For what it's worth, the AC upgrade in the KC-135 is a SPOT OME, so multiple legs, ideally with an overseas component. The AC upgrade candidate is given 3-engine work (including engine failure prior to S1) in the sim during training--the worst he'd get is a U for that training sortie with a chance for additional training. Emergency procedures aren't evaluated on the OME per se...there is normally a table top EPE given at some point, usually a big picture discussion with Dash-1-looking-up going on.
I've never heard of a Q3 for an OME, though I have heard of several "come-to-Jesus" talks with the evaluator during...