If you are going to take the International Certification Commission (ICC) test on November 4, 2006, you have already spent many hours reading and doing practice tests just to fine-tune your knowledge. While no one person will ever know everything that there is to know about medical instrumentation, if you pass, your work and study will place you in the top 10%.

In this article, I will try to point out areas where you may need to spend a little more time to be sure that you have all the information that you need to take the ICC test.

First and foremost, concentrate your reading in areas where you are the weakest. For most biomeds that is in the medical terms and physiology areas, followed by codes and standards. Most of you are very good in the electronics and problem-solving areas.

To help on the physiology and terms, you should go back and read this column in the December 2003; the April and November 2004; and the February, March, April, and May 2006 issues. These are all available online at www.24x7mag.com in the “archives” section. Once you have clicked “archives,” select the issue desired. The columns are all listed in the table of contents for each issue, so getting to the article is easy.

Another great source is the old Spacelabs monitoring series of pamphlets. These are no longer in print, so you may have to go to some of your older colleagues to see if they have copies that you can borrow. While some may direct you to Gray’s Anatomy (the book, not the television show), it is too much to review for most people. What I have suggested for years is to look up terms or procedures when you come across them, which allows you to build your knowledge base in a reasonable manner. Too many people cram for tests, memorizing everything but learning nothing. The key to success is to learn, not memorize.

General Knowledge Needed
On the certification exam, the questions are more general knowledge rather than detailed understandings of a particular gland or organ. You will not be asked to name all the bones in the hand, all the nerves, or all the vessels, but you may be asked about the functions of the major ones. Remember, you are a BMET— not a physician.

In the area of codes and standards, again keep it simple, even if the authors have gone out of their way to confuse matters. A code is enforceable in a court of law, and if you break the law you can get arrested. A standard has no legal standing. A standard from the Association for the Advancement of Medical Instrumentation/American National Standards Institute (AAMI/ANSI), the National Fire Protection Association (NFPA), and the International Electrotechnical Commission (IEC) can all address electrical leakage and not agree on what the limits should be. But if your state legislature has adopted the NFPA standards as the electrical code, then it is no longer a standard but a code. Right now, 38 states do use the NFPA standards for their electrical codes. Remember that Underwriters Laboratories Inc (UL) and MET Laboratories (MET) are testing labs and that their requirements are not enforceable in hospitals. Some states may require that a device be tested by one of the labs and be so marked. It is very doubtful if many hospital shops have current copies of UL, MET, AAMI/ANSI, or IEC standards, because we rely on the manufacturers to conform.

Most hospitals will have a copy of NFPA 99 somewhere in the facility. You should read chapter eight on electrical devices, especially the leakage-testing section, 8.4. You should only refer to either the 2002 or 2005 issue; anything older is out of date and will give you different numbers.

Points from chapter eight to remember:

• The maximum resistance allowed is 0.5 ohms;
• The cord-connected devices have a limit of 300 microamps (MA);
• Some devices can have up to 500 MA (see section 8.4.1.3.5.2);
• Isolated leads are 10 MA and 50 MA on the chassis with the ground open; and
• When doing leakage tests, it is no longer required to open the neutral line.

Problem Solving
Other areas to review include the Health Insurance Portability and Accountability Act of 1996 requirements. These may show up in the problem solving area with a question such as, “What should be done to a device with a hard drive installed that has to be sent out for repair?”

Another topic that may appear in the problem solving area of the test is a question on medical band telemetry and how it is registered so that there are no conflicts.

You should be up to date on the requirements pertaining to BMETs in the Safe Medical Devices Act, specifically what must be reported to the US Food and Drug Administration and when.

In closing, I would like to thank all of you who have commented on these columns over the years, offered suggestions, and took us to task when something was missed. What we try to do in this column is to introduce you to and reinforce the basic facts on the topic that month. It was never our intent to be the most definitive source of information, all the potential variations with equipment, or techniques, because, quite honestly, I am not that smart.

Many of you reading this are extremely knowledgeable about various topics, so please share your knowledge with others by writing, presenting at meetings, or teaching newcomers to our field. Over the last 40 years, we have collectively done a great job in protecting patients and staff from harm, advancing the technology available, and not getting much credit or cash for our efforts. But without us, the practice of medicine would be more practice than science.

David Harrington, PhD, is director of staff development and training at Technology in Medicine (TiM), Holliston, Mass, and is a member of 24x7’s editorial advisory board.