from outdated textbooks.  For these reasons I have attempted to develop a training tool that fits into your pocket.  I am looking for honest feedback and suggestions on how to make the app experience better for both seasoned veterans, and EMTs in training. (After all, aren’t we all still in training?)

Feedback Welcome

I welcome any and all feedback from those that test the app.  It will always be a work in progress, so know that feedback will not be taken lightly.  I am also interested in including other content into the app; so new scenarios, situations and information are always welcome.  Feel free to email me – code3apps@yahoo.com, follow the Code3Apps blog, follow us on Twitter or like us on Facebook.  Thanks again, and stay safe out there.

iTunes Link: EMT Tutor App

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Below is several videos from the Hackensack VAC of drivers navigating a cone course with an ambulance. When navigating the cone course, just as you would in normal ambulance operations:

1. Put on your seatbelt as soon as you get in the ambulance. I have seen several drivers immediately fail the test for not donning their seatbelt. Confirm all passengers are wearing their seatbelts before moving the vehicle.

2. Eliminate and silence distractions. Before you enter the vehicle silence your phone. Turn off the music radio once you are inside.

3. Adjust your mirrors before putting the vehicle into drive.

4. Use your mirrors for all backing maneuvers. I always chuckle when a driver looks over their right shoulder and into the ambulance compartment as they back-up. How is that going to be helpful.

5. When backing through the serpentine course you need to start turning the ambulance as soon as the next cone comes into view. Thus you need to have your mirrors positioned so you see that cone as soon as possible.

6. Small corrections are better. Make small and subtle corrections at low speeds. Big corrections while turning or backing lead to over correction.

7. Place spotters where you can see them. When backing I like to have my spotter on the right side of the vehicle because I have better coverage of the left side mirror. Remind the spotter to check for hazards above and below the ambulance’s as well as to the left and right.

8. Keep your windows open. You should be able to see and hear your spotter.

9. Take your time and relax.

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I just completed day 1 of an NREMT item writing workshop at NREMT headquarters in Columbus, Ohio. So far it has been a great experience and I have learned a lot about the process of constructing test items.

Item Writer Selection

The NREMT regularly invites EMS educators to apply to be item writers. I submitted a resume and cover letter asking to participate. You can get more information about being an item writer by contacting the registry or speaking with them at a conference. When I was selected I was asked which level I would like to participate. I requested EMT Basic and a preferred date.

Workshop Preparation

About 6 weeks before the workshop I received my item writing assignment. I, along with the other item writers in my cohort, was asked to writer 25 items. We were asked to construct items in specific categories, such as cardiac, and in specific areas of the task analysis. For example, I was asked to construct a cardiac item that was related to pathophysiology of an acute coronary syndrome.

The preparation assignment also included reading a large packet of material about the registry test and constructing test items. It was very useful reading.

I was a bit anxious about writing the items because I knew they would be displayed to a group of my peers and together we would tear down and rebuild the items.

Workshop Day One

This morning after about an hour of logistics and introduction we got right into the business of reviewing and rebuilding the questions each group member submitted. Our questions were displayed, one at a time, on the conference room screen. Together we worked to refine and improve the question. Many times the final question looked nothing like the initial question. Since we all wrote questions for the same areas of the EMT-Basic task analysis there were some very similar questions for a few topics, such as cardiac rhythm interpretation (there is a pretty small slice about this topic an EMT-Basic is expected to know).

Lessons Learned … so far

These are some of my lessons learned so far that I think are valuable for students and educators ….

1. Students, it is well worth your time to actually read your textbook.

2. Knowing and being able to apply the basic life support algorithm is the essence of being an EMT.

3. Group review can make a bad item better. Group review can make a bad item worse. And group review can make a good item worse.

4. Items are constructed from a diverse group of field professionals and educators from across the country.

5. Very little, if any, extraneous information in an item survives the group editing process.

6. It is impossible to know if any of the items we are constructing will ever make it as actual scored registry questions. Every item will be pilot-tested by hundreds of actual registry test takers. After pilot testing the item will be analyzed and it will only be added to the live pool if it meets specific criteria.

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While wrestling through a written test I had this idea. Each student takes the test on their own and submits their answers for grading. Then in groups of two or three – just like a real patient contact – students answer the same set of questions. While reading the test questions I had occasions, again just like a real call, I would want to say to another paramedic:

“What do you think is going on here?”
“Should we do A or B?”
“When would it make sense to do C?”

Do you allow students to collaborate on test taking?

For online education one of the frequent complaints is cheating. Well why not require students to take the test with a partner.

What do you think?

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Paramedic Review, a new iPhone App from Limmer Creative, is a sophisticated exam prep app that can be used anywhere at anytime. Much like its counter part EMT Review, a veteran Paramedic or a new medic will benefit from this application. This app is a tool for education, and in my opinion in a world were there is lots of education with a lack of motivation, this tool is a breath of fresh air. The app challenges the experienced and the new EMS professional to answer questions from these categories:

• Preparatory
• Airway
• Patient assessment
• Medical emergencies
• Trauma emergencies
• Special populations
• Operations

An app user is able to test, train and review at anytime. Within the Paramedic Review App, the user is able to create specific questions to test certain areas of knowledge. If you feel like an area of your knowledge is weak, you can design lists of 5, 10, or 20 questions to brush up in that area.

The developers continued with what works, by using the “challenge me” section. Much like the EMT Review app, the user is able to access randomized questions from any of the above mentioned topics.

The tool continued to be fun and engaging as I was sitting around the station. It forced me to think about treatments and patient conditions globally. This is a tool that reminds us not to put blinders on during patient assessment.

Finally, with each question you receive a rationale of why the answer was wrong or correct. This is a great feature in my opinion because I was able to learn from my mistakes.

Paramedic Review is available on ITunes and is well worth the $3.99 purchase price. I hope the Paramedic Review app creators will create a download of more questions. Again, an upgrade of more questions will make the app adaptable.

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This is a guest app review by critical care paramedic JD Graziano. If you want to guest post or review on this blog, check out the guidelines here.

EMT Review, a new iPhone app, is sleek, sophisticated and can be used anywhere at anytime. This app is a tool for education, and in my opinion in a world were there is lots of education with a lack of motivation, this tool is a breath of fresh air. The app challenges

the experienced and the new EMS professional with questions from these categories: preparatory, airway, patient assessment, medical emergencies, trauma emergencies, special populations and operations. Since the app has several options for interactions the user is able to test, train and educate themselves at anytime.

Customized Testing

Within the tool, the user is able to add specific questions needed to test certain areas of knowledge. If you feel like an area of your testing knowledge is weak, you can design lists of 5,10, or 20 questions to brush up in that area .

If the user is feeling smart, then the app has a “challenge me” section. You will get randomized questions from any of the above mentioned topics. I found this section refreshing and fun. It forces you to think about treatments and patient’s condition while gaining critical thinking experience.

Answers Explained

Finally, with each question you receive a rationale of why your answer was wrong or correct. This is a great feature in my opinion because the user is able to learn new material or reinforce existing knowledge. For students this education through testing practice is essential. So when you preceptor asks why you performed a specific procedure, or wants to know a particular on a disease process, you response will not be “that’s what the book said to do” or “ I don’t know, I just memorized that what I was supposed to do.” Instead an intelligible answer will be given and you will be treating your patient with confidence.

Available on iTunes

EMT Review is available on iTunes and can be purchased for $3.99. I am hopeful that updated versions of the EMT Review app for the iPhone will give users access to more questions. The app currently contains about 150 questions.

In conclusion, the EMT Review app is well worth the price. It is adaptable to the user’s needs to practice which is essential for an quiz review app.

JD Graziano is a CCEMT-P currently working for Iowa County Ambulance Service, a rural service in Iowa County, IA. He has been in EMS for 8 years and also has a background in backcountry rescue, avalanche, and snow safety. Contact him on Twitter @ajdgrazinao or email jdpmemt@gmail.com

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A new semester has started for many first time EMT students and EMTs returning to school to be Paramedics. If you are looking for tips and strategies to succeed don’t miss episode 184 of the MedicCast. Rob Theriault and I joined Jamie Davis and a live audience of MedicCast listeners to discuss our top tips for study skills, time management, working with a partner, and more to succeed in EMT class.

Preparation and success in training is one of my favorite topics to discuss. I want to help you succeed. Consider these other programs to get to the top of your class.

1) EMS Boot Camp Session 1 – test taking tips and strategies for EMT and Paramedic students. A webinar that features great question and answer between the audience and me and Jim Hoffman.

2) EMS Boot Camp Session 2 – preparing for EMT and paramedic school. An interactive online training program on how to thrive in school.

3) MedicCast Extra – the bonus content created by Jamie Davis for subscribers to the MedicCast. Inside the extra you will find commercial free podcasts, as well as numerous tips and resources to help you succeed as an EMS professional.

Let me know if you need a guest for your podcast, conference, or staff meeting to discuss how to excel as an EMS professional.

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Multiple choice exams are an inevitable part of initial and ongoing EMS training. Good exam questions are based on the course objectives and content. Question writers attempt to assess your recall of information, but often more importantly, your comprehension and ability to apply knowledge. If you want to get better at taking EMS examinations follow these Everyday EMS Tips:

1. Read my EMS1.com column on taking multiple choice exams.

2. Enroll in EMS Boot Camp session 1. Jim Hoffman and I deliver a 1.5 hour training program with lots of bonus learning content on taking EMS examinations. We are getting great feedback from students using this program.

3. Become a member of the Medic Cast Extra. Everyday EMS Tips friend Jamie Davis has assembled a huge amount of content, study guides, test preparation materials, and more for EMT and Paramedic students.

4. Take lots of test questions using test preparation books. Check out the selection of test preparation books and review guides in the Everyday EMS Tips book store.

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When selecting a practice EMT or Paramedic examination consider these criteria:


1) Lots of questions

2) Questions in each of the NREMT examination categories

3) Explanations of why the correct answer is right. If there is not an explanation make sure to look up the answer.

If you are taking a computer based test make sure it simulates the NREMT computer adaptive test by only serving one question on the screen at a time. EverydayEMSTips.com reader, paramedic, and EMS Education Specialist Deb McCoy-Freeman writes, “Students need to practice exams which give them ONE question at a time with NO opportunity to review previous questions. We’ve always been able to use the exam to help us take the test but no more on the computer exam. One question at a time and once its answered, never to be seen again! Once they have that mindset, it helps alleviate that anxiety upon being presented with the one question test.”

What test preparation resources have you used?

If you are looking for test preparation training program make sure to check out the EMSBootCamp.com test prep session.

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