let's face it.....often, we estimate GCS in the field.......

[EMT613]

Well, as i said, and thoiugh few will really admit, GCS is often estimated in the field instead of an emt going through the whole point-by-point asessment. If one is familiar with the GCS, and when time is of the essence and it has to be calculated stress, that's not a bad idea really to be able to estimate it.

So i guess this opens up several other questiins such as...do you do this? Have you done it with other asessment scales and ratings? Are burn area calculations ever estimated? Should they be? That calcilation may nit sound all that tough to do and we have the rule of nines and all that, but that's an awful lot of relatively time consuming math to be doing when u have a screaming critical burn patient ti treat and the hospital is a fast 5 iin away.

[DwayneEMTP]

I never use the GCS. I don't see its value in a vacuum, and I don't see its value inside of a verbal or written report that will already be describing those values more thoroughly. When it has been required for paperwork I've recorded it later from memory. Probably bad, but there you have it . If it was important to a doc I was working with I'd certainly do it, but that's never been the case...

BSA will always be an estimate... On the few severe burns that I've had I've tried to visualize it as accurately as I could. But I can't see why doing so would ever be necessary with a screaming patient in front of me... I've already made my transport decisions so it's not necessary until I'm ready to talk on the radio, right? Ditto the GCS. And I'm not going to be doing that until I've managed the basics... If I need flight my partner can call and 'medic requests flight for critical burn patient' has always done the trick..

I can't think of another value the I'd purposely spitball... But many values are subjective... LOC, Degree of pain, amount of blood loss... I can't really see why guessing at the GCS would be necessary? Not sniping Brother... Just curious...

[MariB]

BSA is an estimate.

When called in I would use the words " approximately or about " i can't imagine someone taking the time to use exact measurement for burns. Time is critical here. Get them to a burn center!

Well, as i said, and thoiugh few will really admit, GCS is often estimated in the field instead of an emt going through the whole point-by-point asessment. If one is familiar with the GCS, and when time is of the essence and it has to be calculated stress, that's not a bad idea really to be able to estimate it.

So i guess this opens up several other questiins such as...do you do this? Have you done it with other asessment scales and ratings? Are burn area calculations ever estimated? Should they be? That calcilation may nit sound all that tough to do and we have the rule of nines and all that, but that's an awful lot of relatively time consuming math to be doing when u have a screaming critical burn patient ti treat and the hospital is a fast 5 iin away.

GCS is extremely easy to calculate just by speaking to your patient.

[scubanurse]

BSA should be a best estimate, even burn doctors will often disagree as to the percentage. GCS is way too easy to do that is shouldn't ever be an estimate. That is objective data. Anything subjective will vary from provider to provider.

As for field estimates of burn percentage.... treat their pain dude. You shouldn't sit there estimating BSA while they scream in pain. Address the pain, then make a best guess. Doctors aren't really going to listen to your BSA estimate anyways so why delay patient care???

[ERDoc]

Too much emphasis is put on the GCS. It's whole purpose was to assess trauma pts but it has been distorted to all pts. There are plenty of recent literature that shows it is not all that useful (I'll let someone else search for it if they want). It's pretty easy to calculate. About the only time I use it anymore is when EMS is bringing in a pt to decide if the trauma team needs to be activated (trauma surg designed the protocols so we play by their rules).

As for burns, as others have said it is always going to be an estimate. How would you suggest getting a truly accurate measure? Even with the rule of 9s, it's an estimate and no one ever gets burned perfectly within the divisions.

[MikeEMT]

I hate GCS. They updated our ePCR and it is now a requirement to do it twice for EVERY patient. While I see its benefit in say a trauma or ALOC patient I really don't see the need for doing it twice when we have a 5 - 7minute transport time. We have to do a minimum of 2 full exams for every patient anyway.

[EMT613]

Okay, sounds like good advice so thanks. I have not yet worked in the field, but will be soon. And where i live, transport times will be less than ten min, so i need to know what to best spend that time on. Apparently, precise BSA and GCS scores are not those things.

[MariB]

Okay, sounds like good advice so thanks. I have not yet worked in the field, but will be soon. And where i live, transport times will be less than ten min, so i need to know what to best spend that time on. Apparently, precise BSA and GCS scores are not those things.

GCS takes just seconds to do and can be involved in your assessment. I don't even think of doing it, I just am automatically doing it during my assessment.

Example. " can you look at my nose so I can shine this light into your eyes? " patient followed direction.

When telling you what happened, was pt making sense?

How was their motor skills etc, did they lift their arm to help you put bp cuff? , did they point to their chest when telling you their pain?

It isn't something you will think about, heck I don't until I'm doing report unless the pt is in obvious altered status then its to decide if I need to call a heli

And even then I don't need a GCS, I just call dispatch and tell them to alert life flight

[musicislife]

Yea typically I estimate it. I guess I don't see a difference if he is an 8 and I guess a 9. Usually the assessments that are involved in the gcs end up being done anyway, just not as part of a formal gcs. My only exception is if I know we are using a helicopte, because that is usually a bad trauma.

[MariB]

Yea typically I estimate it. I guess I don't see a difference if he is an 8 and I guess a 9. Usually the assessments that are involved in the gcs end up being done anyway, just not as part of a formal gcs. My only exception is if I know we are using a helicopte, because that is usually a bad trauma.

a bad trauma is worth calling a heli no matter what the gcs is here as we are rural. I will put it on the pcr but we also use a revised trauma score. It is instinctive based more than a score of any sort.