Oral Boards Scheduling & Testing

The realm of EMS has continued to evolve and strengthen over the decades, and finding a mechanism to coordinate a diverse group of agencies that involve medical care, fire suppression, hazmat response and technical rescue – all under the umbrella of the U.S. Department of Transportation- can be a challenge to say the least.  It is easy for an agency director or manager to become focused on the microcosm of their own agency or company and lose sight of what challenges, advancements, and innovations the neighboring organization is involved in.  Different goals create different standards, and different standards lead to inconsistent education, unequal training, and discrepancies in provider care.

Mitigation of these differences is where the Tidewater Emergency Medical Services Council (Region 7 EMS Council) comes into play. Through the Office of the Regional Educational Coordinator, Region 7 EMS Council can act as a clearinghouse of knowledge, information, conversation, and standardization.  Region 7 EMS Council functions as an oversight organization that helps to maintain a consistent experience for all prehospital students and interns in the region.

Protocol Training and Testing

Region 7 EMS Council does not provide the initial training or certification for prehospital providers, but Region 7 EMS Council does provide feedback to for-profit as well as municipal training institutions in the region.  One of the most important mechanisms for region wide standardization is the implementation of a Regional Protocol Exam Process.  Providers that wish to practice prehospital care in Region 7 EMS Council come to the region as a certified provider who has successfully passed a National Registry Exam.  This shows that the provider is proficient in the skills, knowledge and abilities set forth by the National Registry of Emergency Medical Technicians. However, it is the nature of EMS to have specific standards of care set forth by Medical Doctors that reflect the capabilities and expectations of a given region. These standards are written down (and managed by Region 7 EMS Council) into a single document known as the Tidewater Regional Protocols.

The Regional Sanctioning Exam is a means by which we can ensure all providers are knowledgeable and proficient in the standards of care that have been established in the greater Tidewater Virginia region. This exam is the product of a combined input of a Training and Education Committee (managed by Region 7 EMS Council) made up of training officers who develop the question content.

ALS Sanctioning

Overview

Providers are inducted into the process through their local fire department, rescue squad, private ambulance services or standby company. Each agency training officer submits to Region 7 EMS Council a contract by which all parties agree to set a one-year timetable to complete a demonstration of individual medical skills and a reflection of a cognitive understanding of the Region 7 EMS Council Protocols.

Moodle Site for Cognitive Testing

Providers are able to show their skill proficiencies with their local training officers, and then take the ALS Sanctioning Exam.  This online exam is managed by Region 7 EMS Council, who ensures the integrity of the questions, and manages the hosting platform that allows for a question bank to provide random questions in a multiple choice format.  These questions are created, updated, and approved by the Training and Education Committee. It should be noted that there is a distinct version of the Sanctioning Exam for the Advanced EMT and the Intermediate/Paramedic. You can access the Moodle Testing site by clicking HERE.

Oral Board Information

Upon successful completion of the Sanctioning exam, the applicant will then be eligible for Oral Boards. The provider must spend time ‘practicing’ this process though trial runs by which the provider is verbally given a likely scenario and must orally explain their assessment, conclusions, and plans of action on how they would provide care in this fictional scenario.  

If the applicant can show they are proficient with the agency training officer, they can schedule the actual Oral Board event with their agency Operational Medical Director, and the Region 7 EMS Council Regional Educational Coordinator. The role of the REC is to ensure the Oral Board Process is fair and consistent with approved standards from the Region’s Medical Directors.

After passing the Regional Sanctioning Boards, the provider is then considered to be approved to practice their skills anywhere in the Tidewater Region. There is no need to go through the Regional Sanctioning Process again when returning or transferring to another Region 7 EMS Council agency once Regionally Sanctioned.

The oral board examination process is implemented to assessparamedic candidates' clinical judgment, patient management skills, and theirability to identify and treat EKG rhythms within a simulated prehospitalenvironment . It evaluates proficiency in EKG interpretation, advanced lifesupport protocols, and clinical decision-making through simulated patientscenarios and knowledge-based questions .

In particular, the Paramedic Oral Board process is designedto allow the OMD to get a chance to ‘get to know’ the providers that operateunder their license and give the OMD a chance to assess the critical thinkingskills of the candidate and how well those skill align with the philosophies ofthe OMD and the agency in particular.

Oral Board Overview

Paramedic oral board examinations specifically evaluate acandidate's proficiency in applying advanced life support (ALS) protocolsduring simulated patient scenarios by:

1. **Presenting Realistic Scenarios:** Candidates are put into a"scenario-driven format" where they are instructed to "pictureyourself on a scene” or “in the back of a medic" and go through thenecessary actions. This includes describing what equipment you would want tobring and what personnel you would want to have on scene.

2. **Assessing EKG Interpretation and Treatment:** The evaluation assessesproficiency in EKG interpretation, including identifying rhythms like AFib,SVT, wide-complex tachycardia, VF/VT, and particularly nuanced EKGinterpretations such as heart blocks and STEMIs . Candidates must demonstratethe ability to apply appropriate treatments based on these interpretations,such as synchronized cardioversion for unstable VT or adenosine for stabletachycardia .

3. **Evaluating Clinical Decision-Making:** Candidates are assessed ontheir clinical judgment and decision-making through these scenarios. Thisincludes managing patient deterioration, selecting appropriate interventions(e.g., synchronized cardioversion over pacing when a patient becomes unstable),and making decisions about transport and ongoing care .

4. **Testing Advanced Pharmacology:** Proficiency in advanced pharmacologyis evaluated, including precise dosing and energy settings for synchronizedcardioversion, antiarrhythmics (amiodarone, lidocaine), adenosine, andunderstanding post-ROSC vasopressor concentrations .

5. **Reviewing Trauma Management:** Scenarios may include trauma modulesemphasizing concepts like the "lethal diamond," early shockdetection, whole blood protocols, TXA/calcium sequencing, and assessment of theshock index.

6. **Assessing Pediatric Emergencies:** The examinations cover pediatricemergencies, including reinforcing non-math, tool-supported sizing and depthstrategies for pediatric airways.

7. **Evaluating Post-Intervention Assessment and Planning:** Afterinterventions, candidates are expected to reassess the patient, correctlyidentify new rhythms, and make appropriate decisions for continued care, andpreparing for potential deterioration .

Sample Practice Exam Questions:

1. You are presented with a patient - a 55-year-old male experiencing acute shortness of breath and chest discomfort. Describe your systematic approach to patient assessment, including key vital signs and diagnostic tools you would utilize. Outline your immediate management plan based on advanced life support protocols, specifically addressing potential EKG findings and their implications for treatment. 
2. A patient has achieved Return of Spontaneous Circulation (ROSC) following a cardiac arrest. Discuss the critical pharmacological considerations for post-ROSC care, including the appropriate use and concentration of vasopressors. Additionally, explain the rationale behind the management of hemorrhagic shock.
3. Describe the key characteristics and differentiation of various heart blocks on an EKG. Furthermore, elaborate on the significance of capnography in prehospital care, particularly its role in monitoring ventilation, circulation, and the effectiveness of resuscitation efforts.

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‍Psychomotor Testing

Candidates for Legal Recognition, Challenge and Reentry in Virginia will need to have their psychomotor competency verified by an Education Coordinator who is affiliated with a fire-based EMS system or accredited training program.  If the provider cannot find a program to affiliate with, Region 7 EMS Council is able to provide this service for a small fee.