Interview Fail

Years and years ago, at the beginning of my career, I was looking for my long-term EMS job. I applied at a private ambulance company that did all the 911 transports for a large city in a different state. It was a big enough city to be busy, with plenty of gory EMS calls and "fun" situations, but also offered suburban response for slow days. There should be plenty of calls and an agreeable climate for me. It seemed like a good place to work. I received word that the application process would continue with a four-day process of testing and evaluation. I got myself a cheap plane ticket and a crappy hotel room and began their hiring process. 

Day one consisted of a written test of the applicants’ didactic knowledge. I have to say, I rocked that. I was about six months out of paramedic school and had just recently passed the initial National Registry test. So I was primed and thought this agency’s test was reasonably easy. They put a six-hour cap on taking the test, but I finished in about an hour. I was nervous - maybe I missed something and got done too soon. So I checked my work. It all looked good, so I stood up to submit it. The test proctor was unimpressed: “You can’t be done yet.”

“I’m done.”

“Nobody gets done that fast. You understand that when I put the test into this machine for grading, it is finished. You can’t retake it…”

“I’m done,” I told him.

He shook his head with pity and put the bubble test answer key into the grading machine. It clicked a few times and spit out my score: 93%. The proctor didn’t offer comment, compliment, or apology. Not even a raised eyebrow. Jerk. Anyway, I was to come back the next day for some scenarios. One whole day down and it only took me an hour.  

On my way out, I got the chance to ask a medic about the job and the company. “How many ambulances do you run for the city?” I asked.

“Forty.” He was a man of few words, apparently.

I clarified my question. “No, no. Not how many physical vehicles the company has. How many ambulances are staffed and out in the city running calls right now?”

“Four. Tee.” The helpful gent told me emphatically before walking away.

That seemed wrong to me. That city was a little smaller than Denver, and Denver was an EMS system that I was vaguely familiar with. Denver ran 12-15 ambulances at any given time. How could this slightly-smaller city be running forty? It didn’t make sense to me.

I spent the rest of the day relaxing. It looked nothing like this. Unfortunately.
(Public domain; Source)

The next day, I showed up at my appointed time to run a few scenarios. I walked into a room with a plastic dummy on the floor.  Behind a table sat three medics. Another medic stood with a piece of paper.* The first scenario was a forgettable medical scenario. It was really vague; the patient was weak and dizzy in a low-grade sort of way, but there wasn’t a whole lot else going on. The vitals were normal, the ECG was normal, and so on. It was just a vague, low-grade, everyday medical call. I think I imagined myself to start an imaginary IV and took the imaginary patient to the imaginary hospital.

“Alright, the scenario is done,” one of the medics told me.  “What do you think was going on with that patient?”

“I don’t know, specifically.” I told him. “It could be anything.” I started to run through a list of medical diagnoses. 

The medic stopped me. “It was an obvious cardiac patient,” he told me, kind of contemptuously.

Weird, I thought. Cardiac patients must present completely differently here. There was absolutely nothing obviously cardiac-related about the scenario.

The next scenario had the same set-up, with three dudes behind a table and a guy with a piece of paper. There was nobody else in the room, though. The proctor told me that I had responded to a shooting. I asked him where the patient was. He said the cops had him in the next room, but they were on the way. So I stood there and waited.

And waited. For about a solid minute, I stood there and stared at the graders. They stared back. Finally, a pretend-cop and pretend-patient walked into the room. As the patient approached, I lifted his shirt. A piece of tape over his xyphoid said “bullet hole.” I told him to keep walking and get into the imaginary ambulance.

Continuing with the scenario, I cut the patient’s clothing off, performed a full secondary exam, and put a non-rebreather mask on the patient. I also started two IVs. All of that was imaginary, of course. Anyway, we were off to the imaginary hospital. Enroute, I reassessed the patient and found him to be experiencing increasing dyspnea with absent breath sounds on the left. I needled his chest. The patient briefly improved, but began to decompensate quickly and become somnolent. I told the proctor that I would nasally intubate the patient. 

“You’ll what?” he asked me. I repeated myself.

“Just like that. You’re just going to go ahead and nasally intubate him. Yeah, right...” he said sarcastically, rolling his eyes and exchanging smirks with the graders behind the table. 

“Yep.” I said with a smile, thinking that with two rolls of Kerlix and a seven-oh tube I could intubate him where he stood. See if he still smirked then. But they decided to let the intubation stand. That was about it. There wasn’t a whole lot else to the scenario.

Afterwards, I was advised that I failed the trauma scenario and would have to repeat it after lunch. Apparently, the failing criteria were that I didn’t go fetch the patient, I let him walk, I didn’t immobilize him, I didn’t check a sugar, I didn’t use an ECG, and I didn’t use a pulse oximeter. I was flabbergasted. One of the failing criteria was that I didn't check a blood glucose on a shot patient? What kind of place was this?!?

I decided it was a kind of place that wasn’t for me. Beyond the rude employees, which I can overlook, the medicine didn't seem to align with my professional ethic. I thanked the guy who had just explained my failures and left. I never returned. I enjoyed two more days of solo vacation and returned home. About a month later, I got my current job. Things worked out for me. I’m glad I wasn’t in a position where I had to take that job, just for the sake of getting paid. 

There is a job out there that is perfect for each of us. Hopefully you are in a position to find yours instead of settling.

*He was the "voice of the EMS gods."  All scenarios are crap because you need a voice of the EMS gods. The voice is the person who answers when you grab a wrist and ask for a pulse rate, out loud. “One hundred.” 
“What does his skin look like?” The voice of the EMS gods answers: “Pink and dry…”