Scene Size-Up
19-23%of exam
Primary Assessment
37-41%of exam
Secondary Assessment
4-8%of exam
Treatment + Transport
20-24%of exam
Operations
10-14%of exam
DocumentationConsentICSHazmatRecertification
Quick Facts
- Exam
- NREMT EMR
- Format
- CAT
- Questions
- 90-110
- Time
- 1h 45m
- Pass
- 950 scaled
- Fee
- $88/attempt
- Retest
- 15 days
- Credential
- 2 years
- TEI
- Included
- Peds
- Integrated
Scene Safe vs Patient First
Scene safe
- Protect responders
- Control hazards
- Request help
Patient first
- After safe access
- No new victims
- Work within system
Safety enables care
First Action Picker
- Scene unsafe→Stage(Request resources)
- Hazmat odor→Withdraw(Uphill upwind)
- Violence possible→Law enforcement(No entry)
- Multiple patients→Triage(Declare MCI)
- Single critical patient→Primary(Treat threats)
- Entrapment→Rescue resources(Do not freelance)
- Fire present→Fire command(Stay safe)
- Power line down→Utility(Keep distance)
Scene Safety
- BSI
- Body substance isolation
- PPE
- Risk-based protection
- Traffic
- Block and stage
- Violence
- Law enforcement first
- Fire
- Stay outside hazard
- Electrical
- Utility secures power
- Hazmat
- Uphill upwind upstream
- Animals
- Secure before entry
Scene Size-Up
- Dispatch
- Prearrival clues
- MOI
- Trauma mechanism
- NOI
- Medical nature
- Patients
- Count early
- Resources
- Request early
- MCI
- Triage system
- Landing zone
- Safe aircraft area
- Staging
- Wait safely
MARCH
Massive bleed before airway when needed
M: hemorrhageA: airwayR: respirationsC: circulationH: hypothermia/head
Primary vs Secondary
Primary
- Life threats
- ABCs/MARCH
- Treat now
Secondary
- History details
- Focused exam
- Trend findings
Threats before details
Airway Picker
- Fluids heard→Suction(Clear airway)
- No trauma→HTCL(Open airway)
- Suspected spine→Jaw thrust(Limit motion)
- No gag→OPA(Unresponsive)
- Gag present→NPA(If allowed)
- Breathing inadequate→BVM(Ventilate now)
- Breathing adequate→Oxygen(As indicated)
- Severe FBAO→Back blows/thrusts(Alternate cycles)
Primary Flow
- Impression
- Sick or not
- LOC
- AVPU
- Airway
- Open and clear
- Breathing
- Rate depth quality
- Circulation
- Pulse skin bleeding
- Life threat
- Treat immediately
- Priority
- Stable or unstable
- Baseline
- First vital set
AVPU
Alert, Verbal, Pain, Unresponsive
A: awakeV: voiceP: painU: none
Oxygen vs Ventilation
Oxygen
- Breathing adequate
- Hypoxia support
- NRB/cannula
Ventilation
- Breathing inadequate
- BVM support
- Chest rise
Oxygen needs breathing
Airway + Breathing
- Snoring
- Tongue obstruction
- Gurgling
- Suction fluids
- Stridor
- Upper obstruction
- Wheezing
- Lower narrowing
- HTCL
- No trauma
- Jaw thrust
- Suspected spine
- OPA
- Unresponsive no gag
- NPA
- Gag present
- NRB
- High-concentration oxygen
- BVM
- Ventilation support
OPA vs NPA
OPA
- Unresponsive
- No gag
- Mouth-to-jaw size
NPA
- Gag present
- Nose-to-ear size
- Avoid facial trauma
Gag decides adjunct
Circulation + Shock
- Massive bleed
- Control first
- Radial pulse
- Peripheral perfusion
- Carotid pulse
- Central perfusion
- Skin
- Color temp moisture
- Cap refill
- Pediatric perfusion clue
- Shock skin
- Pale cool clammy
- Tachycardia
- Early compensation
- Hypotension
- Late danger
SAMPLE
Symptoms, Allergies, Meds, Past, Last, Events
S: symptomsA: allergiesM: medsP: pastL: lastE: events
Secondary Tools
- SAMPLE
- History framework
- OPQRST
- Pain framework
- Vitals
- Trend changes
- DCAP-BTLS
- Trauma findings
- Focused exam
- Chief complaint
- Full exam
- Unclear trauma
- Stable reassess
- Every 15 min
- Unstable reassess
- Every 5 min
OPQRST
Onset through time frames pain
O: onsetP: provokesQ: qualityR: radiatesS: severityT: time
DCAP-BTLS
Trauma signs from head to toe
DeformitiesContusionsAbrasionsPuncturesBurnsTenderness
Pressure vs Tourniquet
Direct pressure
- Initial control
- Most wounds
- Pressure dressing
Tourniquet
- Life-threatening extremity
- Tight until stopped
- Time documented
Escalate for extremity hemorrhage
Bleeding Picker
- Minor bleeding→Direct pressure
- Severe extremity→Tourniquet(Stop bleeding)
- Deep neck wound→Packing(Protocol driven)
- Open chest wound→Occlusive seal(Monitor breathing)
- Impaled object→Stabilize(Do not remove)
- Amputated part→Cool container(Avoid freezing)
CPR + AED
- Rate
- 100-120/min
- Adult depth
- 2-2.4 inches
- Child depth
- One-third chest
- Adult ratio
- 30:2
- Two-rescuer child
- 15:2
- AED analyze
- Clear patient
- Shock
- Resume CPR
- Pauses
- Under 10 seconds
Transport Picker
- Unstable airway→Rapid transport(Ventilate enroute)
- Shock signs→Rapid transport(Treat bleeding)
- Major trauma→Trauma center(Follow protocol)
- Stroke signs→Stroke center(Time matters)
- Chest pain→Cardiac-capable(Monitor closely)
- Imminent birth→Prepare delivery(Do not delay)
Oxygen Devices
- Nasal cannula
- Low-flow oxygen
- Simple mask
- Moderate oxygen
- NRB
- High oxygen
- BVM reservoir
- Ventilate with oxygen
- Inadequate breathing
- BVM first
- Hypoxia
- Treat promptly
- Position
- Comfort if breathing
- Suction
- Clear before oxygen
Bleeding + Trauma
- Direct pressure
- First bleeding step
- Packing
- Deep junction wound
- Tourniquet
- Life-threatening extremity
- Tourniquet time
- Document visibly
- Chest seal
- Open chest wound
- Splint
- Joint above below
- PMS
- Before and after
- Amputation
- Cool not frozen
Medical Emergencies
- Anaphylaxis
- Epinephrine auto-injector
- Asthma
- Assist prescribed inhaler
- Hypoglycemia
- Oral glucose awake
- Stroke
- FAST screen
- Chest pain
- Aspirin per protocol
- Seizure
- Protect airway
- Opioid
- Naloxone per protocol
- Heat stroke
- Rapid cooling
Special Populations
- Pediatrics
- Integrated throughout
- PAT
- Appearance breathing circulation
- Infant pulse
- Brachial check
- Pregnancy
- Left lateral tilt
- Childbirth
- Support not pull
- Geriatric
- Falls high risk
- Abuse
- Report suspicion
- Behavioral
- Safety and deescalation
START RPM
Respirations, Perfusion, Mental status
R: breathingP: radial/cap refillM: commands
Certification vs Licensure
Certification
- National Registry credential
- Exam pathway
- Not practice permission
Licensure
- State authority
- Practice permission
- Local scope
Credential vs legal practice
Legal Picker
- Awake adult agrees→Expressed consent
- Unresponsive patient→Implied consent
- Minor present→Guardian consent(If available)
- Competent refusal→Explain risks(Document)
- DNR present→Protocol(Verify validity)
- Media asks→Protect privacy(No details)
Exam Logistics
- Launch
- April 7 2025
- Basis
- 2023 BLS analysis
- Format
- Computer adaptive
- Items
- 90-110
- Pilot
- Unscored embedded
- Time
- 105 minutes
- TEI
- Interactive item types
- Results
- Account posts
START vs JumpSTART
START
- Adult MCI
- Walking wounded
- RPM logic
JumpSTART
- Pediatric MCI
- Breathing checks
- Child logic
Adult vs pediatric triage
Certification Path
- Course
- State-approved EMR
- Standards
- Meets EMS standards
- Course age
- Within two years
- Verification
- Program Director
- Skills
- State BLS competency
- ATT
- 90 days
- Fee
- $88 per attempt
- Recert
- Every two years
Expressed vs Implied
Expressed
- Patient agrees
- Capacity present
- Explain care
Implied
- Cannot consent
- Emergency need
- Reasonable care
Permission vs presumed permission
Operations Core
- PCR
- Objective care record
- Radio
- Clear brief report
- Handoff
- Findings interventions response
- Consent
- Permission for care
- Refusal
- Capacity and risks
- DNR
- Follow local protocol
- Negligence
- Duty breach harm
- Confidentiality
- Minimum necessary sharing
ICS + Triage
- ICS
- Command structure
- IC
- Incident commander
- START
- Adult MCI triage
- JumpSTART
- Pediatric MCI triage
- Green
- Walking wounded
- Red
- Immediate care
- Yellow
- Delayed care
- Black
- Deceased expectant
Common Traps
Unsafe scene
Stage and call ≠ Do not enter
ATT vs certification
ATT schedules exam ≠ Certification follows requirements
Oxygen vs BVM
Adequate gets oxygen ≠ Inadequate gets BVM
Primary vs secondary
Primary finds threats ≠ Secondary gathers details
Tourniquet timing
Apply when needed ≠ Document application time
Scope creep
EMR provides BLS ≠ No advanced procedures
CAT item count
90 not automatic pass ≠ 110 not automatic fail
Pediatric content
Integrated across domains ≠ Not separate domain
Pearson results
Pearson cannot disclose ≠ Registry account posts
Retest wait
Reapply when posted ≠ Retest after 15 days
Last Minute
- 1.Weights: 19-23/37-41/4-8/20-24/10-14
- 2.Scene safe before patient contact
- 3.Primary drives about 40%
- 4.Pediatrics are integrated
- 5.CAT: 90-110 items
- 6.Pass point: 950 scaled
- 7.ATT valid 90 days
- 8.Retest wait: 15 days
- 9.BVM for inadequate breathing
- 10.Shock skin: pale/cool/clammy
- 11.OPA: no gag
- 12.NPA: gag present
- 13.Tourniquet time documented
- 14.Recert: 8/4/4 = 16
- 15.Certification is not licensure
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