Do we diagnose, rule in/out, or just load and go.

[mobey]

I was always taught that EMS workers or nurses were not allowed to diagnose.

If you don't have a working diagnosis, you should not be treating..... just transporting.

That old saying is a copout.

[scott33]

I was always taught that EMS workers or nurses were not allowed to diagnose.

It's a field diagnosis.

[spenac]

If you don't have a working diagnosis, you should not be treating..... just transporting.

That old saying is a copout.

Exactly. W/o a "field" or "working" diagnosis you could not even place a bandaid on a cut. I do not know why so many are so afraid to admit that we must make a diagnosis of some sort if we are to do any more than be taxi drivers.

[tskstorm]

On my ACR/PCR there is a box that says "presumptive diagnosis" in that box I've seen EMT's and Medics write "Rule in xyz" "Rule out abc" "see comments" "unknown etiology" "RMA" I saw an ACR yesterday while I was on an ICU rotation doing chart review which said "PE vs CVA" at first glance I was thinking this is silly, a Pulmonary embolism vs a stroke ? and based on the other info in the ACR the patient presented with Shortness of breath with wheezing and AFib the Medics treating gave 2 Albuterol treatments and paced the pt. I was quite confused on the presumptive/working diagnosis ... upon reading the comments/notes closer I realized in the comments the person used PE to mean Physical Exam, and wrote CVS to mean Cardiovascular system I finally realized the Medic meant physical exam vs cardiovascular assessment.

You need a good assessment to even pick a protocol to follow.. Without a working diagnosis you can't do your job correctly. Local protocols will have a different treatment order for different etiologies that lead to the same condition, the one that comes to mind is Altered mental status patients, If you suspect overdose you give Naloxone before D50, It may not alter the medications you give and the order you give it might not have an undesirable effect however you did your job incorrectly...

[crotchitymedic1986]

Its all about semantics and turf protection. The docs dont want you stealing their thunder, but EMS is no different. For instance:

An EMTI can place an EOA/EGTA/Combitube in a patient's throat, therefore they are controlling the airway. Obviously with a combitube you have the chance to actually blindly intubate the patient. But if any EMTI came into this room and started bragging about the "intubation" he did last night, the medics in this room would be on him like white on rice.

[spenac]

Its all about semantics and turf protection. The docs dont want you stealing their thunder, but EMS is no different. For instance:

An EMTI can place an EOA/EGTA/Combitube in a patient's throat, therefore they are controlling the airway. Obviously with a combitube you have the chance to actually blindly intubate the patient. But if any EMTI came into this room and started bragging about the "intubation" he did last night, the medics in this room would be on him like white on rice.

Why? Intubation is an Intermediate skill. As an Intermediate I have intubated many patients. I even as an Intermediate can RSI and perform surgical cric. Sorry your starting to show your time away again.

[freethinker]

"Its all about semantics and turf protection. The docs dont want you stealing their thunder, but EMS is no different.

I do not know why so many are so afraid to admit that we must make a diagnosis of some sort if we are to do any more than be taxi drivers.

I hope you have a diagnosis in mind before you start shoving tubes, needles, and medicines into patients, but with that being said, we can not make a true diagnosis on many patients due to our inability to do labs and xrays."

Assessment is different from diagnosis in two distinct, important ways: the content and the process. In terms of the content, assessment is treating the symptoms, whereas diagnosis is figuring out the true extent and mechanisms of the presenting pathology. In terms of the process, assessment is performed and thought about differently than the way in which a doctor would perform a differential diagnosis.

A doctor's thought process might assume, for instance, that the patient's respiratory distress has already been treated with what they consider 'basic' procedures- oxygen, IV, etc. Notice that to them almost all procedures will seem basic since by necessity a doctor approaches medicine from a more broader vantage point. The doctor thinks foremost about the root cause of the respiratory distress and the accompanying definitive treatments.

It is absolutely essential to do a good pre-hospital assessment and provide the appropriate treatments, but we should remember that, no matter what, we are not doctors without going to medical school. If at some point in the future higher-ups decided to allow field decisions to be made regarding denial of transport and/or field treatment alone, that would require a true-blue differential diagnosis. That would require a doctor, not a pre-hospital allied health provider, and thus would spell the end of all of us. So we should be careful what we wish for.

[spenac]

"

. If at some point in the future higher-ups decided to allow field decisions to be made regarding denial of transport and/or field treatment alone, that would require a true-blue differential diagnosis. That would require a doctor, not a pre-hospital allied health provider, and thus would spell the end of all of us. So we should be careful what we wish for.

Why? We deny transports to those that can safely go by other means. We also treat many conditions on scene but will not transport them. It will require more individuals get real education not just monkey skills.

[Richard B the EMT]

We also treat many conditions on scene but will not transport them.

I'll allow for local and agency protocols allowing for not transporting after treatments are started, but presume to allow for specifics on each call type. As a case in point, EMTs in New York are allowed to give nebulized albuterol to asthma patients, but if treatment is started, in the FDNY EMS Command, that means the patient is going to the hospital by either ALS, or BLS, but the patient is definitely going!

[VentMedic]

I'll allow for local and agency protocols allowing for not transporting after treatments are started, but presume to allow for specifics on each call type. As a case in point, EMTs in New York are allowed to give nebulized albuterol to asthma patients, but if treatment is started, in the FDNY EMS Command, that means the patient is going to the hospital by either ALS, or BLS, but the patient is definitely going!

In this situation, the patient absolutely needs to be seen by a doctor as soon as possible. Albuterol only alleviates the symptoms for a short period of time. It is not treatment for the cause which needs to be followed up before it exacerbates further. Because a patient feels a little better immediately after the treatment (with 6 L of O2 added), it gives both the patient and health care provider a false sense of security. Meanwhile the inflammation could be continuing its progression until you could end up with a severe condition quickly.