armymedic571

I never took you as the type to sneer at the dark humor that accompanies our profession. Or....have I misread your statement?

Dwayne...... Thanks. I need that laugh.

Its funny. I hung a Lido drip just the other day. I had the pleasure of another medic on the back of the MICU with me. After I set the rate (gravity) on the thumb wheel. He smiled at me and said, "yup, it's set at 30 bups a minute". Now that I think of it. Hilarious. We have also discussed using 500 ml bags. This would increase your gtts/min, there-by lowering your margin or error. However, you inherently give the patient more fluid, which may go against what you are trying to accomplish.

You know. I agree with you to an extent, but listening to our patients and letting them have input into their care is good health care. Fore Example: You have a chest pain patient who needs a cath lab, but wants to go to a hospital that does not provide that service. It is better to help them come to the right decision by educating them, rather than hijacking them. Not only is that illegal, it would increase their anxiety level, which is just bad patient care. It is your job to give the patient the best pre-hospital care available. But, it is their right to decide what care they do or do-not want.

I think having a patient who is well informed as to the different medical services in the region is a patient that will want to be active their medical treatment. Although, I realize that this sometimes can be detrimental these people usually understand why your suggesting one hospital over another when it comes to the different specialty hospitals.. That is for those of us that have the luxury of having multiple hospitals available to us. I think the important part is that if the patient is AOx3, the key is how you present yourself. People skills are still a very important part of this profession.

I recall reading an article several years ago that stated BS level directly effected mortatily rates in AMI. I couldn't find the exact article, but here is another that stated much the same. http://content.onlinejacc.org/cgi/content/abstract/40/10/1748 http://www.ncbi.nlm.nih.gov/pubmed/15136307 PS- a link to the full study can be found for the first one on the right hand side.

You know..... It was my understanding as well, that Dr Cowley used this slogan as a means to market the trauma system he was involved with. It is ironic that people still utilize this phrase in modern teachings within our community.

Fair enough. Believe it or not, I downloaded those from the NREMT website. ????? BTW, if you find yours, it would be nice to have a look! NO worries Wendy..... I do understand what you are saying. I do agree. Once again no worries. I was jsut trying to accentuate my point. Sorry if I pissed you off . My point was simply this. Eventhough the steps are literally the same, it is way the information is processed that differentiates the exam. Since, I think we have been all agruing practically the same point for four pages now, I would say it is time to put this bed. Thanks for playing everyone.

Great point on oxygenation vs ventilation. That is somethig that seems to be over looked in most programs. I do have a quesiton for you though. Why not insert an NPA? (if indicated of course) A nasal pharygeal airway would be more suited for a patient with an intact gag reflex.

NO, NO, NO.... I am trying to say that the tools are just that. TOOLS. It is the art of the assessment, the physical hands on of the patient and interview that are the important points. It is a fact, step by step, the patient assessments are the same. MY POINT and the bottom line, is that education does make the difference. (Funny how we seem to be arguing the same point! ) I have attached two skill sheets from NR. One BLS and the other ALS. They are (except for diagnostics) the same. Patient%20Assesment.pdf patientassessmentmanagementmedical.pdf

Agreed. Fair enough then.

So, if I understand you correctly. You are saying that although a BLS provider could go though the steps, that they might not appreciate the subtle clues that are present, as a more educated, more expeienced provider would? How exactly am I glossing this over? Seems some here are coping out over the inability to do a patient assessment. (Not you specifically. Please don't be offended) I don't like your analogy. I am talking about the physical assessment. I think you are putting too much emphasis on the diagnostics. Besides, if the Medic was as stupid as you say, he/she wouldn't know what to do with those either. I also don't like the pulse comment. All providers are taught to check a pulse. Is it present? Stong, or weak and thready? Regular or irregular? At that point who cares what the rhythm is, we are trying to determine adequacy in perfusion. Thanks for the feed back. I really do appreciate it. Matty, Thanks for the honset reply. And of course Paramedics and Nurses don't perform the same assessment (Nurses would have to go back to school) Just kidding ..... Your first sentence is a little harsh don't you think? If your basic providers are that bad. Then... Your second statement is more towards what I was getting at. But, what has changed in your assessment? The steps, or the way you interpret the information you find? Thanks again... .

I am not disagreeing with you. My original purpose for starting this thread was to highlight that despite the fact that the actual step in the ALS/ BLS assessment, besides diagnostics are exactly the same. That BLS providers do not have the base level education to properly allow formulation of differentials and treatment modalities. As above. However, I would agrue that a BLS provider who does a complete and thorough assessment should be able to formulate a general impression between "Sick/Not Sick". Also as above. Lung auscultation is part of the assessment. But once again, the lack of education might prevent the development of differentials, or treatment modalities. But formulating a good general impression between sick and not sick. I am not fully convinced. I feel that if a BLS provider does a complete exam, they should at least be able to tell the ALS provider that the pt is sick, unstable. They may not know why or how (goes back to education), but know enough to say that all is not well on the Eastern Front .

I don't think that you are going to find many here that disagree with you. I read the study and article that came out of the Toronto program last year. Amazing to say the least. It would be nice to see something like this in the US. Actually, I could be wrong, but aren't there a few systems in Arizona trying this right now. Anyone have details? This is true and that's why it is tragic. Despite increased education. some of our cohorts and our Medical command mentors refuse to get with the times. I know of a very educated medic who will simply state his reason for transporting an arrest as, "that's the way I've always done it." Quite depressing actually. It is. I also think US Med Command Docs, administration and management, need to allow their providers to make these calls. I know of several systems where these issues are micro-managed at the management/Command level. Kiwi said it best. Education and Knowledge. I find it Ironic. The best ER physician I know in fact is a Family Practice Doc and not EM certified. However, he was a Paramedic. Most of the EM docs we have are very risk adverse and will try to transfer something out or divert before accepting a potentially tough patient. I think where JPINFV was coming from, was that some medics are just that lazy. I apply the monitor even when it is obvious, mostly to have complete documentation. I think it would be fair to say that we can discuss/debate this issue all day. In the end (at least in my opinion) it goes back to two things) 1. The National EMS model. We all need to be on the same page. Just like every other medical profession. 2. Increase not decrease education standards.

Now that's hilarious . Are you saying that I am irritating? The original post I saw was all rearranged. Genius. Jeff

I am not disagreeing with you. Just wanted some clarification on her post .

Ahhhh, that's not true. I thought we were trying to have a real discussion here. My bad. Besides, I like the sun....

I am not trying to be smart here. But, are you trying to insinuate that BLS providers are not taught critical thinking skills? Or, are you just stating that treatment modalities are different because of education levels? Would you agree that the assessment part of it, step for step, is the same?

That is a dangerous assumption. I know some paramedics that have a lot more education and experience with body systems and A & P than most nurses in practice. However, you are correct. This is not about skills or drugs. Although, I have been wrong before. I think the point here is that Pre-hospital folks need to be accredited and licensed by their own governing body, as are nurses, PA's and physicians.

I am not convinced

I just caught that. I guess I should follow my own advise....Attention to detail. I would say that my last post still applies though. Although I have no actual knowledge of how the San Fransisco Hospitals work in regards to ER techs. I know that at where I work, the ER techs are EMT-basics, and are taught 12-lead placement, and phlebotomy skills. I guess that would be neat, if it applies.

You Sir, need to get into a new line of work. If that is the most intellegent reply that comes to mind.......FAIL! It is basic issue like this, that effect OUR profession. Disappointing to say the least.

That's what I was going to recommend. But more like ER tech, EKG tech. That way you can use your EMT-I skills, and learn something in the process. That way, when you do turn 21, you will have more experience than some of your counterparts. Of course, I don't know of how San Fran Hospitals run in regards to ER techs, etc.

First- thanks for the replies. This was my first thread on this site, so...... I think some of you missed this. I am really going back to basics here. Diagnostics! That was more for what I was getting at. Remember, a 12-lead is a diagnostic. But I like where your head is at. It's OK Dwayne. I get that a lot. At times I can have a very abrasive personality. I spend half of my time in the military, and the other half in a civilian hospital on a Paramedic unit. some people just don't know how to take me..... I want to see if we can get any more replies, but I have a felling that most are in the same opinion as me. Just one Caveat to the original post. Let me know how you voted when you post. Makes it easier. thanks J

So, since we have been doing a little ALS vs BLS thing lately. I thought I would throw this out there. But.... Besides diagnostics, what is (are) the differences between the ALS and BLS assessments, if any? This might sound like a silly question. But I am kind of curious to see how peope view this. Especially after some of the more recent topics. GO!