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COVID-19 modifications for NREMT practical testing

Maintaining a safe environment during practical stations and psychomotor skill testing


As instructors, we have a need to reasonably protect both our instructors and candidates during this COVID-19 pandemic.

AP Photo/Elaine Thompson

The importance of providing the NREMT Psychomotor Exam for newly graduated EMT candidates looks different. As instructors, we have a need to reasonably protect both our instructors and candidates during this COVID-19 pandemic.

This past weekend, I put on an NREMT Psychomotor Exam in Montana for 35 candidates. Following are best practices we implemented to maintain social distancing and cleanliness.

Be sure to follow your local and state guidelines on group activities. This checklist is meant to be a resource only and does not replace legislative and legal advice in your area.

Locally, we postponed any NREMT Practical Exam testing for 60 days and then, in early June, scheduled a testing date based on the Governor’s updated directive in Phase 2 of opening Montana. Even with restrictions lifted, we made a number of modifications to protect both the candidates’ and the instructors’ safety. Here is an overview of those modifications.

Planning NREMT practical testing modifications

We broke up the candidates in separate testing flights. Each flight had 17-18 candidates. And, at any given time, half of the candidates were in testing stations. Ideally, there were less than 10 people gathered with at least 6 feet of distance between them.

Upon arrival

When they arrived for testing, the candidates were provided the following instructions:

  1. Candidates staged in the lobby; ideally providing 6 feet of separation
  2. An instructor took each candidate’s temperature with an infrared thermometer
  3. Each candidate was provided a disposable mask
  4. As they moved into the main classroom, candidates washed their hands
  5. In the main room, we had taken out most of the chairs and repositioned the remaining chairs evenly spaced throughout the classroom. The candidates could sit in one of the 18 chairs available.
  6. Formal instructions were read out loud and the candidates completed and signed the COVID-19 waiver (view the waiver below)

COVID-19 form

This Health Reporting Agreement form was created using a number of other health department examples (including the State of Montana DPHHS Employee Health Agreement for COVID-19 form) as a template. Some modifications included:

  • Temperature (to be filled in)
  • Loss of taste or smell?
  • Feeling sick? Fever-like symptoms? Fever/chills?
  • Coughing?
  • Shortness of breath?
  • Have you traveled outside of Montana recently?
  • Have you been in contact with someone who is known COVID-19 positive?

Testing stations

  • We used 12 instructors (13 including myself as the lead who stayed in the main room)
  • Wherever reasonable, we utilized mannikins in place of human patients to minimize exposure
  • Instead of an EMT assistant, assistance by the “EMT partner” was verbalized
  • With upwards of 18 candidates to test in each testing session, we duplicated as many stations as possible to streamline the process and minimize the number of people who were in contact with the candidates – this resulted in nine stations, leaving nine candidates in the room at any given time with plenty of space to spread out.
  • Stations included:
  • Station 1. Patient Assessment Management – Trauma (high fidelity simulator)
  • Station 2. Patient Assessment Management – Medical (live patient), two stations
  • Station 3. BVM Ventilation of an Apneic Patient (airway mannikin), 2 stations
  • Station 4. Oxygen Administration by NRB Mask (airway mannikin), combined with Station 3 (candidates would test both stations at the same time)
  • Station 5. Cardiac Arrest Management/AED (CPR mannikin), 2 stations
  • Station 6. Spinal Immobilization – Supine Patient (Heavy Dan mannikin)
  • Station 7. Random EMT Skills (live patient)

Lessons from modified NREMT practical testing

Be sure to over-inform everyone. We emailed all candidates and all instructors prior to the testing day with an outline of the updated modifications. This allowed them to feel more at ease, proactively answer questions regarding social distancing and offers individuals an opportunity to opt out if they choose.

In addition, we maintained the following expectations:

  • All modifications above were required for everyone – every candidate, every instructor and every station
  • EMT candidates and instructors were required to complete the COVID-19 Release Form
  • EMT candidates and instructors had to wear a mask during testing
  • Instructors did their best to maintain a minimum of 6 feet away from the candidates during testing
  • Candidates had to wear gloves for each station. (bonus scene safety and BSI were practiced and not just verbalized)
  • Instructors disinfected the testing station between candidates
  • All tables, chairs, etc. were disinfected in the main room before, between stations, and when we finished

Maintaining a safe environment

Special shout out to my EMT Daughter, Hannah Kaull, who has been on the frontlines of COVID-19 Screening and assisted me with her insight into best practices on the COVID-19 Waiver Form.

What are you doing to maintain a safe environment during practical stations and psychomotor skill testing? Be sure to share! We can all learn from each other. Comment below or email me at columnist Krisendath D. Kaull, a paramedic and former firefighter, specializes in technology trends and their effect in Public Safety. During almost 15 years in both rural and urban fire and EMS settings, he has enhanced technology communications between field EMS providers and emergency departments.