PHECC EMT common mistakes
PHECC EMT · Understand the traps and how to avoid them.
When asked to assess breathing, the candidate reports only the rate and skips depth, effort, chest expansion, and auscultation, so a silent chest or shallow tiring breathing is missed.
Candidates learn 'rate, rhythm, quality' as a checklist and treat breathing assessment as counting respirations within the 10-second pulse check, without linking findings to adequacy of ventilation.
What to do instead
Practise a fixed sequence every time: look (chest expansion, accessory muscle use, recession, cyanosis), listen (air sounds, audible wheeze/stridor), feel (air movement at the mouth, tracheal position), then count for a full 30 seconds and record rate, depth, effort, and symmetry together.
The candidate gives high-flow oxygen to every patient, including a COPD patient with a hypoxic-drive history and a patient with a normal SpO2, rather than titrating to a target saturation.
Oxygen is remembered as 'always harmless and always indicated', and candidates conflate 'give oxygen' with 'give 15 L/min via non-rebreathe' because that is the most rehearsed setup.
What to do instead
Learn and state the target range aloud in practice: aim for 94-98% (or the locally taught COPD target of 88-92% where applicable), start at the lowest flow that achieves it, and reassess after each change. Be able to justify why a patient with SpO2 97% on air does not need a mask.
On a collapsed patient the candidate checks the pulse before assessing breathing, or spends more than 10 seconds feeling for a carotid pulse, delaying compressions.
Pulse-taking feels like the 'more medical' action and candidates worry about starting CPR on someone with a pulse, so they over-check and lose time.
What to do instead
Drill the sequence agonal-gasp recognition, then simultaneous check of breathing and pulse for no more than 10 seconds, then immediate compressions if unsure. Rehearse the rule that if there is any doubt about a pulse, you compress.
The candidate delivers compressions that are too shallow, allows full chest recoil to be lost by leaning, or pauses compressions for long periods to check rhythm, insert an airway, or discuss the case.
Under scenario stress candidates focus on the next task (airway, history, handover) and treat compressions as background activity, and fatigue degrades depth within the first minutes.
What to do instead
Practise with a feedback mannequin and a metronome at 100-120/min, aiming for 5-6 cm depth with complete recoil, and rehearse swapping the compressor every 2 minutes with a pause under 10 seconds. In scenarios, narrate 'compressions continuous' whenever you do anything else.
The candidate manages a catastrophic bleed or open fracture by reaching for a dressing and bandage first, without controlling the immediate threat, and does not consider the mechanism of injury before moving the patient.
Candidates follow a 'bandage the wound' script from first aid training and skip the primary survey priority of catastrophic haemorrhage and the c-spine implications of the mechanism.
What to do instead
Use a structured primary survey where catastrophic haemorrhage is addressed before airway, and state the mechanism aloud. Rehearse direct pressure, packing, and tourniquet indications, and practise immobilising before extrication in every trauma scenario.
The candidate assesses a limb injury by looking only at the wound or deformity and omits distal neurovascular status (pulses, capillary refill, sensation, movement) before and after splinting.
The visible injury dominates attention, and candidates do not know that documenting distal status before and after intervention is what detects a deteriorating limb.
What to do instead
Make 'check distal to the injury, splint, check again' a verbalised habit, and record both sets of findings. Practise on every limb scenario until it is automatic, including for suspected fractures with no visible deformity.
The candidate jumps to a working diagnosis and treatment before completing a full patient assessment, and takes a history that ignores onset, duration, provocation, and associated symptoms.
Pattern recognition from study cases feels efficient, and candidates fear silence, so they fill time with questions that do not discriminate between conditions.
What to do instead
Anchor on a structured assessment (primary survey, then history and secondary survey) and use an OPQRST-style pain/symptom history plus SAMPLE. In practice, write down the discriminating features you need before asking, and justify each question's purpose.
The candidate fails to recognise and act on a time-critical presentation, such as a suspected stroke within the thrombolysis window, an anaphylaxis needing adrenaline, or hypoglycaemia, and instead continues routine assessment and transport.
Candidates are reluctant to commit to a serious diagnosis without certainty, and time-critical 'load and go' decisions are under-rehearsed compared with routine assessments.
What to do instead
Memorise the small set of time-critical conditions and their immediate actions (adrenaline IM for anaphylaxis, glucose for hypoglycaemia, rapid transport with pre-alert for stroke or STEMI). Practise stating 'time-critical, requesting pre-alert' explicitly in scenarios so it becomes a reflex.
The candidate gives a handover or documentation that is disorganised, omits vital signs and times, or records opinion as fact, and cannot state their own scope of practice or when to escalate.
Handover and documentation are treated as an afterthought at the end of a scenario, and candidates have not rehearsed a fixed structure or the boundaries of their role.
What to do instead
Use a standard handover structure (for example, identification, presenting problem, history, observations with times, treatment given and response, plan) and practise it aloud in under a minute. Know the EMT scope of practice and rehearse the phrase for requesting advanced practitioner backup.
The candidate obtains no or inadequate consent, does not maintain confidentiality in front of bystanders, or fails to recognise when to involve safeguarding or report a concern.
Candidates focus on clinical tasks and treat ethics as theoretical, so they do not translate consent, capacity, and confidentiality into concrete scene behaviours.
What to do instead
Rehearse the practical script: introduce yourself, explain what you are doing and why, seek consent before each intervention, and move sensitive conversations away from bystanders. Learn the local triggers for safeguarding referral and mandatory reporting, and state them in scenario debriefs.