Things you've missed

[JPINFV]

678, no worries. However, if you look closely, it seems to me that this is turning into another bls vs als discussion. How do I say this without offending anyone ... Yes, again, if there is a critical error noted in my primary survey, I will initiate rapid transport. However, if not, I'm not going to rush. I should mention as well, that in my area, our average transport time is only 10 minutes without lights and siren usage (and only 9 minutes and 30 seconds with haha), and I'm not a huge fan of performing initial assessments in the ambulance unless our scene prevents patient privacy (ie. shopping mall etc.)

Of course, especially with your short transport time, you have to ask if you're doing your patients any favors. As a basic, I can take the time to educate myself and do a 30 minute physical as well. Sure, I can find tons wrong, but as a basic there is nothing that I can do about it other then give oxygen and get to the hospital.

Ok, you're an ALS provider. You have 100 times the training, 100 times larger scope of practice then I do. I'm not going to argue that. Now, lets say, you find a crainial nerve that's damaged. Is there anything that you can do for it?

As some point diminishing returns set in. Are you doing your patient any favors by delaying transport to an extent that you would be at the hospital by the time you're done with your assessment in order to find something that you can't do anything prehospital to fix?

That said, I would rather take a prehospital provider that does too much of an assessment then one that doesn't do enough of an assessment.

[Mediclcems]

Ok I'm ready to get beat up Dust and Rid.....I disagree with your on scene time.....Time is muscle and all that......We can sit on scene all day and try to figure out what is wrong with a patient, but when it comes down to it, the patient needs a hospital with a physician.....Not a medic who wants to try to diagnose without the equipment to do it...ie CT, MRI, Cath Lab.....

Get an airway....get an IV.....get a 12 lead....and BGL(if needed)...and DRIVE.....(12 lead and BGL can be done in route) Take a ff rider along if needed......I don't want anyone treating my mother who will sit on scene for 30 minutes when she's having an MI......And how long did you say it took to get to the hospital??????

But I'm just a pathetic EMT-B with no knowledge....but I do have common sense

Let the beatings begin

[hammerpcp]

I give you the spirometer, can't argue that

Chest percussion, we covered it just as in depth in my PCP class as we did in my Nursing class if that helps... I don't know how in depth yours was so that's all I have to compar to.

But your point on that is moot as you yourself point out that you are the only one to your knowledge that actually does it. And regardless... it doesn't take long. So why are you taking so much longer as an ACP than a PCP does? I truly don't see where the extra 14 minutes is coming in.

Okay..........I've let this go long enough. An RPN is hardly the same as an RN so stop taking on airs. And yes we did cover chest percussion in PCP class. Just enough to know what it is. :roll:

I have never seen anyone attempt to do this in the field for several reasons the main one probably being ambient noise. Half the time it’s nearly impossible to auscultate the lungs effectively. Also it is a skill that takes a lot of practice to perfect. The difference between chest sounds on percussion can be very subtle and difficult to interpret. Obviously Lithium thinks he can do this accurately. I am a PCP and I often spend 15-20 minutes on scene, so I can see how it would be easy to spend that extra ten minutes if you are starting a line or giving drugs or doing a pelvic exam.

But seriously, it is definitely a balancing act between doing the extra assessments/interventions and getting the pt to definitive care.

[hfdff422]

9 times out of 10, you know if the patient requires rapid transport or not the second you walk in the door. If you walk-in and are thinking this person does not look good, you take a baseline and start O2 while you are putting them on the cot. If the patient is not in serious danger, then spending a few minutes to get a thorough history and do some tests that could assist the ER is likely going to improve the patients care in the ER.

[Defiant1]

ok, uh, i'm gonna go off the current topic that appears to be in here and go to the original of having missed something. i don't know if this counts, but during the practical portion of the NREMT-B exam, me and my partner didn't get vital signs, no respirations, no pulse other than feeling to see if they had one, and no BP. yeah, needless to say, we had to retest on it that night.

[Dustdevil]

Still trying to figure out how the comment that an assessment and initiation of treatment can take up to thirty minutes somehow turned into the ASSumption that Lithium ALWAYS spends at least half an hour on his patient assessment.

Everytime a topic turns into a marathon back and forth like this, it can be traced back to somebody's silly assumption.

Let's try actually taking the time to read these posts carefully before launching into stupid tirades that are irrelevant to the topic.

As with every other question in EMS, the answer to why an ACP does a more thorough assessment than a PCP lies in going back to school.

[Lithium]

akroeze, again, it looks as though you won't understand why it takes an ALS provider that extra time until you are one. There's multiple people on here (oddly enough, usually ALS providers ... hmmm) stating they can understand where that extra time comes from. What about if I said that when I was working air, that oft times we would spend 50 to 60 minutes preparing our patient for flight? Would you find that a little much? Because honestly, that's around average for a CCP transfer.

JPINFV, yes, I COULD do something for that damaged cranial nerve. Any idea what that would be? Report my findings to the receiving facility. If you don't look for something, you won't find it.

Hammer, yes, I can percuss chests, and if you wish, I would be more then willing to show you how :wink: but what's this with pelvic exams? :shock: Remind me to get in and out of Hamilton as quickly as possible.

Dust, thanks for the defense.

I think Im pretty much done with this thread ... it's gotten way off track for me.

peace

[MedicMal]

I agree!!!

Come on people, lets get back to the original post please

MedicMal

[akroeze]

Okay..........I've let this go long enough. An RPN is hardly the same as an RN so stop taking on airs.

I only mentioned RPN cuz it was the only thing I had to cmpare to. My percussion asseessment skills were just as in depth in my PCP training as it was in my RPN. How is this an objectionable statement? I didn't think that it was implying a superiority complex.... and when did I ever claim that an RPN is the same as an RN? I'm confused.... please explain.

And yes we did cover chest percussion in PCP class. Just enough to know what it is. :roll:

We practiced chest percussion. We went over what the different sounds could mean when involved with different pathologies. When we learned a disease, we learned what would be found on percussion of the chest. What more is there to learn about percussion that a higher level would have that a PCP doesn't?

I have never seen anyone attempt to do this in the field for several reasons the main one probably being ambient noise. Half the time it’s nearly impossible to auscultate the lungs effectively. Also it is a skill that takes a lot of practice to perfect. The difference between chest sounds on percussion can be very subtle and difficult to interpret. Obviously Lithium thinks he can do this accurately.

I agree with you totally, never seen it done... don't see it as practical at all in most cases.

I am a PCP and I often spend 15-20 minutes on scene, so I can see how it would be easy to spend that extra ten minutes if you are starting a line or giving drugs or doing a pelvic exam.

But seriously, it is definitely a balancing act between doing the extra assessments/interventions and getting the pt to definitive care.

I'm not taking issue with being on scene a long time. It was with the idea that an ACP needs almost double (according to Lithium's numbers) the amount of time in the house that a PCP does. I was asking him what he assesses that takes twice the time a PCP would to assess. That's all.

[MedicMal]

I agree with Lithium, maybe you're having a hard time accepting that ACPs can take longer on scene because you don't have ACP knowledge.

MedicMal