911: Helping or Hindering?

You rush to the scene of an emergency only to find a man calmly playing the piano. As you walk towards him, he looks at you with half his face drenched in dripping blood. He has a deep laceration above his eyebrow, underneath which you can see his skull.

I am a first responder and as I found myself in this precarious situation, I thought to myself: ‘How did I get here? I have no idea what I’m supposed to do — I’m not right for this job! This man might die because of my incompetence!” So in attempt to address this question, let’s look at the process that got me here today.

Round 1: A multiple-choice exam

I was up against 250 applicants for 20 open positions as a first responder. The first round that weeds out most applicants was a simple multiple choice test. The exam tested basic first aid knowledge, and the content on the exam DID match the content that was taught in the handbook. However, does this test truly measure competence as a first responder? A question could ask, “What is anaphylaxis? — A, B, C or D?” but pure factual knowledge does not measure your ability to handle such an emergency. But even with a scenario question: “What would you do if a patient was having an anaphylactic attack?” The nature of a multiple choice exam limits you to a few choices — one of which may sound vaguely familiar so you happen to choose that as the correct choice — or you simply guess and STILL happen to get the right answer.

Round 2: Real-Life Scenarios

Congratulations! You got a high score on the exam and now you go to round two where you must respond to “real-life” emergency scenarios that assess your ability to treat injuries, deal with patients and handle a stressful emergency. But how exactly are you judged?

Recalling from my own experience, I would walk into a room to find some patient in distress typically with an important medical history and an injury that required treatment. Peering over my shoulder was a judge who would vigorously fill out an evaluation form as I responded to the pseudo patient. However, the actors and judges were not the same for all examinees. So can I say that my score was an accurate measurement of my responding skills? OR could it have been a product of the patient (who may have poor acting skills and would prompt a shoddy response), the judge (who may be more lenient in grading), AND my actual ability? Would my score differ if I took my exam during the morning rather than the afternoon (where all actors and judges were an entirely new set of people)? Could I be considered an outstanding responder to one judge, but only mediocre to another judge?

In the back of my mind, I think that I only got a high score on the multiple choice test because I studied all of the information the night before the test — but I did not really UNDERSTAND the material; I could just recognize the answer given the choices. And I MUST have only been assigned the ‘easy-grading’ examiners that misjudged my lacking performance as better than average. It must be a fault in the grading system, because the person standing there with the bloody piano man should have known what to do.