Abdominal Exam

[VentMedic]

How is that different from your education as a working EMT?

When working on a truck when have you gotten an indepth discussion about A&P exactly as you would in a college classroom and a lab?

You've seen decompensation from the palpation or decompensation that naturally occurs? If the latter, then the palpation can help give you a sense of urgency and perhaps help you with transport priority decisions.

And if it was you palpation that caused the pain or aggravated the condition due to uneducated and untrained hands? On a sick patient in the back of an ambulance is not a good time for someone who has knowledge of A&P to get their first practice.

Negative Vents, A&P is a not a prerequisite for medical school and many students have not taken it. The A&P they do get in school (depending on the school) may only be in specific systems by the time they start doing exams during 1st year preceptorships. Additionally, supervision is not always "direct" for all patient contacts. And their physical exam skills lab time may be limited to less than 10 hours (maybe 2 of abdomen).

What do you call the cadaver lab they get in med school? How about the pathophysiology classes they get in med school? They don't just take basket weaving classes in med school or at least those in the med schools in Florida don't and I'm pretty sure the UC med schools don't either. Somewhere they are taught what the body is made of.

I've been present for all physical skills labs a local prestigious medical school. In the end they get great training, but with their first exams they have practice time similar to some EMT.

Have you been to their lectures? Their cadaver labs?

Med students still look pretty ackward trying to figure out a ventilator even after we lecture them for 40 hours. Howe much lecture and lab is done for the EMT on "medical conditions"? Medical illnesses are the weakest link of all for the EMT as their primary focus is first aid and CPR.

Now, that doesn't invalidate the arguments made about needing better education before attempting skills.

You are comparing med school to a 110 hour EMT first aid course?

Edited January 11, 2010 by VentMedic

[daedalus]

Why would they be doing it on their own accord? They should be doing it under your direction, since you're a part of their education.

How is that different from your education as a working EMT?

You've seen decompensation from the palpation or decompensation that naturally occurs? If the latter, then the palpation can help give you a sense of urgency and perhaps help you with transport priority decisions.

Negative Vents, A&P is a not a prerequisite for medical school and many students have not taken it. The A&P they do get in school (depending on the school) may only be in specific systems by the time they start doing exams during 1st year preceptorships. Additionally, supervision is not always "direct" for all patient contacts. And their physical exam skills lab time may be limited to less than 10 hours (maybe 2 of abdomen).

I've been present for all physical skills labs a local prestigious medical school. In the end they get great training, but with their first exams they have practice time similar to some EMT.

Now, that doesn't invalidate the arguments made about needing better education before attempting skills.

Most of the med students that are being placed into preceptorships while still in first year are at med schools with a primary care emphasis and these students are usually placed with family medicine physicians. They typically have already completed gross anatomy or are in the middle of it in school. They are also in the middle of whole classes dedicated the the physical exam called something like "physical diagnosis" (which the hours they spend in this lab class in a 2 months probably well exceed the EMT 120 hours) Like the whole point of this thread, first year med students do not go into a room and work up their own patient and do what they want, they do what their preceptor tells them too. I, nor anyone else, is arguing against allowing EMT students to palpate an abdomen. I am arguing against an EMT student deciding to launch into an exam on his own accord, without the permission of the preceptor (which you will realize if you re read the original post in this thread). They just do not have the education to decide for themselves what is indicated or not. Comparing a medical student with four years of biological science intensive undergraduate education, with a 120 hour first aid class student is really the extreme end of apples to oranges.

[AnthonyM83]

When working on a truck when have you gotten an indepth discussion about A&P exactly as you would in a college classroom and a lab?

Never, which is exactly why I'm confused about Daedelus's comment suggesting that an EMT who has completed the 110 hour course has such a better understanding of A&P, especially when A&P is commonly done toward the beginning of EMT class.

Aside from that, the EMT should not just be prodding. The point of direct supervision is to guide their technique, in general, and specific to that patient. My EMT 'preceptor' asked me to show him what I was going to do first, then guided me through it with stable patients. That included deciding which patients I would not be doing the exams on.

What do you call the cadaver lab they get in med school? How about the pathophysiology

Again, I'm specifically saying that by the time they graduate, they have a great education. BUT by the time they do their first physical exams on patients (with mostly indirect supervision) they might not have most of that training. The example was the local school where they might only have 2 hours of abdomen exam skills lab before doing it on real patients (example: screening patients at clinics).

This was in response to comparing to other professions that wouldn't allow practice of exams on patients with so little practice.

[AnthonyM83]

Most of the med students that are being placed into preceptorships while still in first year are at med schools with a primary care emphasis and these students are usually placed with family medicine physicians. They typically have already completed gross anatomy or are in the middle of it in school. They are also in the middle of whole classes dedicated the the physical exam called something like "physical diagnosis" (which the hours they spend in this lab class in a 2 months probably well exceed the EMT 120 hours) Like the whole point of this thread, first year med students do not go into a room and work up their own patient and do what they want, they do what their preceptor tells them too. I, nor anyone else, is arguing against allowing EMT students to palpate an abdomen. I am arguing against an EMT student deciding to launch into an exam on his own accord, without the permission of the preceptor (which you will realize if you re read the original post in this thread). They just do not have the education to decide for themselves what is indicated or not.

Sir, your original post, which I originally quoted and was replying to, stated, "As a EMT ride along student, your primary responsibility is just to observe." I disagree with that idea and believe it contributes to under-education of EMTs. Primary responsibility should be to observe and perform directly supervised skills. This is especially important when most exam partners in EMT schools present healthy and in ideal circumstances with lower anxiety (in both examiner and examinee).

I am not addressing whether a student can jump in and start doing what he wants during a ride-along. That was a separate topic within the same thread.

Comparing a medical student with four years of biological science intensive undergraduate education, with a 120 hour first aid class student is really the extreme end of apples to oranges.

Which is why I did not make that comparison.

Instead, I compared a first year medical student with only A&P in specific body systems with very limited skills sessions doing screening exams at clinics with semi direct supervision with an EMT student, only as it applies to contesting the point that higher medical professions do not have students assess with incomplete education.

As a side note, many medical students have not had intensive 4-year undergraduate education in biological sciences. Many are English, Psychology, Music (etc) majors who took only the basic prerequisites. Even many biology majors cannot tell you much about anatomy, as many undergrad programs place heavy emphasis on biochemical processes, genes, and even general animal physiology, but low emphasis on human anatomy. Freshman zoology, 4-6 years prior, might be the closest to an anatomy class a new medical student's biology undergrad required (provided he was even a science major). A bio undergrad can tell you all about the citric acid cycle and SN2 reactions, but not always how many ribs we have (depends on the program).

[Lone Star]

I realize I'm going to infuriate a lot of these 'super medics', but what I don't understand about the whole 'Basics keep your hands off patients' mentality is this: not one of you were born with this 'super brain' pre-filled with all the knowledge you've acquired over your years of college education. Some of you were 'educated' in EMS practices while the program looked a lot like what we saw on "Emergency!".

Many seem to have forgotten that they too, started out as the same 'advanced first-aiders' that you refer to the EMT-Basic as; and your education at that time was even LESS than what's being required today!

The whole point of what we do, is to gather as much information about the patient's condition on scene as we can; (whether we actually are able to understand it or not), and pass that information on to someone who actually DOES understand it. In order to gather this information, we have to TOUCH our patients *gasp!*.

There has been a lot of comments about the EMT-B being 'ignorant' because they don't fully know what they don't know. But who is actually more 'ignorant'? The Basic that doesn't know that they don't know, or the 'old-timer medic' that seems to have forgotten that they didn't always know what they know now?

I've been in this profession long enough to have seen the arrogance of some medics manifest in many different forms. From being 'too good' to respond to the late night nursing home call because it was 'beneath them', to what I'm seeing now. *DISCLAIMER*: I'm in no way implying that ALL medics exhibit this mentality!

EVERY job/profession/career has an 'entry level', EMS is no different! The biggest 'difference' I see is that only EMS tries to eat the young and drive them from this field. You don't see the lawyers circling like sharks around a paralegal, you don't see the MD's/DO's attacking interns like piranhas that haven't eaten in a month either! Only in EMS do we smell 'fresh meat' and attack like a pack of wild hyenas....

It seems that the whole mentality has shifted from 'teach those that know less than you and encourage them to continue on in their education', to 'seek out those that don't know as much as you and drive them from the field after destroying them'!

We've all bitched and complained about how 'short handed' the field is, but you have to ask yourself if it MIGHT be a direct result of the latter mentality listed above....

Just because the 'lower license levels' may not know as much as you 'super medics', doesn't mean that they don't belong in EMS; nor are they to be relegated to only putting 'band-aids on boo-boos'!

There are a lot of medics out there that have the 'collegite credentials' that still can't function without 'the book', and not everyone without a college education is a 'blithering idiot'!

It seems that 'ignorance' has been confused with 'not knowing' lately. Ignorance is not admitting that there's things out there that you DON'T know, and a lack of knowledge is NOT ignorance.

Remember people, arrogance can kill just as fast and just as dead as ignorance!

[VentMedic]

I realize I'm going to infuriate a lot of these 'super medics', but what I don't understand about the whole 'Basics keep your hands off patients' mentality is this: not one of you were born with this 'super brain' pre-filled with all the knowledge you've acquired over your years of college education. Some of you were 'educated' in EMS practices while the program looked a lot like what we saw on "Emergency!".

Many seem to have forgotten that they too, started out as the same 'advanced first-aiders' that you refer to the EMT-Basic as; and your education at that time was even LESS than what's being required today!

The whole point of what we do, is to gather as much information about the patient's condition on scene as we can; (whether we actually are able to understand it or not), and pass that information on to someone who actually DOES understand it. In order to gather this information, we have to TOUCH our patients *gasp!*.

There has been a lot of comments about the EMT-B being 'ignorant' because they don't fully know what they don't know. But who is actually more 'ignorant'? The Basic that doesn't know that they don't know, or the 'old-timer medic' that seems to have forgotten that they didn't always know what they know now?

I've been in this profession long enough to have seen the arrogance of some medics manifest in many different forms. From being 'too good' to respond to the late night nursing home call because it was 'beneath them', to what I'm seeing now. *DISCLAIMER*: I'm in no way implying that ALL medics exhibit this mentality!

EVERY job/profession/career has an 'entry level', EMS is no different! The biggest 'difference' I see is that only EMS tries to eat the young and drive them from this field. You don't see the lawyers circling like sharks around a paralegal, you don't see the MD's/DO's attacking interns like piranhas that haven't eaten in a month either! Only in EMS do we smell 'fresh meat' and attack like a pack of wild hyenas....

It seems that the whole mentality has shifted from 'teach those that know less than you and encourage them to continue on in their education', to 'seek out those that don't know as much as you and drive them from the field after destroying them'!

We've all bitched and complained about how 'short handed' the field is, but you have to ask yourself if it MIGHT be a direct result of the latter mentality listed above....

Just because the 'lower license levels' may not know as much as you 'super medics', doesn't mean that they don't belong in EMS; nor are they to be relegated to only putting 'band-aids on boo-boos'!

There are a lot of medics out there that have the 'collegite credentials' that still can't function without 'the book', and not everyone without a college education is a 'blithering idiot'!

It seems that 'ignorance' has been confused with 'not knowing' lately. Ignorance is not admitting that there's things out there that you DON'T know, and a lack of knowledge is NOT ignorance.

Remember people, arrogance can kill just as fast and just as dead as ignorance!

Once name calling starts in attempts to invalidate education, it just provides more evidence there is a need for increasing the education at the entry level.

There reason most of us moved on from being first aiders at an EMT level is to provide a higher level of care with more indepth understanding to our patients.

BTW, you are the only one who has directly used the word "ignorant" in reference to the EMT.

Edited January 12, 2010 by VentMedic

[daedalus]

I realize I'm going to infuriate a lot of these 'super medics', but what I don't understand about the whole 'Basics keep your hands off patients' mentality is this: not one of you were born with this 'super brain' pre-filled with all the knowledge you've acquired over your years of college education. Some of you were 'educated' in EMS practices while the program looked a lot like what we saw on "Emergency!".

Many seem to have forgotten that they too, started out as the same 'advanced first-aiders' that you refer to the EMT-Basic as; and your education at that time was even LESS than what's being required today!

The whole point of what we do, is to gather as much information about the patient's condition on scene as we can; (whether we actually are able to understand it or not), and pass that information on to someone who actually DOES understand it. In order to gather this information, we have to TOUCH our patients *gasp!*.

There has been a lot of comments about the EMT-B being 'ignorant' because they don't fully know what they don't know. But who is actually more 'ignorant'? The Basic that doesn't know that they don't know, or the 'old-timer medic' that seems to have forgotten that they didn't always know what they know now?

I've been in this profession long enough to have seen the arrogance of some medics manifest in many different forms. From being 'too good' to respond to the late night nursing home call because it was 'beneath them', to what I'm seeing now. *DISCLAIMER*: I'm in no way implying that ALL medics exhibit this mentality!

EVERY job/profession/career has an 'entry level', EMS is no different! The biggest 'difference' I see is that only EMS tries to eat the young and drive them from this field. You don't see the lawyers circling like sharks around a paralegal, you don't see the MD's/DO's attacking interns like piranhas that haven't eaten in a month either! Only in EMS do we smell 'fresh meat' and attack like a pack of wild hyenas....

It seems that the whole mentality has shifted from 'teach those that know less than you and encourage them to continue on in their education', to 'seek out those that don't know as much as you and drive them from the field after destroying them'!

We've all bitched and complained about how 'short handed' the field is, but you have to ask yourself if it MIGHT be a direct result of the latter mentality listed above....

Just because the 'lower license levels' may not know as much as you 'super medics', doesn't mean that they don't belong in EMS; nor are they to be relegated to only putting 'band-aids on boo-boos'!

There are a lot of medics out there that have the 'collegite credentials' that still can't function without 'the book', and not everyone without a college education is a 'blithering idiot'!

It seems that 'ignorance' has been confused with 'not knowing' lately. Ignorance is not admitting that there's things out there that you DON'T know, and a lack of knowledge is NOT ignorance.

Remember people, arrogance can kill just as fast and just as dead as ignorance!

The only person in this thread I see knocking down the EMT's role in patient care is you. While I may not think that EMTs are educated enough to do a job such as independent care of emergency patients, I think of myself as an advocate for EMTs and want us as a profession to grow to the level of competence though education needed to take on this role. You want respect as a medical professional yet you readily admit you don't know what exam findings mean, and you see nothing wrong with this as long as you can pass that information on. Thats embarrassing and is really a testament to the sad state of prehospital provider education in this country.

There is no use in communicating exam findings that you do not understand to some one who does. The clinician taking over care of your patient will be able to do their own exam and understand what they are doing. You run a risk of incorrectly interpreting a finding because of poor technique or no understanding of pathophysiology. For example, while in my clinical time on the ED, I had a hypotensive patient where the labs came back with a low hemoglobin and hematocrit. I thought wow this guy must be bleeding somewhere, and when the internal medicine team came from downstairs to admit the patient I told them my theory, for which I was promptly put in my place after the attending immediately dismissed the anemia due to the patients severe renal disease. I had totally forgotten about the kidneys role in regulating hematopoiesis.

To be honest, your rant sounds like that of someone who does not understand the need for education and you are displaying the very type of behavior you are condemning. When it comes to patient care, egos need to be checked at the door. While there is no room for paramedics who think they are too good to run calls, there is also no room for disgruntled EMTs who think they don't need any more education in medical science.

Edited January 12, 2010 by daedalus

[medichopeful]

a lack of knowledge is NOT ignorance.

Ignorant

–adjective

lacking in knowledge or training; unlearned: an ignorant man.

Ignorance

–noun

the state or fact of being ignorant; lack of knowledge, learning, information, etc.

Edited January 12, 2010 by medichopeful

[AnthonyM83]

I'll have to disagree with the assessing to things we do not fully understand (as even a paramedic doesn't fully understand every finding he has). In high volume hospitals with wait times up to several hours at time, the information we present to the triage nurse can greatly influence whether patient is sent to the primary ER, the secondary ER without monitored beds, or the outside waiting room or lobby. The nurses do not have the time to perform a full assessment on each patient. It's not uncommon to have 2 codes going on at a time, STEMI patients waiting for a few minutes in a hallway, SEVERE respiratory distress, and so on (you get the picture, sure you've seen it more than I have), so incoming patients get a quick report from us and frighteningly if we don't give any indications that there's something urgently wrong, then they don't necessarily ask.

[Lone Star]

Once name calling starts in attempts to invalidate education, it just provides more evidence there is a need for increasing the education at the entry level.

I'm not trying to invalidate education, I'm standing up for those that are just coming into the field and getting hammered because of the mentality that 'if you're not a paramedic, you don't have a place in the EMS system.

There reason most of us moved on from being first aiders at an EMT level is to provide a higher level of care with more indepth understanding to our patients.

There's nothing wrong with further education. Again it's the 'seek out the lower license levels, destroy them and drive them from the field' that I've got a problem with. I've also been working on furthering my own education to be able to provide better care for the patients I come in contact with. But nowhere in the books I've read is the whole 'seek and destroy method' advocated.

BTW, you are the only one who has directly used the word "ignorant" in reference to the EMT.

Is it not the same message sent if you refer to someone as a 'woman hater' instead of calling them a 'misogynist'?

The fact that I came out and put 'the word' to the mentality is nothing but pure semantics.

*edited for spelling*

Edited January 14, 2010 by Lone Star