How much is too much?

[chbare]

I have to chime in with a contrary view that is also supportive. Emergency Medical Services is a highly specific series of actions that are taken, according to the illness or injury, to intervene and prevent further injury and death.

As much as I agree that in order to further the profession we must expand our education, I still hold to let's stick to the basics. Personally, I would snooze through your presentation (no offense meant) primarily because it's going to take you an awful long time to build all all the theories it took in chemistry to get to the point where it was decided that administering Glucose to a diabetic can make an unconscious patient conscious.

My experience in the field was that rather than getting deeper with theory, I got much more focused on action. The less time I spent in my head, the more room I had for my patient. Rather than Chemistry being emphasized, I would prefer connection, because that's what 80% of our patients need most.

If you want to include Quantum Theory, then, since it shows in essence (if you want to take it deep enough) that we create our own reality, then the intervention of the medic would be holding your patient's hand and saying, "Don't think that!" Funny how that goes right back to connection, isn't it?

AND I think that the work you do can be pivotal in prompting a lot of medics to go deeper into medicine. Understanding the processes of which you and your patient are a part is important and can help you to reduce future pain and suffering for the patient. But action always comes first.

I think you have taken my intent out of context. My presentation was very basic and did not involve even a single bit of calculus. Again, I think it is important to understand in a basic sense, how electrons act and the fundamentals of chemistry. This is the basis for the "action" that you describe. How can we expect paramedics to appreciate the negative consequences of giving sodium bicarbonate when they have never been taught about chemical reactions or Le Chatelier's Principle? Sure, we can say bicarb will increase the CO2 and expect them to memorise this phrase like it was yet another mundane and meaningless number to be forgotten following the test, or we can tell them why this occurs and perhaps more will stick. What about carbon dioxide transport? Should we continue to tell medics that it is magically transported as bicarbonate and hydrogen ions, or perhaps give them a little more to go on? The list could go on; however, my point is that I want to try and find an optimal "depth" that should be taught to entry level providers.

Considering the chemistry, I have gone to great lengths to make it highly interactive and intuitive. The basics are quite easy to grasp and it is amazing to see people look at the periodic table with a new found respect when they realise how electrons are gained, lost and shared and how some of these processes we talk about begin. It is quite powerful when somebody realises that electrolytes result from the loss or gain of electrons and that the 154 mEq/L on the side of the IV bag, a serum potassium and Ph actually mean something that they can understand.

EDIT: I must admit that perhaps the direction I am taking will ultimately fail. Do not take my comments as attacks; however, I have a hunch that people want to learn and will blossom if we give them more of the story, but ensure they understand it and conquer it. I believe it is a powerful and potentially life changing experience when you understand a concept that was at one time magical and unknown. Of course, my feelings could be full of crap...

Take care,

chbare.

Ah...the conundrum of EMS textbooks. We pushed Brady to let us push the envelope with our 5-volume paramedic texts--and we did. Then, we started to lose some business to the one-volume Mosby text--so we developed the Essentials book. I pushed hard to modify Ric Martini's college A&P book for EMS. It worked and has sold well but we continually get requests for a lower level A&P book in addition to Anatomy and Physiology for Emergency Care, Second Edition. The lower level book will be out later this year. We are finishing a pathophysiology book and I am again trying to push the envelope. It seems we push forward with content only to have a segment of the EMS community push back. I wish I had a nickel for every time I've heard. "Just give us a book that will get us through the test." Interestingly, I've never heard that phrase in the world of medicine. My congratulations to you for attempting to push the educational envelope. I've about given up. I've been often asked, "Which comes first? Improved EMS pay or improved education?" While it is a "chicken or the egg" argument, I would say that education has to come first. It is hard to believe that some oppose accreditation of paramedic programs. What's the deal?

BEB

Bryan E. Bledsoe, DO, FACEP, FAAEM

Clinical Professor of Emergency Medicine

University of Nevada School of Medicine

Department of Emergency Medicine

University Medical Center of Southern Nevada

Medical Director, MedicWest Ambulance

Las Vegas, Nevada

Thank you, I guess only time will tell if this turns out to be a positive experience.

Take care,

chbare.

Edited August 25, 2010 by chbare

[brentoli]

It seems we push forward with content only to have a segment of the EMS community push back. I wish I had a nickel for every time I've heard. "Just give us a book that will get us through the test." Interestingly, I've never heard that phrase in the world of medicine.

Seems to be the new culture of people my generation and younger. You know something is broken somewhere when you are an "outcast" for wanting to learn and progress, while everyone else is content in the status quo.

[Kiwiology]

Good on you mate you are a true striver for excellence in a setting which barely demands what is acceptable and was done away with in other parts of the world a decade or more ago.

Of interest is that our Bachelors and Graduate Degrees (for Paramedic and Intensive Care Paramedic respectively) make small use of the American textbooks; probably because lifting the Bledsoe "Essentials" book is an OSHA hazard as it's so damn heavy!

The other thing that grinds me is the US can have a two year Paramedic (ALS) program however up to what, like half of it, is in arts and underwater basket weaving or getting drunk 101, WTF! Our Paramedic program for example is three years full time, 24 classes and I can tell you all 24 are Paramedic specific as we do not have general education requirements.

Once again, good work mate, Kiwi owes you a beer.

... or we could get drunk at the Circus in Reno with Dr B

[spenac]

Ah...the conundrum of EMS textbooks. We pushed Brady to let us push the envelope with our 5-volume paramedic texts--and we did. Then, we started to lose some business to the one-volume Mosby text--so we developed the Essentials book. I pushed hard to modify Ric Martini's college A&P book for EMS. It worked and has sold well but we continually get requests for a lower level A&P book in addition to Anatomy and Physiology for Emergency Care, Second Edition. The lower level book will be out later this year. We are finishing a pathophysiology book and I am again trying to push the envelope. It seems we push forward with content only to have a segment of the EMS community push back. I wish I had a nickel for every time I've heard. "Just give us a book that will get us through the test." Interestingly, I've never heard that phrase in the world of medicine. My congratulations to you for attempting to push the educational envelope. I've about given up. I've been often asked, "Which comes first? Improved EMS pay or improved education?" While it is a "chicken or the egg" argument, I would say that education has to come first. It is hard to believe that some oppose accreditation of paramedic programs. What's the deal?

BEB

Bryan E. Bledsoe, DO, FACEP, FAAEM

Clinical Professor of Emergency Medicine

University of Nevada School of Medicine

Department of Emergency Medicine

University Medical Center of Southern Nevada

Medical Director, MedicWest Ambulance

Las Vegas, Nevada

Doc thanks for trying. In the Paramedic course I taught I had to fight with those in charge to be able to even use your essentials book as they said it goes to deep. I personally hate that I treat patients with very serious problems with some very strong and potentially dangerous meds yet I have so little education. Yet even as little as I have many seem to even want less. They want to really be taxi drivers rather than part of the medical profession. Many students kept saying just tell us whats on the test I'll learn the rest as I go after I'm certified. That just sickened me. I almost walked away from the class in the middle of it.

[Quakefire]

Just my two cents, after completing our first week of the ACP course. Our A&P started with intro chemistry and bonding and so on. Unfortunately it has confused most people. The issue with it is most of the people have been out of high school for well over five years and remembering chemistry (not a requirement even for the PCP course) isn't all that easy. Quantum mechanics scares alot of people.

As for text books being "too smart" or dumbed down. Well we kind of need a middle ground. We are using Emergency Medicine by Tintinalli. The book is too "smart" for our purposes, besides as Kiwi stated, its an OH&S hazard due to weight (it hurts to study if the book sits on your lap). By that I simply mean that most people require a dictionary to read the book. Yes we understand it, but a lot of the terminology used is not common in EMS (at least around here). I'm not against big scary Latin words, just it would be nice to have it written in a way that would allow those of use without a medical internship to catch up on some of the terminology.

[chbare]

Just my two cents, after completing our first week of the ACP course. Our A&P started with intro chemistry and bonding and so on. Unfortunately it has confused most people. The issue with it is most of the people have been out of high school for well over five years and remembering chemistry (not a requirement even for the PCP course) isn't all that easy. Quantum mechanics scares alot of people.

As for text books being "too smart" or dumbed down. Well we kind of need a middle ground. We are using Emergency Medicine by Tintinalli. The book is too "smart" for our purposes, besides as Kiwi stated, its an OH&S hazard due to weight (it hurts to study if the book sits on your lap). By that I simply mean that most people require a dictionary to read the book. Yes we understand it, but a lot of the terminology used is not common in EMS (at least around here). I'm not against big scary Latin words, just it would be nice to have it written in a way that would allow those of use without a medical internship to catch up on some of the terminology.

This is exactly my internal debate, how far can I go without loosing people. All the students were able to understand the periodic table and that the atomic number = neutrons = electrons. They understood that periods indicate the number of energy levels and that groups tell us about the number of valence electrons. They were able to understand the octet rule and the basic principles behind ions, ionic bonds and covalent bonds. I had to take a little time and do a visual demonstration, but they were able to understand the concept of a mole and relate the equivalent and miliequivalent to labs and IV solutions.

I am actually pretty happy with this level of understanding, but wonder if I could push it a bit further and look at reactions, acid/base chemistry and perhaps electron configurations. Most of the math at this level is still fairly basic and the Quantum stuff was more of a history of how we learned about the atom with some of the major formulae and constants mentioned. I think most people understand that electrons orbit around the nucleus, they just do so in a way that is not analogous to the solar system. I want to take it a bit further, but as some people have implied, a fine line exists.

It would be fun if people could see a demonstration of how I go about teaching, then critique and provide feed back. I feel I have a very easy and intuitive system. In addition, I encourage people to use the periodic table during testing and focus on learning what the table tells us versus learning every atomic and mass number for every atom, then regurgitating said numbers.

Take care,

chbare.

[rock_shoes]

Just my two cents, after completing our first week of the ACP course. Our A&P started with intro chemistry and bonding and so on. Unfortunately it has confused most people. The issue with it is most of the people have been out of high school for well over five years and remembering chemistry (not a requirement even for the PCP course) isn't all that easy. Quantum mechanics scares alot of people.

Sorry if I sound harsh here but I think this is a bit of a “piss or get off the pot” situation. As much as it is understandable these concepts will be difficult for many people who are several years distant from their secondary school Chemistry class, these concepts are critically important. Do we need to delve deeply into quantum mechanics for the purposes of paramedic education? Not really. We do however absolutely require enough general chemistry to grasp the various types of chemical bonds, the octet rule, acid base balance etc.

As for text books being "too smart" or dumbed down. Well we kind of need a middle ground. We are using Emergency Medicine by Tintinalli. The book is too "smart" for our purposes, besides as Kiwi stated, its an OH&S hazard due to weight (it hurts to study if the book sits on your lap). By that I simply mean that most people require a dictionary to read the book. Yes we understand it, but a lot of the terminology used is not common in EMS (at least around here). I'm not against big scary Latin words, just it would be nice to have it written in a way that would allow those of use without a medical internship to catch up on some of the terminology.

Funny thing. My class will be using the same text. Agreed it’s an OH&S hazard. Why can’t they break these monstrosities into several smaller volumes? You shouldn’t have to strain your neck because the textbook you’re reading is so enormous it can’t be held at eye-level (a big thank-you to my grandfather for building me a beefy enough book-stand for these beasts). That said I don’t believe this book is too much. In fact I think it’s probably just about right. If we are going to progress and gain acceptance as professional providers we need to speak the same lingo as everyone else. I think the better tact here would be adding a medical terminology course to the pre-requisite list.

I’m fortunate in having originally worked towards an engineering degree prior to making the switch to EMS (somehow I managed make the switch without my friends and family having me committed). Having done this has left me with a couple semesters of university level Calculus, Linear Algebra, Calculus Based Physics, Chemistry, English Composition, Drafting, and Psychology that I would never have had to round out my paramedic education otherwise. I don’t consider all of these classes to be directly applicable but having done them has been nothing but beneficial.

I am actually pretty happy with this level of understanding, but wonder if I could push it a bit further and look at reactions, acid/base chemistry and perhaps electron configurations. Most of the math at this level is still fairly basic and the Quantum stuff was more of a history of how we learned about the atom with some of the major formulae and constants mentioned. I think most people understand that electrons orbit around the nucleus, they just do so in a way that is not analogous to the solar system. I want to take it a bit further, but as some people have implied, a fine line exists.

Please do push just that little bit further (particularly with regard to acid/base chemistry). Understanding these basics will enable providers to utilize a much more complete decision making process.

[Quakefire]

I too agree that if a big is too heavy to be comfortably rested in your lap, the book is too big. But don't let them hear you say you should break it down into smaller volumes as they would still charge over two hundred for the book, but it would be for each volume instead.

I too come from a science background as a physics major, so physics chemistry calculus philosophy and psychology. Glad to hear there are some BC people getting back into school. From the two BCAS people we have in our class it sounds like that wasn't happening too much lately