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

[BushyFromOz]

Back to the GCS thing, there is 2 parts to this for me. The first is that we perform the assessment as intended by jennet and teasedale when the situation requires it (granted, its for more than just head TBI) And this is for a couple of reasons. GCS 9 is the trigger point of some advanced interventions (RSI, IFS) and so making the request for additional support or performing the intervention requires GCS to be performed properly. Now that i said that we use it, we also (most of us anyway) fully understand the limitations of it as a tool, but in the absence of another easily applied assessment tool that is repeatable by all of our staff (over 3 thousand) it is i think appropriately used. I dont know if there are other / better tools, this is just the one we have.

The next is the use of GCS informally, and i dont really know how to explain this without sounding like a knob, but its kind of a broad statement that lets another ambo get a 'feel" for what you are looking at. An example i guess would be calling another car for assistance and instead of saying "respiratory failure and an altered conscious state", saying "respiratory failure and a GCS of around 7" just seems to enable peoples intuition and "gut" feeling to come into play, giveing them a slightly better idea of what you are looking at without having to go into all of the observations and vital signs and is particularly handy when im pressed for time. I think this "estimation" is very important.

Having said all that, because its part of our practice to use it both formally and informally is almost cultural so i guess its almost intuitively understood after 20 years

[croaker260]

FWIW, the GSC is on its way out. Most agencies are going to the simplified motor score (SMS) but I personally like the FOUR SCORE better.

SMS:

http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2006.05.019/pdf

FOUR Score:

http://www.coma.ulg.ac.be/images/four_e.pdf

[BEorP]

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.

I know that I am getting in late here, but I disagree with the whole premise of the question. Many "estimates" of GCS that I see done prehospitally get it completely wrong so I go through it properly. As others have pointed out, GCS may not be the best way to assess level of consciousness but if we are using it then we should use it correctly. All too often I see a patient being scored as 3 when they are in fact higher than that but the provider did not bother to actually assess it properly.

This may not always have huge implications for patient care, but it could potentially create the impression of improvement when there has been none.

[ERDoc]

I'm also not a fan of a test that gives a dead person 3 points, but that is just semantics.

[AnthonyM83]

Croaker could you support your claim that most agencies are going to the SMS system? I'm not refuting its value, just the claim. Also, there's been studies showing how inconsistent GCS scores are when done on the same patient by different providers. One reason might be the true exam has criteria we never hear about like patient crossing midline to localize pain. Question: what do people mean by taking the time to do a proper GCS assessment? You look at your patient, ask him a question, and ask for his arm for a BP or IV.... Or pain to see if any change. You end up doing that at least twice for all calls even if not thinking about it, no. Once at beginning and at least some other time along the way...?

[runswithneedles]

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.

our service requires us to do it on scene and enroute accompanied by the times

[croaker260]

FWIW, the GSC is on its way out. Most agencies are going to the simplified motor score (SMS) but I personally like the FOUR SCORE better.

SMS:

http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2006.05.019/pdf

FOUR Score:

http://www.coma.ulg.ac.be/images/four_e.pdf

I appologize, a more accurate statement is that there are increasing recommendations to go to the SMS...based on the same studies that are critizing the GCS. I do not have any data on the number of agencies that are actually doing this. I also know that we are hearing some of the same rumblings from out trauma and neuro services and I expect a formal shift to something else with in the next 18 months, and it seems that the SMS is the main canidate for replacing the GCS.

[Just Plain Ruff]

So if you guesstimate the GCS and someone pushes you to explain why you came up with a specific number and you can't. They show that you are wrong, that's a shitty feeling I can tell you.

[EMT613]

I don't like the word "guestimate". You're either estimating or guessing, so which is it? It's an estimate. As long as you know the criteria, you can mention what elements of the GCS your estimation was based on when you have a few more minutes to do so when you get to the hospital. I doubt you're going to loose your job over getting it wrong by a couple points. And if you have time or gumption to give calculate an exact answer, then go for it. I'm not discouraging it for those who can do so.

[MariB]

A couple of points could mean the difference in going to a different level of trauma center. Flying a patient as opposed to driving etc.

I think one could lose their job easily