This was the I-03 exam; the written exam for the tougher of the two Vermont EMT-Intermediate grades.
I didn’t post about it because I was terrified that I wouldn’t pass it. Many people don’t; it has a high failure rate even among long-time Vermont I-90 practitioners; I-90 is the less difficult Intermediate certification level. Going into the exam, I felt that too much time had elapsed since my class ended; over six months. I was nervous.
An I-03 I had spoke to a few days prior told me to study that state protocols and I’d be fine. So I did.
The test ended up having many difficult questions having nothing to do with the protocols; leaving the exam, I had no idea if I’d passed it.
I got the results yesterday… I passed.
Having now passed the national EMT-I registry written and practical exams and the Vermont EMT-I written, I have only to pass the Vermont practical exam. This consists of three stations; assessment and management of a critical patient; airway management (esophageal intubation by Combitube); and intravenous cannulation and medication administration. I’m scheduled to take these on Wednesday.
This is interesting if you are into it... Combitube intubation. In the field, an EMT does not use the laryngoscope - the bladed device with the tubular handle inserted into the patient's throat - for Combitube intubation. Instead, the EMT grabs the patient's tongue and mandible with the thumb and forfinger and pulls them open. EMTs do use the laryngoscope for endotracheal intubation; I've been taught to place ET tubes but Vermont does not allow them at the Intermediate level, only at the Paramedic level.
Last night, I worked overnight at my paid squad.
At three, I woke to the tones. We were being toned to a frequent flyer, a thirty-year-old male that lives in an assisted living facility. He’s a noncompliant diabetic. We get frequent calls for him; half the time, he’s on the verge of death; the other half, he’s bored and wants the excitement of the ambulance and emergency department.
Though I’ve met him several times, I’ve been fortunate to not be the primary caregiver. The guy has open and half-healed sores all over his body; he picks at everything. His medical condition makes him recover and heal slowly. He’s confined to a wheelchair due to the advancing health issues. This time the tones were for bleeding from the heel.
I unhappily clambered out of bed, put on my pants, boots, and coat, and went out to the apparatus room. I opened the bay door, pulled the ambulance out into the door yard, then closed the door. I dozed for two or three minutes until my partner arrived; my partner lives in town so was covering from home.
My partner got in and we went over to the facility. We both gloved-up getting out of the rig and wheeled the stretcher inside.
On the way in, I had to fold the head-end of the cot up and fold down the tubing underneath so the stretcher would make a particularly-tight turn into the building.
We went into the guy’s room. He was okay except that he had picked some kind of blood blister on his heel and was bleeding heavily. Not life-threateningly heavily, but gross-congealing-blood-all-over heavily. He did not appear to be in distress.
He claimed he hadn’t been picking at the blister although he had dried blood all over his fingers. He had already bandaged his heel but blood was seeping through.
We had to prepare the stretcher before we could put the patient on it; unbuckle the three straps that would secure the patient but at present held the pillow and blankets, lower the stretcher to the same height as the seat of the wheelchair.
As I reached for the pillow, I noticed that there was a fresh spot of blood on the pillowcase. An odd stain; we change the linens on every call. I went to reach for the pillow to investigate and noticed that I had blood all over one of my gloved hands. Palm, back, index finger.
I hadn’t touched the patient.
I looked down at my end of the cot. There was blood all over the frame. Lying on the nylon case for our pulse-oximeter was a neat square of congealed blood, about an inch wide and a quarter inch thick. Opaque scarlet jello.
My first though was that somehow I’d cut myself badly getting out of the ambulance. I vaguely remembered my pinky catching on something.
I looked myself over; no gaping wounds. My gloves were intact.
My partner was okay, too.
It was my partner’s turn so he applied an additional dressing to the patient’s heel while I changed gloves. He got out some additional gauze and removed the red jello from the cot.
We got the patient onto the cot and started to wheel him out. On the way outside, going through the cramped turn, I noticed blood all over the outside door and jamb.
We loaded the patient and I went inside to tell the overnight attendant about the blood on the door. She rolled her eyes; “He insisted on going out for a cigarette after he called you.”
At the hospital we carefully cleaned the cot. We took the nylon case out of service and put it in the bucket of bleach when we got back to the station.