Bill Brown and I managed to make it through the EMT refresher course taught at Arbutus Volunteer Fire Department and pass the written portion of the certification process. The only thing remaining was the practical exam – a test of skills.

We rode together in Bill’s car to a community center in Havre de Grace, where the next state practical exam was being held.  Dozens of EMTs from across Maryland were there.

Several rooms had been set up into stations, each one testing a particular skill. One station simulated the treatment of a burn victim. Another station required the splinting of a fracture. Some stations were designed to examine a specific action, such as performing a primary assessment. There were 20 stations in all.

Although every student was scored individually, most of the stations were intended to be acted out in pairs, the way ambulance crews work in the field. Bill and I paired up for the practical exam since we already knew each other and nobody else would partner with us.

When a station simulated a scenario, the instructor would describe the case we’d be presented with and gave us a few minutes to talk together before the test began.

The rooms were crowded and hot, with equipment and manikins scattered about, and victims walking around wearing moulage – fake blood and simulated injuries.

Bill and I completed station after station, both of us comfortable with our performance.

The final station was a victim with multiple trauma, several severe injuries including a sucking chest wound and a severed brachial artery in the upper arm. Obviously, part of the station was seeing how well we prioritize life-threatening conditions. Either one of the chest wound or the arterial bleed could be fatal within a matter of minutes.

Bill and I took our 60 seconds before the timer began to plan out our approach and strategy – a luxury to mull things over one never gets in the field. I would stop the arterial bleed while he attended to the chest wound, take care of the life-threatening stuff first and then work from there.

When the station was completed, Bill and I stood up and shook hands, pleased with a job well done. Bill grinned with his goofy disarming smile.

You flunked, the instructor said.

What???

You flunked, he repeated. You failed three stations, including the multiple trauma patient. You have to pass at least 18 of the 20 stations.

“What did we do wrong on the last station,” Bill asked.

The chest wound and arterial bleed are supposed to be done in sequence, according to the ABCs of airway, breathing and circulation.  You’re supposed to finish caring for the chest wound before attending to the arterial bleed.

“But we did them both at the same time,” Bill said.

“That isn’t how we do things in Maryland,” the instructor said.

“That’s ridiculous,” Bill said. “What are we supposed to do, one of us stands around while an artery spurts all over the place?"

“GET OUT OF HERE,” the instructor bellowed. “YOU’RE THROUGH!”

The room turned suddenly silent as dozens of faces turned toward us. Clearly, we weren’t wanted here, and any further discussion would be futile.

“Come on,” I sighed. “Let’s go home.”

Part 30: Three Ways to Failure