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April 15, 2008

Well folks the time has come again to show if I am worth my salt. Every four years EMT’s of every certification level have to take a re-certification test in the state of Virginia if they are in Non-affiliation status. Since I haven’t been with the squad that I am with long enough, they couldn’t waive the requirement (waaaah!). So for the last few days, I have been studying the dredded “Blue book” the EMT bible so to speak. It has every cotten picking scenario you could think of. I read one today that asked, and I am paraphrasing here….”You come across a patient who was a participant in a knife throwing contest, (poor guy must have lost), upon arrival on scene you find your patient pulseless and apneic. What should you do?

A. Secure the knife and transport them immediately to the nearest hospital

B. Secure the knife and begin CPR

C. Carefully remove the knife then throw them in the back of the ambulance and haul tail (ok I threw that in)

D. Carefully remove the knife, control bleeding, cover wound and begin CPR, have your partner ready your patient for rapid transport and rendevous with ALS if your crew is not ALS

it went something along those lines… Any way I picked D which was obviously right.  That ticked me off though because the answer I would have picked E.  call the police and run,  wasn’t on there… these are the kinds of questions which get on my nerves don’t show how clever you may be or how well you read a question. I would rather, have tried and true questions like. “If you come upon a person who is wheezing, what type of airway obstruction are they likely to have outside of choking?” The answer would be: A lower airway obstruction. Or here is one: Do you defibrillate asystole? The answer is a resounding No!!! Ask me stuff like that and I am home free, am I lazy, no! I just don’t feel like thinking this week!! It’s just been one of those weeks, I am suffering from Dain Bramage!! Yall know what I mean. Pray for a sister… I’ll put up a post that makes more sense after I take this marathon test. Anybody got any bright ideas for studying at the ninth hour. This is like Garden of Gethsemane type studying, Lord let this cup pass from me….

Be blessed folks


8 Comments leave one →
  1. April 16, 2008 6:38am

    Funny question, but not for me… I’m a professional knife thrower and former paramedic. Why is D the correct answer. To me it seems that B is the way to go. Forgive me if I’m wrong but we agree that CPR is on the plate BUT why remove the knife? Securing it in place would avoid further damage. I believe that any stab wound is better left to the ED to remove than pulling it out in the field. One more thing, there’s nothing in the question that says the patient was stabbed. It only says he was a participant in a knife throwing contest. So why even discuss removing the knife if he wasn’t stabbed?
    David R. Adamovich, Ed.D.

  2. April 16, 2008 6:38am

    Hello there Mr. Knife thrower
    I was thrilled to pieces when you got me on my jitterbug piece I could not stop laughing and I still am. That knife question had to be the dumbest question in the book. It probably sounded so silly because I didn’t have the book beside me but I went and got the thing so you could actually read this silly question. As a Paramedic this is one for the record books. They should never ask questions like these really!!! We are taught to never ever ever take out objects just secure and break all land speed records to the hospital right? ok here goes hold on to your knives because you might want to throw them after this…

    You are called to a local knife-throwing contest, where a 42 year-old man has a large dagger impaled in the middle of his chest. Your assessment reveals that he is pulseless and apneic. How should you manage this patient and his injury?

    a. Carefully remove the knife, control the bleeding, and begin CPR
    b. Carefully remove the knife, control the bleeding, and attach an AED to the patient.
    c. Secure the knife in place with a bulky dressing and transport immediately .
    d. Make sure that the knife is secured, initiate CPR, and transport immediately.

    According to the book the correct answer is “a” and it gives this explanation:
    “Generally, impaled objects should be stabilized in place and not removed; however, if they interfere with the patient’s airway or your ability to perform CPR, they must be carefully removed. The knife in this patient is impaled in the area where chest compressions must be performed (precordium). The AED is not indicated for victims of traumatic cardiac arrest. Blood loss is the most common cause of traumatic cardiac arrest and, therefore, the AED would not be of benefit.”

    Got any knives left, or did you throw them all at the screen? Is this the most idiotic book or what? The entire book is like this and the doctor that wrote it has a strange fixation on shallow breathing, thank God I was a combat medic in the Army and stuff like this crap doesn’t phase me. I just hate the fact that they have changed the testing method from seeing if you know your stuff, to seeing how clever you are. I hate that crap, I went to college I have a science degree. I have nothing to prove to anyone I just like to get out there and volunteer along with working in the ministry. Do they need to make it this ridiculous? Thank God I don’t have to go to the practical stations anymore, last time I played a patient and they nearly killed me! Thanks for reading my post and correcting me, I should have just put it in there like the book had it but I was tired from reading the darn thing all day, with it’s super silly scenario’s. Believe me they are worse than what I just wrote. Hey I like your site, can you really throw like that? I can’t hit the broad side of a barn! I’m jealous!!!!

  3. April 17, 2008 6:38am

    Yes, I can REALLY throw like that. Former world champion and now professional performer with 10 world records for the speed of my throwing. But all that is not the point here. Back to the question. OK, this time it does mention there is a stab wound to the precordium. Answer D seems more likely than A. Let’s try this scenario… YOU remove the knife, start CPR and transport. YOU get to the hospital with a dead patient on your hands. YOU’RE getting your a** sued by the patients family for removing the damn knife and killing the patient. Tell that to the author who wrote answer A. For heaven’s sake, how are you going to control the bleeding you’ve obviously caused, in the words of his attorney, when it’s internal and the result of YOU removing the knife?

  4. April 17, 2008 6:38am

    Hahaha I can’t agree with you more Mr. Knife thrower!!! My thinking is the knife is acting as a cork and to remove it will cause damage of the worst kind. I hated that book with a passion, and I hated the test even more. It was 100 questions of absolute stupidity. I honestly think they all got together in a room and said, “hey I know let’s think of the most ridiculous scenarios and the worst answers and put it in book form and test form to boot”. Blazing idiots! I actually had a test question that asked the following impossible to answer nonsense….
    The ultimate goal of the EMT course is to:
    A. Cause no further harm to the provider or patient
    B. Gather as much fancy equipment as possible (I swear this was on the test)
    C. Treat life endangering conditions that are outside of your scope of practice
    D. Be determined by local protocols and regulations

    Ok A is out, so is B and C but D? It just sounds so incomplete, as if some moron wrote it. Wait! Some moron did! Anyway halfway through the test I lost my place in bubble land and when I went back to check my bubbles to my answers they were all wrong so I had to erase all the way back to question 41. I finally asked the proctor for another bubble sheet and explained to him what happened, then he loudly asked, “aren’t you here for a re-test?” I said “no, I am a re-cert I already have my license and CEU’s I just need the written test no practicals.” “Hmmm”, he says “what’s your name?” I tell him, and he says, loud enough for the folks on the International space station to listen in, “it says here you failed your first test!” I show him my letter of permission from the state that was needed to even get in the door which states that I am a candidate for re-certification (which lasts 4 yrs, but you knew that). All this for another bubble sheet, I swear! Sheez, you would have thought those things were made of Gold. I could have used one of your knives(tee hee hee). And oh how I would have missed by a looooooong shot! You know I’d be aiming for his toe and all! haha!

  5. April 17, 2008 6:38pm

    Wait, A and D are the only possibilities ruling out the stupidity of B and C. But given the choice of either A or D I would pick A. Since the question asks the “ultimate GOAL” the A is a goal and D is not. Now here’s the chance to pontificate on the entire EMS system and all the education and testing… it’s a crock of shite and a waste of time. If I were to redesign the entire system I’d do ONE THING ONLY: teach providers to deal with the presenting problem based on an anal following of local protocols. Period. That’s all you have to do. It’s NOT the EMT’s job to diagnose nor treat – that’s the job of the emergency department. The primary responsibility is to stabilize (control bleeding) or remedy the condition (administer glucose, for example) to an unconscious person suspected of a diabetic malady, transport, and deliver the patient to the hospital – hopefully no worse than when arriving upon the scene. All the education is icing on the cake and makes a bunch of know-it-alls who think they are smarter than the emergency department professionals. The time in training would be much better spent on local protocol review and implementation. After all, NO MATTER WHAT HAPPENS TO THE PATIENT, the EMT is held to only one standard – did you follow the designated protocol based on the conditions present? It’s either YES or NO. The EMT’s ability to diagnose the malady is inconsequential. His ability to stabilize, transport and report what happened is the bottom line.

  6. April 17, 2008 6:38pm

    Furthermore, whether or not you are able to identify the stages of pregnancy is irrelevant to your ability to “catch” the baby, clear its’ airway and deliver both baby and mother to the hospital.

  7. April 18, 2008 6:38am

    Ha hahaha Throwdini why couldn’t you have been my teacher, author of my book, Etc….Great minds Do think alike!!!! I’m reading your comments falling on the floor thinking, “I love this guy!” Keep em coming. And hey…. why don’t you teach????

  8. April 20, 2008 6:38am

    You ask, “Why don’t you teach????” Well, let me answer it this way, “My real name is The Rev. Dr. David Adamovich, professor with a PhD in physiology (I taught electrocardiography at the graduate level for 18 years), paramedic (and also Fire Chaplain), pool hall owner (Doc’s Billiard Emporium), professionally trained chef (graduate of the professional program of Institute of Culinary Education), ordained minister (non-denominational Christian); my friends call me ‘Throw’ and in my spare time… I throw knives.” So the answer is I did teach in one of my other careers. I wrote a 416 page text book on electorcardiography and same for many years. (Hahaha, I just did a search for it and it’s still showing up on-line…
    The Heart. Fundamentals of Electrocardiography, Exercise Physiology, and Exercise Stress Testing
    by David R. Adamovich
    ISBN-10: 091436300X
    ISBN-13: 978-0914363002
    List Price: $35.00).
    I developed a post MI walking treadmill test while working in cariology at a medical center. But for now I’m barely telling you the number of hats I’ve worn. Those above are the few that I remember.
    No doubt I could still read an ECG in about 5 seconds but why would I? I’d rather throw knives around pretty girls and set/break world records.
    TGT (

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