The first two weeks at the eight week FDNY EMS Academy are a review of the six-month EMT courses we originally took in order to receive our New York State certification.

“Wherever you purchased your EMT certification doesn’t matter to me,” Instructor DiFrenna says. “You’re here now to do it right.” He’s alluding to the fact that many EMT classes are too easy on their students, and that too many EMTs don’t know what they’re doing. “And don’t think we won’t fail you if you don’t measure up. Believe me, I am not here to be your friend. I’ll throw you out tomorrow if you can’t handle the work.”

At the end of this refresher course, after we pass the written exam and successfully complete the practical skills testing, we’ll move on to the bulk of the course, six weeks of what the Fire Department wants us to know to be able to function as EMTs for a city which, with 1.5 million calls a year, boasts the highest emergency call volume in the nation.

We’re told that the hardest part of those six weeks will be putting all our skills together for “scenarios testing.” In a scenario, the instructor offers you and your partner a simulation of the kinds of situations you might find in the field. You’re required to verbalize and act out what you would do to assess, treat, and transport your patient. You might be handling a car-accident trauma victim with a broken rib and possible internal bleeding when suddenly a medical issue arises, say a heart attack, and you have to switch gears and treat something that is now more severe than just the fractured rib. Or, as a friend who already graduated told me, you’re doing CPR on a patient in the back of an ambulance when suddenly the instructor reaches up, flips a switch, and the lights go out. What do you do now?

“Improvise,” DiFrenna always says. “Only do it within NYC protocols.”

Protocols are the hard-and-fast rules set forth by the Office of Medical Affairs, a group of doctors under whose licenses all of NYC’s EMTs and paramedics practice, spelling out what kind of first-response medical aid can be given in any situation. Though each situation will be unique, our job is to assess and treat the basic presenting problem. And the basics are as easy as ABC: Airway, Breathing, and Circulation. Is the patient’s airway open? Is his breathing adequate? Is his circulation intact? Now transport. No matter what the injury or illness, no matter how distracting or ugly, always come back to the ABCs. Our job is not to know exactly what’s wrong with patients so much as to recognize and treat their symptoms, then get them to a hospital as fast as we can.

Of course we make mistakes. These are learning situations. But we’re told not to make any mistakes in the field. Because, as DiFrenna puts it, “Every right-to-life save-the-whales right-left-wing person out there with a cell phone video-camera is ready to put you on the front page of the Daily News.”

All our instructors are veteran members of the service – intelligent, witty, each one speaking perfect Brooklynese and full of vivid stories from their years on the street. They’re passionate about EMS, and stringent about who gets to wear the uniform.

For instance, my classmate Moncrieff thinks his stubbly soul-patch is his ticket to individuality, but our gas masks must fit snugly to our faces, so no goatees are allowed. No earrings are allowed either – no jewelry except wedding bands.We get command-disciplined for infractions. And these go into our permanent files, showing what foul-ups we were as students. We don’t want to go to our future battalions with a dark cloud hanging over us.

Otherwise, the instructors are accommodating and helpful. But only if we first help ourselves.

“We don’t fail students,” DiFrenna says. “Students fail students. We just document the failure.”

Phys ed takes place every, day rain or shine. The first week, we run a mile and a half a day. After two weeks, we’re up to 3 miles a day.

“At this rate,” I tell Moncrieff, huffing and puffing beside me, “by the end of eight weeks we’ll be running to New Jersey.”

I come down with the flu and end up jogging with a 101 degree fever, in the drizzle, coughing up my lungs. We all get nicknames. Mine is Typhoid Klopsis.

Aching and sore, we take a practice final two days before the real one, covering the entire 500-page textbook. I score a lousy 87. I argue three questions that I think can be interpreted differently, desperately trying to raise my score to a 90. I want those extra points because the student who finishes at the top of the class gets to choose his battalion.

Instructor Beaufort, a tough woman with a scrubbed freckled face, considers my arguments, then shakes her head. “Nice try, Typhoid,” she says.

I shrink back into my seat as she moves right into the cardiovascular section of the practice exam, which apparently many of us did poorly on.

Two days later, the two-week refresher portion of the Academy over, we’re about to take our final exam. I look around the room. We look happy, despite the grueling schedule. Despite waking up before sunrise. Despite the fact that it’s summertime and rather than going to the beach we’re spending our weekends studying trauma assessment and the pre-hospital management of rising intracranial pressure, with or without hemorrhagic shock.

We take our exam, and after lunch the grades are posted on the wall outside the classroom, beside our state EMT numbers, so that the results are anonymous. A 75 is passing.

I look for my number, and see a 93 next to it. I can’t believe it. In fact I don’t believe it, and repeat my EMT number to myself, thinking maybe I got it wrong.

“When you get your grade, keep moving,” Beaufort says.

Fifty people file past. When the last of them get through, I double back to make sure.

Yup, 93. I look to see who got the highest grade, expecting the three medics, who are in with us EMTs before moving on to the medic portion of their training, to have scored higher.

and the next highest is a 90. After that, it’s all 80s and 70s. Some 60s.

When the girl behind me asks how I did, I lie. “88,” I say, not sure why.

The medics discuss the grades amongst themselves, shocked that a mere EMT beat them out. Afterwards, they’re a lot friendlier to us.

Back in the classroom, I notice that five students are missing, bags gone and seats pushed in. A failing grade results in separation from the program. “Separation” is a polite word for termination.

A note from Moncrieff, written on torn spiral notebook paper, lies on my desk. “I’ll be back for the next class,” it says, in shaky script. “I’m not a quitter.”