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I was called to a 57 y/o man complaining of a sudden onset of mid line abdominal pain while sitting in his office doing some paper work. Patient has a history of hypertension and high cholesterol and is non compliant with his meds. Patient had not eaten lunch yet and tells us the pain feels as if something is "pulling apart" in his belly and lifts up his shirt to reveal an vertical 5-8cm oval lump in his abdomen just off the mid line. While in route to the hospital my EMT "ride along" placed him on oxygen, moves down and begins to palpate the abdomen? I yanked his hands up telling him not touch the any of my patients abdomens, ever! Regardless of what anyone thinks is wrong with this patient, could someone please tell me why we still teach EMTs to palpate the abdomen!

I do not know if it is still true but at one time having a drivers license in Vermont imposed a duty to stop and render assistance to the best of your ability if you were the first uninvolved driver to find the wreck. That information is decades old and I can only hope that the state has changed it's rules to some more common sense approach. I do stop if it is safe to do so but I would not have stopped at the roadside under the conditions that existed in this incident. I also have a very strong advantage in that my work vehicle is equipped with a road hazard beacon, an arrow board, and five of the thirty six inch traffic cones with the double reflective stripes. That equipment is required for electricians who work adjacent to class three (high speed) roadways. I still will not stop if I cannot position out of the travel lanes. If I can, then I do what I can, with a regular jump bag, that is provided by my fire department. It is often true that the most I can do is to try to prevent a second accident. I do not carry step chocks or immobilization equipment so I have no business entering a car unless someone is in extremis and there is some effective intervention I can perform. My concern about entering the car is that at over two hundred pounds and six feet three inches in height I'm bound to cause some motion in any light vehicle I enter. In keeping with first of all do no harm preventing a second collision is often all that I can effectively achieve. -- Tom Horne

If the patient is complaining of abdominal pain, the physician is going to do his own assessment whether you needlessly provoke additional pain in the prehospital setting or not. I vote for leaving the patient's abdomen alone unless it's going to influence your transport decision or destination. Tom

Thing is, this all came about back in the early 70s, when EMS personnel were supposed to be "the eyes and hands of the doctor". We were to do an exam, report the findings to the base physician, then follow his orders, a la "EMERGENCY!" We don't do that anymore. We've outgrown that delivery model. Consequently, there is no longer a need to teach people to perform tests they are incapable of interpreting. Whether the guy's belly hurts to palpation or not, an EMT is going to do the exact same thing: Transport. It's high time to quit doing things just because it's the way we've always done them. If there is no benefit to the patient, there is no medical indication.

Nah, we were saying the very same thing. He noted that experience is often used as an excuse for not needing education by those who don't have education. And you may notice that you never hear those with the education saying it is useless or "ridiculous". The only ones who knock it are those who do not have it, and are thus not qualified to judge its usefulness. Take a year of prerequisite courses, including the two full A&P courses, and then go to EMT school. From there, go directly to paramedic school. Be sure it's a Nationally Accredited school (most are not), and one that results in a degree, not just a certificate.

This is really two separate questions: 1. How long until your unit is available for the next run. 2. How long until you actually clear the hospital. It should rarely take any more than fifteen minutes to make your unit available for the next run. It is the driver's job to IMMEDIATELY take the cot back to the ambulance, clean it and the ambulance, replace linen, restock supplies, and notify dispatch that we are available, but still out at the ER pending paperwork. The driver shouldn't be dicking around in the ER, flirting with nurses, gawking at patients, eating and drinking snacks, smoking fags, or just generally being useless until AFTER the unit is ready for the next run. In my experience, the problem is usually that the driver fiddle-farts around forever before returning to the truck to ready it. As for actually returning to the street, it takes as long as it takes. If there is opportunity to do so without neglecting my patient, I will do some basic charting enroute. Mostly, I only get demographic info during the trip, as well as charting vitals and other immediate concerns. The narrative will all be done at the hospital when I can concentrate solely upon it, with all information finally available. That usually takes no more than thirty minutes max, and unless a priority run comes in, will always be completed before leaving the hospital. Of course, if you're using the lame-arse charting system (whether electronic or hardcopy) that is a simple system of box-checking and drop down answers, then this should all be happening in about half the time of a narrative. In that case, the medic should be ready at about the same time as the driver, unless there are unusual complications.

On scene the patient was outwardly stable. From the history, visualization of the abdomen and vital signs this pt was potentially unstable 2 large bore were started in route, and run kvo, on arrival I advised the ER staff I was treating a rule out AAA and they confirmed it by a sono. Patient was taken to the O.R. he burst on the table but was saved. I did not palpate , auscultate or percuss in the pre-hospital setting did I harm the patient? What was a the very real possibility here had I delayed transport and started "gently manipulate, palpate, percuss and auscultate" this abdomen while the patient was sitting in his office chair? More importantly would your full abdominal exam rule out a AAA in the field? And just to set the record straight. While I did yank his hand away I did not reprimand him in front of the patient and to be more specific after the pt had been handed off it was during our debeif I asked him not to palpate the abdomen of my patients and gave him the above mentioned reasons.

Ok,All good replies, however things like "The standard of care" and "Ive always been taught to" don't really address the issue address. Yes I agree we have to present a good picture the the ER staff as part of the transference of care. As far as listening for lung sounds thats a different topic so I would like to remain on point and discuss the abdomen. Our local "protocols" do not specifically address things such as how to do a physical exam although it is in the state curriculum and the national registry. That being said I am not satisfied that the state or the national registry have all the answerers. There are many procedures we do that are contradictory to the curriculum. For example compression only CPR with no BVM or advanced airway or permissive hypothermia wich is not even addressed in the classroom and over drive pacing just to name a few. This forum should be read thinking out of the box and nothing read here is law however is may be the stuff law is made from. An EMT should be able to take a proper history(including recent bowel movements number and quality, urination frequency color and oder, nausea vomiting, fever,etc...) vital signs, visualize the abdomen for discoloration or deformity and yes even gently touch abdomen to feel for temperature or pulsation. However the additional information gained by invasively poking your fingers into the four quadrants of an acute abdomen in the pre-hospital setting can spark major problems can dramatically contribute to a poor prognosis and that can only be handled surgically. I feel the risk of the EMT pushing on a hot appendix and rupturing it, perforating an diseased bowel, bursting an abdominal aneuyrsm or causing the patient to vomit and compromise the airway to name a few, however minimal, are too great for the new information that could be potentially gained. Remember that because patients can be ticklish, rigidity, lumps or mases could easily be a reaction caused by the patients own embarrassment, or your cold hands, and as such palpation is low on the list of objectivity even in the hospital setting. Regarding auscultation and percussing the abdomen. These are probably the top 2 most objective techniques. Even if you were an expert at interpreting bowel sounds and the percussive sounds or "fluid waves" across the abdomen, these techniques cannot be done in a moving ambulance. Regardless of the findings nothing here would change your treatment in the field and delaying transport to perform these properly would only delay definitive patient care. Students are taught to palpate the abdomen to have the skill and pass the test bla bla bla. We also educate using a objective body of evidence rather than just teach chapter 6 pages 132-158 from the manual?

You bet. I am almost done with paramedic school, and while I am working at my EMT job I still ask my paramedic permission before doing certain things. As a EMT ride along student, your primary responsibility is just to observe. You may be asked to assist with vital signs or other simple procedures within your scope of practice, but other than that, you should not start conducting your own examination of a patient or starting to do something on your own without being asked. My two cents, anyways.

Very sad to hear. I personally have never stopped at an accident while off-duty for that very reason. I know an engine and an ambulance can be there in 5 minutes, and there's hardly anything I can do in that 5 minutes to make a difference. Remember that your safety is always first. Thanks for the article Vent.

CHOMP!!CRUNCH!!

"The clinician need not be afraid of properly palpating the abdomen because no evidence exists that aortic rupture can be precipitated by this maneuver." Article by Dr. Robert E. O'Connor MD Proper assessment provides a differential for the provider to work with..I believe that the OP should have shown the student or basic the proper method to palpation. Definitely using this tool to differentiate (potentially) between a hernia, bowel obstruction, or AAA could be valuable..although all are potential surgical emergencies. Palpation, percussion, and auscultation are invaluable tools, if skills are honed appropriately..IMHO

http://www.emsresponder.com/article/article.jsp?id=11598&siteSection=1 Through a friend who works per-diem in that area, this place is the middle of freaking nowhere (as much as anything can be in New England, I suppose). During a storm last winter he drove 2 hours through the snow at the request of his officer- because otherwise, that town and 7 others wouldn't have had a paramedic anywhere near them for the duration.

So i take it the latex fetish is out then annie????????? Stick to leather, works for me

Not to worry though...I'm sure he's got a good 'firm grip' on the problem! He'll soon have the solution 'in hand'!

http://www.youtube.com/watch?v=_SXNAtwYMBw

I wouldn't hold my breath.

It worked, or is that because you have an objection to the last game shown & find it hard to swallow???????