EMT-Basic Exam: Practical Skills Examination

Before you can even qualify to take the EMT-Basic exam, you must first pass a state-approved practical examination. Although the exact protocols for this exam may vary from state to state, most follow the national practical examination process. The exam tests five mandatory skills and one random skill.

The mandatory skills include assessing a trauma patient, assessing a medical patient, applying a bag-valve mask device to an apneic patient with a pulse, assessing a cardiac arrest patient, and immobilizing a patient. The random skill may be one of several of the examiner’s choosing, such as administering oxygen, controlling bleeding, or applying a traction splint.

Each skill is assessed by an experienced examiner who will provide you with the necessary information to perform the task. These examiners will consult performance checklists as you go through each station. The checklists outline the logical order that most EMT-Basics would follow when performing a particular skill. At some stations, such as the spinal immobilization station, you may be demonstrating your skills on an actual person. Of course, you will not be able to demonstrate some of the more invasive techniques, such as inserting an airway adjunct, on a volunteer. Instead, you may be required to completely verbalize your actions to the examiner or perform your interventions on a dummy.
It is important to remember that missing a single step will not result in automatic failure of a station. The reason that most EMT-Basic candidates fail a skill is because they do something, or fail to do something, that would ultimately result in harm to the patient, themselves, or other EMT-Basics. As long as you focus on the critical criteria for each station, missing a step here or there should not result in failure.
This guide will review the techniques that you should know before taking the practical skills examination.

The best way to prepare for the practical skills examination is to practice the skills in class and review each of the following sections carefully.
Remember, a thorough understanding of the concept behind each skill will ensure your success on the exam, so be sure to examine the “

A. Patient Assessment
The patient assessment station of the EMT-Basic practical examination is broken into two sections: trauma assessment and medical assessment. This station is designed to test your ability to think through a situation and verbalize your response. Your “verbal” treatment of a patient should coincide with the actual treatment you provide. Being able to verbalize the care you provide to a trauma or medical patient generally indicates your ability to actually perform the skill safely and efficiently in the field.
 

1. Trauma Patient Assessment
The trauma patient portion of the patient assessment station is intended to test your ability to carry out an assessment of a patient who has suffered multiple traumas and verbally treat the patient’s condition.
You’ll be required to perform the patient assessment just as you would in the event of a real emergency, which includes communicating with the patient. While you assess the patient, you must clearly state your findings. Clinical information that would not be otherwise obtainable through visual or physical examination may be given after you demonstrate how you would gather this information in the field. During this test, you may presume that you are working with two EMT-Basics who are following your commands. This station has a 10-minute time limit. The station’s examiner will time you and offer supplementary clinical information. The examiner may also ask for additional information about your assessment and treatment.
When taking this portion of the practical skills examination, the first skill areas you’ll be tested in are performing the scene size-up and taking the proper body substance isolation (BSI) precautions. After these two skills are complete, the examiner will assess your ability to perform an initial assessment, a focused physical exam, a patient history, a rapid trauma assessment, and a detailed physical examination.

Tip: Remember to verbalize each step or action you take when assessing the patient.
Although this station covers a broad range of topics, there are some basic concepts to remember that will help you prepare for this portion of the examination:
- Take the proper BSI precautions. This includes wearing gloves, protective eyewear, and a mask. Depending on the situation presented, other protective gear may be necessary.
- Make sure that the scene is safe before approaching the patient. Some scenarios may include dangerous conditions that require special precautions. Remember to ask the examiner about the safety of the scene and state how you would proceed.
- All critical trauma patients require spinal stabilization, so it is important to take the proper spinal precautions while you attend to the patient. You may choose to do this by stating that you will instruct your partner to maintain manual stabilization of the patient’s head.
- State your intention to apply immobilization devices such as cervical collars or backboards.
- Provide the patient with oxygen. All critical trauma patients require oxygen treatment. This treatment can be provided through either a nonrebreather mask or a bag-valve mask at 15 L/min. Application of oxygen should occur as soon as you’ve assessed the adequacy of the patient’s respirations.
- Find and treat problems connected to the airway, breathing, hemorrhage, or shock in a timely manner. Problems in any of these areas could threaten your patient’s life.
- You must be able to accurately determine whether the patient’s condition indicates rapid transport or continued on-scene treatment and assessment. While some scenarios call for detailed physical examination and careful on-scene treatment, others require rapid transport to a medical facility with very little time spent on the scene.
- Remember to perform the initial assessment before the detailed physical examination. Assessing the patient’s airway, breathing, and circulation is the most important part of the overall assessment. Once you have determined that the scene is safe, the initial assessment should be the next step. When you perform the detailed physical examination, remember to use the DCAP-BTLS method when checking for injuries.
- Transport the patient within the 10-minute time limit. If you start transport before the end of your time, remember to perform the detailed physical exam while the transport is in progress. Not transporting the patient during the allotted time may result in failure of the station.

2. Medical Patient Assessment
This portion of the patient assessment station is similar to the trauma patient assessment portion. In this case, you are assessing a patient who is suffering from a medical issue, such as an illness. You have 10 minutes to complete the task.
With trauma patients, you can usually see the patient’s problem and treat it accordingly. Conversely, with medical patients, the problem is usually not visible and you must rely on your assessment to determine the nature of the patient’s condition.
In addition to the standard scene size-up and initial assessment, these types of scenarios require a considerably more detailed physical exam and patient history. You must identify the patient’s condition based on his or her signs, symptoms, and history. Possible patient conditions may include respiratory or cardiac distress; altered mental status; allergic reaction; poisoning/overdose; or environmental, obstetrics, or behavioral emergencies.

While this section is similar to the trauma patient assessment, there are also some important concepts that are exclusive to medical patient assessment. It is important to ask questions that are relevant to the patient’s complaints. These questions form the basis of your understanding of the patient’s condition and will indicate the appropriate treatment. The questions you ask will guide you through the scenario. There are a required number of questions you must ask based on the nature of the patient’s condition:
- Respiratory—five or more questions
- Cardiac—five or more questions
- Altered mental status—six or more questions
- Allergic reaction—four or more questions
- Poisoning/overdose—five or more questions
- Environmental emergency—four or more questions
- Obstetrics emergency—five or more questions
- Behavioral emergency—four or more questions
You will not be awarded credit for this step unless you ask at least the minimum number of questions required by the patient’s condition.
When treating the patient, you should remember to obtain authorization from the medical direction physician for treatments that require approval. You’ll also need to verbalize any standing orders that you choose to incorporate.

Tip: Remember to ask the patient the required minimum number of questions about his or her condition to help you determine the appropriate treatment.
It is also critical to avoid any treatment that may be inappropriate or dangerous. Attempting any form of treatment that is not appropriate for the patient’s condition or that may harm the patient could result in failure of the station.

Related Topics You Should Review:
- Patient assessment
- Medical emergencies
- Trauma emergencies B. Applying a Bag-Valve Mask Device to an Apneic Patient with a Pulse

In this station of the practical skills examination, you will be required to properly ventilate an apneic patient with a bag-valve mask device. In this scenario, there are no bystanders and artificial ventilation has not been started. The only treatment you need to be concerned with is management of the patient’s airway and ventilatory support. First, you’ll ventilate the patient for 30 seconds, after which time the effectiveness of your ventilator volumes will be assessed. The examiner will then inform you that a second EMT-Basic has arrived on the scene and that you must control the airway and maintain the mask seal as your partner provides ventilation. You have 5 minutes to complete the station.
During the test, the examiner will time your progress and observe your ventilations. When you’ve ventilated the patient for 30 seconds, the examiner will either inform you of your partner’s arrival or, in some cases, play the role of the partner.
While you’re ventilating the patient, the examiner will be checking that you verbalize the opening of the airway and insertion of an airway adjunct. Remember to select the appropriate size mask and create a proper mask-to-face seal. Next, ventilate the patient at the proper rate with the adequate volume and connect the reservoir and oxygen, adjusting the flow to 15 L/min or greater.
When your partner takes over ventilation, the examiner will check that you verbalize reopening the airway, creating a proper mask-to-face seal, and instructing your partner to resume ventilations at the proper rate with the adequate volume.
Initiation of ventilation should be immediate. When the examiner tells you to begin, you must open the patient’s airway and start artificial ventilations with the bag-valve mask. Because you are not required to manually insert an airway adjunct, you can simply verbalize this action. You will be required to ventilate the patient for 30 seconds with room air.

Tip: Maintain a secure mask-to-face seal at all times for proper ventilation.

Ensure that ventilations are not interrupted for more than 20 seconds. Be efficient when connecting supplemental oxygen and the reservoir, as this process may cause an extended interruption if you don’t perform the action quickly. You can also save time by noting the location of all your equipment before you begin the test. When you attach supplemental oxygen tubing and the reservoir after ventilating the patient with room air for 30 seconds, remember to state that you’ve set the oxygen flowmeter to 15 L/min. In some cases, you may have to physically set the flowmeter.
You are allowed one inadequate ventilation during this practical exam. A ventilation is declared inadequate when the patient’s chest fails to rise or rises only slightly. The most frequent cause of inadequate ventilation is an improper mask-to-face seal. When this seal is not maintained, inadequate volumes result. If you have trouble with this procedure, you may try firmly holding the mask to the patient’s face and pressing the bag against your leg. When you are working with your partner, the mask should be secured to the patient’s face using the “E-C-clamp” method.
You should ventilate at a rate of around 12 breaths per minute and wait for the chest to fall completely before you start the next ventilation. Be careful not to ventilate the patient too fast as this can lead to hyperventilation and gastric distention.

Related Topics You Should Review:
- Respiratory emergencies
- Artificial ventilation 

C. Cardiac Arrest Management/AED
At this station, you will be asked to manage a prehospital cardiac arrest through the integration of CPR skills, defibrillation, airway adjuncts, and patient and scene management skills. As the scenario begins, you’ll find a patient in cardiac arrest. You’ll have a first responder and an EMT-Basic to assist you. The first responder will perform one-rescuer CPR—other than this, your assistants will do only what you direct them to do. You must take control of the scene and initiate patient resuscitation with an automated external defibrillator (AED). When it becomes necessary, control the patient’s airway and ventilate or direct one of your assistants to ventilate the patient with adjunctive equipment. You have a 15-minute time limit. The examiner will time you and may serve as one of your assistants.
This test has four components: assessment, transition, integration, and transportation. Remember, you must verbalize all of your actions during this station.
In the assessment phase, ask the first responder how long the patient has been in cardiac arrest and how long CPR has been in progress. It is important to do this without interrupting the administration of CPR. Once you understand the event of the cardiac arrest, activate the AED and attach the AED pads to the patient without interrupting CPR. When the AED is activated and fully attached, begin rhythm analysis of the patient. While analysis is in progress, ensure that all rescuers are clear of the patient. Physical contact with the patient at this time may interfere with analysis. When all rescuers are clear of the patient, if indicated by the device, deliver one shock and then ensure CPR is resumed immediately following the shock.
Next is the transition phase, during which you must direct your assistants to resume two-rescuer CPR. During this process, you should assess CPR effectiveness. Feel for a carotid or femoral pulse as your assistants perform chest compressions. At this point, ask any other necessary questions about the patient’s cardiac arrest, medical history, and the events that led up to the onset of the cardiac arrest.
During the integration phase, you are required to integrate the proper airway management into the situation without interrupting chest compressions. Don’t forget to verbalize the measurement and insertion of an oropharyngeal airway. Next, ventilate or order the ventilation of the patient with either a bag-valve mask device or a pocket mask. Following five cycles of CPR, ensure everyone is clear of the patient and reanalyze the patient’s cardiac rhythm. Deliver another shock, if necessary. Keep in mind that CPR should be resumed as soon as the shock is delivered.
In the transportation phase, you’ll need to place the patient on a long spine board, continue CPR, and begin transport to a medical facility. Remember to verbalize each of these steps. At this station, you should initiate use of the AED immediately. Ventricular fibrillation is the most frequently occurring initial cardiac dysrhythmia seen during early cardiac arrest in adults, so defibrillation is the most important treatment. Apply the AED pad while chest compressions are in progress. This will help reduce any interruption of CPR.

Tip: Keep in mind that CPR should be actively administered at all times, except during cardiac rhythm analysis and shocks. Don’t forget to resume CPR immediately after the analysis and shocks.

Ensure that all rescuers are clear of the patient before administering a shock. Anyone in physical contact with the patient when a shock is delivered may be injured.
Review the steps for operating the AED. Using the AED is a critical component of this scenario and you must know how to use it properly and safely. It is also critical that you don’t prevent the AED from delivering a shock in any way. The AED is designed to precisely recognize shockable rhythms. When the AED indicates a shock is required, it should be administered immediately. You should not remove the AED pads from the patient or disconnect the AED cable from the AED at any time.

Related Topics You Should Review:
- Cardiac emergencies
- Automated external defibrillator
- Ventricular fibrillation 

D. Spinal Immobilization
At this station, you will be tested on your ability to properly immobilize a patient who may be in either a seated or a supine position. The position of the patient is predetermined by the examiner or chosen at random as the scenario is prepared. You’ll have 10 minutes to complete this station. Remember to verbalize all of your actions.
During this scenario, you’ll use a half-spine immobilization device, such as a short spine board or a vest-style device. As the scenario begins, you and an EMT-Basic assistant enter the scene of an automobile accident. You determine that the scene is safe and identify one patient. Your assistant completes the initial assessment and finds that the patient’s vital signs are stable and that there are no critical conditions requiring immediate attention. You must treat the patient’s unstable spine using a half-spine immobilization device. Remember, your assistant will only follow your instructions during this scenario. Once the initial immobilization is complete, you may transfer the patient to the long spine board verbally.
Along with timing your progress, the examiner will observe your actions and those of your assistant while testing the effectiveness of your attempt at immobilization by trying to manipulate the device.
Remember to place the patient’s head in a neutral, in-line position. You can direct your assistant to carry out this manual immobilization. Once the head is manually immobilized, it’s important to apply a correctly sized cervical collar before ordering your assistant to release the patient from manual immobilization. Ensure that your assistant does not release manual stabilization of the patient’s head before you have the cervical collar in place and the patient is immobilized to the device. To ensure that manual stabilization is not released before stabilization is maintained mechanically, you should direct your assistant to maintain manual stabilization until you’ve carefully reassessed the patient’s peripheral pulses and neurologic status.
It is also important to avoid excessive or uncoordinated patient movements, as they may compromise the stability of the patient’s spine. Because the individual maintaining stabilization of the patient’s head is in command of any movements, ensure that your assistant is aware that all movements are at his or her command. All movements must be executed in a uniform fashion, with the patient being moved as a unit at all times.
Remember to apply all immobilization devices gently and carefully. When you’re applying the half-spine immobilization device, secure the patient’s torso before securing the patient’s head. If you secure the patient’s head first, you may cause unnecessary movement of the patient’s neck while you secure the torso. The head should not be immobilized until full immobilization of the torso is completed.
Do not attempt to position the entire device and then return to tighten the straps. As you position the half-spine immobilization device, check that the device fits the patient snugly under the arms. After positioning is complete, step back and examine the patient to ensure that the device is centered, and then secure the straps.

Tip: Remember to verbalize your actions. Your EMT-Basic assistant will only follow your commands.

Be careful to ensure proper head immobilization in the half-spine immobilization device. When positioning the patient on the half-spine immobilization device, remember that the area between the patient’s lower back and the back of the head should always be in an in-line position. In addition, you should remember that the support pad included with the half-spine immobilization device will not be used in most cases, as it is most frequently used with patients who have spinal deformities that don’t allow for normal alignment.
When you are securing the patient’s torso, do not to affix the straps so tightly that the patient has difficulty breathing. To avoid this problem, you should ask the patient to take and hold a deep breath while you secure the strap, repeating this technique for each strap. This will allow for proper chest expansion. This technique applies only when immobilizing a patient from a seated position.
An improperly positioned head at the completion of immobilization may lead to failure of the station. You should be certain that the patient’s cervical collar is correctly sized and that you’re not using the support pad unnecessarily.
Remember to assess motor, sensory, and circulatory functions after immobilization is complete and after you’ve stated that the patient has been moved to the long backboard. During this test, you are required to assess the patient before and after placement of the half-spine immobilization device.

Related Topics You Should Review:
- Spinal injuries
- Head injuries
- Immobilization devices

E. Random Skills
Along with the five mandatory skills included in the practical skills examination (trauma patient assessment, medical patient assessment, applying a bag-valve mask device to an apneic patient with a pulse, cardiac arrest management/AED, and spinal immobilization), you will need to demonstrate your abilities to perform one additional skill that is chosen at random. You won’t know what this skill will be until the day of the exam. The possible skills you may be tested on include the following:
- Oxygen administration
- Airway adjuncts and suctioning
- Mouth-to-mask ventilation with supplemental oxygen
- Traction splint
- Immobilization of a joint injury
- Immobilization of a long bone fracture
- Bleeding control and shock management

1. Oxygen Administration
In this station, you’ll be tested on your ability to correctly assemble the required equipment for administering supplemental oxygen in the field. You’ll be expected to properly assemble an oxygen tank and regulator and then administer oxygen to the patient with a nonrebreather mask. Once you have accomplished this task, the examiner will instruct you to discontinue use of the nonrebreather mask because the patient is not tolerating this treatment. You’ll then administer oxygen with a nasal cannula. When you have successfully initiated oxygen administration with a nasal cannula, the examiner will instruct you to completely discontinue oxygen administration. You have a 5-minute time limit.
When assembling the oxygen tank and regulator, avoid any leaks. Note whether the pin index safety system on the tank is correctly aligned with the corresponding fittings on the regulator. If you hear oxygen leaking when you turn on the tank, turn it off and recheck the fittings.
It is important to ensure the proper flow of oxygen before applying the nonrebreather mask. You must set the flow rate to 12 L/min or higher, so the patient receives the proper oxygen flow.
It is also important to remember to fill the reservoir bag with oxygen before you place the nonrebreather mask on the patient. The nonrebreather mask can’t deliver 100 percent oxygen if the reservoir bag isn’t filled. When you set the flowmeter, block the outlet port of the mask with your finger until the reservoir is completely filled.
When you’re instructed to switch from the nonrebreather mask to the nasal cannula, remember to reset the flowmeter to within a range of 1–6 L/min. Remember, oxygen delivered through a nasal cannula at a rate greater than 6 L/min can be dangerous for the patient.

2. Airway Adjuncts and Suctioning
At this station, you’ll be tested on your ability to correctly measure, insert, and remove an oropharyngeal and a nasopharyngeal airway. You’ll also be required to perform suction on the patient’s upper airway. You have 5 minutes to complete the station.
It is extremely important to select the correct-fitting oropharyngeal airway for the patient. If the airway you choose is too large or too small, it may lead to further complications. It is recommended that you measure the correct size oropharyngeal airway from the corner of the mouth to the angle of the jaw or the earlobe. You can tell if you’ve placed an oropharyngeal airway correctly if the flange is resting flush with the patient’s lips.
It is just as important to select a properly sized nasopharyngeal airway. It is recommended that you use the measurement from the corner of the nose to the angle of the jaw or the earlobe to help you select the correct size nasopharyngeal airway. Always lubricate the nasopharyngeal airway before inserting it. You should never rotate the airway into place as this could harm the patient. Insert the airway with the bevel facing the nasal septum or the base of the nostril. If you encounter any resistance while attempting to insert the airway, don’t force it. Remove the nasopharyngeal airway and try inserting it in the other nostril.
When you begin the suctioning portion of the test, you should measure the suction catheter in the same fashion as the oropharyngeal airway. Don’t attempt to initiate suction while you’re still inserting the catheter. Suctioning should be performed in a circular motion only as the catheter is being removed from the mouth.

Tip: Because oxygen is removed during suctioning, remember to administer oxygen before and after you suction a patient’s airway. Also, limit suctioning to 10–15 seconds.
The insertion of any adjunct in a way that could harm the patient may lead to failure of the station. Take your time and do not attempt to force any airway into place.

3. Mouth-to-Mask Ventilation with Supplemental Oxygen
At this station, you’ll be required to ventilate a patient with supplemental oxygen via the mouth-to-mask technique. You may start the test with the assumption that mouth-to-barrier ventilation is already in progress and that the patient has a central pulse. The only treatment you’ll have to provide is ventilatory support with the mouth-to-mask technique and supplementary oxygen. You’ll ventilate the patient for 30 seconds, during which time the examiner will assess the appropriateness of the patient’s ventilatory volumes. You have a 5-minute time limit.
Because this scenario requires supplemental oxygen, you’ll need to attach the oxygen tank and set the flowmeter. You may do this immediately upon initiating ventilations or after first ventilating the patient with room air.
Pocket masks used without supplemental oxygen can deliver good tidal volume to the patient, but will only provide 16 percent oxygen. If you set the flowmeter at 15 L/min, you can supply the patient with 55 percent oxygen and good tidal volume.
Remember to deliver each breath over 1 second and be sure that the patient’s chest rises. You can secure the mask to the patient’s face using one of two acceptable methods. The first method involves placing the mask on the face while kneeling at the patient’s head, grasping the angles of the jaw, and tilting the patient’s head back. When using the second method, execute a head-tilt chin-lift maneuver while kneeling astride the patient and place the mask on his or her face.
It is crucial to ventilate the patient at a rate of 10–12 breaths per minute. You can maintain this rate by ventilating the patient every 5 to 6 seconds.

Tip: You can count out loud or to yourself if you think it will help you maintain the proper rate of ventilation.
It is also critical that you allow the patient time to completely exhale during ventilation. If you’re ventilating too quickly, the patient may not be exhaling properly, which can lead to hyperventilation and gastric distention. Ensure that the patient’s chest falls completely before starting the next breath.

4. Traction Splint
The traction splint station of the practical skills examination assesses your ability to use a traction splint to stabilize a midshaft femoral fracture. During this scenario, an EMT-Basic assistant will aid you in applying the splint by applying manual traction at your direction. You’re only required to treat the isolated femur injury. You’ll be instructed to assume that the scene is safe, the initial assessment has already been completed, and that the focused assessment indicated a midshaft femoral deformity. You won’t have to monitor the patient’s airway, breathing, or central circulation. You have 10 minutes to complete the station.
Proper traction must be maintained at all times. To ensure that traction is always maintained, you should communicate with your assistant to avoid any “surprise” moves and ensure that the traction splint’s locking mechanism is fully locked after traction is complete. You can also direct your assistant to place his or her foot against the foot of the patient’s uninjured leg before assuming manual traction. This will prevent the patient from sliding when manual traction is pulled and will help your assistant maintain his or her balance.
Evaluate the patient’s motor, sensory, and circulatory functions in the injured extremity before and after you apply the splint. Once the extremity has been manually stabilized, check the patient’s motor, sensory, and circulatory functions immediately. Assess these functions again after application of the splint. You may also check these functions after the splint is fully secured.
As you prepare to apply the splint, compare the splint to the uninjured leg to ensure that the end of the splint extends no more than 12 inches beyond the injured leg. This will prevent the leg from becoming overextended when mechanical traction is applied. While you or your assistant performs manual stabilization of the leg, ensure that it’s as straight as possible and that the patient’s foot points upward. This position should be maintained until the splint is fully applied. Using this technique will prevent the leg from rotating unnecessarily.
It is very important that your immobilization attempt fully supports the femur and prevents any leg rotation. To ensure that this happens, ask your assistant to stop you when the degree of mechanical traction either meets or slightly exceeds manual traction. Mechanical traction that fails to meet manual traction may result in a “drop” of the leg. You should also ensure that all straps have been firmly secured to prevent leg movement.
Remember that the leg should not be fully secured to the splint before applying mechanical traction. After you’ve applied manual stabilization and checked the patient’s motor, sensory, and circulatory functions, apply the ankle hitch and manual traction. Next, position the prepared splint beneath the injured leg and lower the leg into the splint. Next, secure the ischial strap and apply mechanical traction. Once mechanical traction is in place, fasten the Velcro straps that will secure the injured leg to the splint.

5. Immobilization of a Joint Injury
This station requires you to correctly immobilize an uncomplicated shoulder injury. You only have to treat the specific, isolated shoulder injury. When you start the scenario, the examiner will instruct you that the scene size-up and initial assessment are complete and that the focused assessment has revealed the shoulder injury. You won’t need to monitor the patient’s airway, breathing, or central circulation. You have a 5-minute time limit.
When you immobilize the patient’s shoulder, it’s critical that the joint is supported properly and is not bearing any distal weight. While applying the sling, ensure that the elbow is in flexion and the hand is pointing toward the uninjured shoulder. When the sling is properly applied, the elbow of the injured extremity will rest inside the sling and support the shoulder. You should use caution when applying the sling. Any downward pressure on the injured extremity would force it to bear distal weight.
You must also remember to immobilize the bone above and below the joint. You may have some difficulty identifying which bone is proximal to the injured shoulder. Most shoulder dislocations occur at the glenohumeral joint. This is where the humeral head joins with the glenoid fossa of the scapula. As a result, the scapula would be the proximal bone requiring immobilization. When applied properly and fully secured, the sling will immobilize the scapula.
Throughout the entire process, you should be monitoring the patient’s motor, sensory, and circulatory functions in the injured extremity. Make your first check after you have manually stabilized the extremity. Complete your second check after applying the sling and swathe. In this case, circulatory function can be assessed with capillary refill.

6. Immobilization of a Long Bone Fracture
At this station, you’ll be asked to correctly immobilize a closed, nonangulated long bone injury. The scene size-up and initial assessment have already been completed. The examiner will inform you that the focused assessment of the patient revealed a closed, nonangulated injury of the radius, ulna, tibia, or fibula. You won’t have to monitor the patient’s airway, breathing, or central circulation. You have 5 minutes to complete the station.
The most important thing to remember while immobilizing the patient’s injured extremity is to avoid any unnecessary or sudden movements. Any movement can result in further injury. You should stabilize the extremity manually and maintain stabilization until the whole extremity is fully immobilized. Exercise caution during application of the splint, being very careful not to move the extremity suddenly.
Don’t forget to immobilize the joints adjacent to the injured bone. With radius or ulna injuries, the elbow and wrist should be immobilized. With tibia or fibula injuries, the knee and ankle should be immobilized. In most cases, long bone injures will be immobilized with padded board splints and cravats.
Remember to assess the patient’s motor, sensory, and circulatory functions before and after you apply the splint. Your initial check of these functions should take place as soon as you have established manual stabilization of the injured extremity. You will need to assess motor, sensory, and circulatory functions again after the splint has been applied and the extremity is fully immobilized. You may use capillary refill to check the patient’s circulatory function.

7. Bleeding Control and Shock Management
This station is scenario-based and is intended to assess your ability to control a hemorrhage. At the beginning of this practical exam, the examiner will read you a scenario and you will have the opportunity to ask questions. The examiner will provide you with updates on the patient’s signs and symptoms as you proceed through the scenario. Based on the information you receive from the examiner, you’ll determine the necessary treatment. You have a 10-minute time limit.
During the scenario, you can assume that the patient’s airway is clear and that he or she is breathing adequately. Keep in mind that the patient will require treatment with high-flow oxygen. All victims of shock must be administered 100 percent oxygen. However, it is important to remember that controlling any bleeding should be your first priority before applying oxygen.
You should initially try to control bleeding with simple techniques, such as direct pressure and elevation. More advanced techniques should only be attempted if simple interventions fail. For example, tourniquets should be used as a last resort because they can sometimes lead to a loss of circulation in the affected extremity. Above all, you must stop or at least control the bleeding as quickly as possible.
Once you have the bleeding under control, don’t forget to verbally initiate transport.

Related Topics You Should Review:
- Oxygen administration
- Oxygen equipment
- Artificial ventilation
- Respiratory care
- Immobilization
- Musculoskeletal care
- Fractures
- Joint injuries
- Long bone injuries
- Soft tissue injuries
- Shock
- Hemorrhage