EMT Interview Tomorrow

[Kiwiology]

Good on you mate, better pray like your life depends on it, cos it does, remember ... Yoopers

Edited June 13, 2012 by Kiwiology

[Curiosity]

Reviving an old post.

I have an interview with an other service in a few weeks. My experience with interviews is confusing. I've had one very professional, and one very casual which landed me a job. Both interviews had similar types of questions. The ones where there's a "by the book" answer and there's a "real live" answer.

Example: your truck is scheduled for a deep clean and your partner tells you he doesn't feel like doing it. What do you do?

Book answer: inform your supervisor

Real life answer: anything that doesn't involve ratting your partner out over what I consider such a trivial thing unless of course this is an every day occurrence. Real live, you gotta work with this person every shift for 12 hours. Creating animosity isn't healthy.

How do you answer these types of questions?

And here's an other question that screwed with my head:

Called for patient A experiencing ischemic chest pain. STEMI positive. Your on the second floor of a building, no elevators. Patients spouse suddenly develops chest pain, non STEMI. Backup is half hour away. What do you do?

Help! I hate these questions!

[systemet]

Example: your truck is scheduled for a deep clean and your partner tells you he doesn't feel like doing it. What do you do?

Book answer: inform your supervisor

* Discuss it further with your partner and try and change his mind

* Stress the importance of the deep clean for protecting the safety of yourself, your partner, other crews and the patient.

* Inform your partner that you will do the deep clean yourself, this one time, but in the future you expect them to help.

* Keep an eye on their behaviour in future instances to make sure that they're not violating other company policies.

* Report it to management if it becomes part of a trend of unprofessional behaviour, but only after addressing your concerns with your coworker.

* Identify to the interviewer that, because this is a relatively minor breach that you can compensate for by yourself, you don't think it needs to generate a formal complaint to management, as you realise that they're very busy, and that you don't want to waste their time with trivial matters. Emphasise that were this issue of a more serious nature, e.g. reckless driving, improper patient care, theft, suspected use of alcohol or narcotics on shift, you would report it immediately.

How do you answer these types of questions?

I think that most of the time they want to see that you're a reasonable person. You're going to do your best to get along with people, but your not going to drop your own high personal standards. That you attempt to address minor issues with your colleagues yourself without running immediately to management and burdening, but at the same time, that you won't attempt to cover up a more serious issue.

Any time the person's behaviour is described as unreasonable, you're going to mention that you'd try to change that behaviour.

Called for patient A experiencing ischemic chest pain. STEMI positive. Your on the second floor of a building, no elevators. Patients spouse suddenly develops chest pain, non STEMI. Backup is half hour away. What do you do?

What an odd scenario. It's quite unlikely, although I'm sure someone here has probably seen something like this happen at some point.

You now have two patients, a duty to act to both of them, and extremely limited resources. Your decisions are whether you attempt to transport them both yourself, wait for backup, or call rotary wing (presumably "backup" includes rotary wing and they're more than 30 minutes?). You can't leave either, otherwise it becomes abandonment.

There's no information about the treatment plan for the identified STEMI (I find it odd that we already know the wife is a NSTEMI, which presumes we've assessed her, done a 12-lead, and done some sort of point-of-care testing and got back a positive troponin, all of which takes time).

I'd suggest that the reasonable thing would be to call for backup, and begin treating both. If you have extra hands available, you could attempt moving towards the incoming unit, depending on where it's coming from, and how long it takes to package.

[Curiosity]

Yes, that scenario was already set and established there was st elevation on a 12 lead and such. While asking for backup, the interviewers state there's an MCI somewhere in the city and no ones available. (they want to see what you will do on your own). One monitor, one O2 delivery system, one stair chair, can't abandon one to carry the other down, can't leave one downstairs alone to go get the other, no one in the building to keep an eye on your patients, can't make ischemic chest pain pts walk down stairs. Suppose to keep patients on cardiac monitor in order to administer meds...

It's obviously something that will never happen but I think they want to see if you'll go by the book, which would mean you can't do anything, or break a rule or two in order to help these people. In my seat, I would break rules to help, but in the interviewers seat, is that what they want to see or do they want to make sure you'll follow every rule in their book to the letter?

[systemet]

Yes, that scenario was already set and established there was st elevation on a 12 lead and such.

Sure, the ST elevation on the monitor makes the one patient an MI, providing its not suspicious for one of the common imitators like LVH, LBBB (w/o Sgarbossa criteria), pericarditis, BER, etc. The point was more that your second chest pain patient with a nondiagnostic MI isn't a NSTEMI until you have positive enzymes.

Point-of-care testing being fairly rare in EMS, and the available devices often quite slow, it just seems unlikely that you'd know this. It's also some really bad luck to have two people in the same room suddenly develop coronary occlusions. I realise that this is the point where someone's probably going to mention something else extremely rare like "Broken Heart Syndrome"/Takotsubo cardiomyopathy, but this is really reaching.

While asking for backup, the interviewers state there's an MCI somewhere in the city and no ones available. (they want to see what you will do on your own).

I get this, but this additional information now changes this again, doesn't it? I mean, previously it was a 30 minute ETA for backup. If there's now no available resources, then isn't that backup ETA becoming an hour+?

One monitor, one O2 delivery system, one stair chair, can't abandon one to carry the other down, can't leave one downstairs alone to go get the other, no one in the building to keep an eye on your patients, can't make ischemic chest pain pts walk down stairs. Suppose to keep patients on cardiac monitor in order to administer meds.

As ridiculous as this interview question is --- I think it's quite unfair that they asked this --- I'm almost starting to like it, because the idea seems to be to see whether the candidate has critical thinking skills.

If we allow the initial premises to stand, that somehow we have one patient we 12-lead, and has a STEMI, a second patient develops some sort of anginal symptoms, we then decide to 12-lead them, find something nondiagnostic, then decide to POC test them, work out both are having MIs, and only then find out that our backup truck is 30 minutes + (shouldn't we have called that when we found the first STEMI?). Another major flaw with the initial story, is that we're told this patient has sudden onset chest pain, but we have enough necrosis for markers to be positive, implying the process has been going on for a few hours. Possible, I guess, but again very unlikely.

If you don't have a backup truck coming in a reasonable time period, both get ASA, call FD or PD for lift-assist. I *know* FD has someone who can help in an urban environment, it's not like they're busy. One patient can go down on the stair stretcher, one on the chair. I'd put the monitor on the STEMI, as they probably have a higher risk of sudden arrhythmic death. As for oxygen -- is anyone complaing of dyspnea, and does anyone have SpO2 < 95%? If so, they should probably get it. If both, then lets give it to the STEMI.

.

Maybe you can have a calm first responder drive, so your partner can assist in the back, and along the way you get some lines, and consider some NTG, while you transport to an appropriate facility, which, if you're urban, probably should be somewhere with an available cathlab.

It's obviously something that will never happen but I think they want to see if you'll go by the book, which would mean you can't do anything, or break a rule or two in order to help these people.

In this situation several of the rules come into direct conflict. Sitting on scene for 30 mins + for the next backup unit means delaying transport of a time-critical patient, etc. I would argue that the rules were designed with the aim of providing a framework for the delivery of optimal and safe patient care, that they certainly weren't designed with this particular set of circumstances in mind, can't be expected to apply to every possible situation, and that some of the rules need to be modified to provide the best and safest possible care.

Off-topic, I love to find reasons to break rules. I think a lot of us do. It's probably not best to tell the interviewers this. [Obviously, the rules should only be broken when they actually violate the laws of common sense and good patient care.]

In my seat, I would break rules to help, but in the interviewers seat, is that what they want to see or do they want to make sure you'll follow every rule in their book to the letter?

I hope they would want to see that you understand the intent behind the rules, and why they're in place, and that you can logically work your way through a complex situation. I would hope that they are trying to see whether you can "think outside of the box", without being a complete cowboy, and that you're only going to disregard these rules when its necessary for patient care.

Of course, this is EMS. So they could just be looking for someone who has completely crushed any sense of independent thought, and will blindly follow the protocol books and mid-90's phone book size mass of SOPs. But, if they're interviewing like that, it might not be the greatest place to work anyway.

Just wanted to add, I've read through what I've written, and I realised it may sound a little pushy / aggressive. I'm not better than anyone else here, and am sure I would have had a hard time with a question like this on an interview. Good luck in the future.

[Curiosity]

Thank you. I know this doesn't have one correct answer. It's a stupid scenario to give.

I was wondering what exactly the interviewers were look for as an answer. Patient care or rules. Around here, as sad as it is, rules are what matter to them. If a patient dies, but the rules are followed, then their butts are covered. Unfortunately, my conscious is not.

[systemet]

Thank you. I know this doesn't have one correct answer. It's a stupid scenario to give.

I was wondering what exactly the interviewers were look for as an answer. Patient care or rules. Around here, as sad as it is, rules are what matter to them. If a patient dies, but the rules are followed, then their butts are covered. Unfortunately, my conscious is not.

I would always choose patient care, if the rules are directing you away from it. I'm not suggestiing you suggest titrating oxygen therapy in an MI if your local protocols clearly state that they want 100% FiO2; or that you decide not to C-spine someone presenting without deficits with a series of anterior abdominal stab wounds, if they clearly state they want these patients in c-spine. Just that if you're presented with a situation where there's a clear disagreement between some SOP and good patient care that you go for patient care.

A decent employer should be looking for attitude and personal attributes as a very high priority. If they're looking to retain people for 10 years + and they're a quality system, they can train someone inexperienced and mentor them. But if you come in day one with no critical thinking skills and a terrible attitude, it's not going to be worth their time, even if you bring a lot of experience. At least, that's how I see it --- to be clear, I've never had any HR responsibilities. A good service should get enough people applying for a position that they can afford to be picky.

That being said, a lot of employers in EMS aren't good employers. A lot of them expect to lose 50% or more of their new hires over a 5-10 year period. A lot of regions don't have a lot of paramedics, and might have trouble getting more than 5 candidates for 20 spots, so you never know.

Good luck.

[Curiosity]

I passed the interview!!! Now to a second informal interview with the chief! So excited

[emtdennis]

Any progress, when is the next interview? Whenever it is, Good Luck with it.

[Curiosity]

Second interview done. It went well I think. Offers go out next week. Fingers crossed.