Scaramedic Posted June 1, 2006 Posted June 1, 2006 From the "Field lab draws by ALS" thread. As far as technique and "accurate" blood draws or whatever, I'm in medic school right now and we do clinicals at the same level 2 facility I mentioned above. We do blood draws in the ER all the time as part of IV practice, and the instruction/technique is exactly the same as that performed in the field. I see no reason why EMS blood draws should be treated any differently than an ER blood draw as the technique (and equipment!) is exactly the same. Also, even in the ER I was never taught any specific order to fill the tubes, so I dont know how much that really matters... Like I said, I'm just a medic student right now but I really dont see any good reason to deny EMS blood draws other than as an attempt to control who gets to charge for the service. You bring up a point that made me think in a new direction. Should Paramedic students rotate through the lab? I worked in a lab at a level 1 trauma center for the last 4 years, so I am coming from a Paramedic/Lab Tech perspective. First off let me deal with the draw order does not matter issue. You perfectly highlighted the problems we had with staff draws in any unit in the hospital. The order of draws is extremely important, as well as the way the blood is drawn, it can skewer the test results. I have seen tests results that were far out of range, when investigating I found that the Nurse had drawn all the blood in a EDTA (purple) tube and then transferred it to the other tubes. I have seen severely hemolized blood because the staff had done a syringe draw and "pumped" the syringe to get the blood. The number of tests that we had to put disclaimers on is ridiculous. This is why our hospital as well as many others insist that blood is drawn by phlebotomists, not hospital staff. This is not a slam against hospital staff, its just we can keep phlebotomists up to date on draw techniques, it is hard to educate a whole hospital on proper technique. So this brings us to my question. Why not have Para students work in the lab during their rotations. It would give them exposure to draw techniques, but more importantly it would give them education in regards to what lab values represent and the underlying causes. Here's an example... You respond to a 76 yo female, C/C decreased LOC, pt is very confused, very weak, and non ambulatory. Pt is usually ambulatory and A&OX4. Family states history of NIDDM and Chronic Lymphocytic Leukemia (CLL). You check the blood sugar and find pts BSL is 134. How many of us know what CLL is? Do we know that CLL causes Hemolytic anemia? Do we know why this pts Hemoglobin level is low? The patient in this case was once again my mother her HGB was 4. This is something that a lab technician would know. This is not something taught in Para school. If Para students spent some time in a lab, studied the test results, and saw cells under a scope they might better understand the disease processes and therefore better understand what they see in the field. We have talked about Citrated (blue) top tubes for coag tests on this thread, but how many medics understand what a D-Dimer test is? Do we know about such things as Disseminated Intravascular Coagulation (DIC) or Venous ThromboEmbolism (VTE). Look these terms up, learn the underlying causes and it will give you another train of thought for what you might be seeing. I do not believe that every medic should know all this stuff (OK I do believe it but I won't go there) but a basic understanding would be a good thing. Lab exposure time would introduce them to a new equation to consider, altered blood values = s/s of a certain disease. It does not matter what the exact values are to the medic as long as they know the basics of how blood chemistry/make up can affect the patient. I believe that time in the lab, not shadowing a phlebotomist but bench time with the techs, would make them better medics. Am I completely goofy? Are some programs doing this? I would love to hear your opinions. Peace, Marty :joker:
Ridryder 911 Posted June 2, 2006 Posted June 2, 2006 I think exposure to any medicine is good however, a few hours in the lab, I personally do not believe is beneficial. Learning to draw which in order etc., can be written down and as described most services no longer perform lab draws. Exposure to micro, blood bank etc. would be more beneficial after completion of a microbiology course, learning gram staining, the wonder of e-coli, and truly learning cardiac marker (CKMB, CPK, Tro-I, HbNP, etc) as well BUN, Creatnine, and H & H levels and what they represent physiological is and should be introduced in advanced level as part of the standard of education. I required Intermediate level to learn these for ICU rotation and they always described it was beneficial for later in Paramedic programs. Too many medics do not understand the necessity of knowing and having a full knowledge of general lab values. Any medic that transports from any hospital or clinic area, should be very familiar. So many patients as well are immuno compromised or have resistant disorders, which are very nasty and medics need to be more aware of such etiology and cases. As Dr. Bledsoe describes, it is one of the fundamentals of emergency medicine.
AZCEP Posted June 8, 2006 Posted June 8, 2006 Have to agree with Rid on this one. If they spend the shift following a phleb around, they haven't really learned much. If they spend the time with the tech, they will discover how and why the numbers do the things they do. The students won't be happy about it, and chances are the lab techs won't be thrilled, but it would be a great learning tool. We recommend that our students spend time with each of the ancillary departments to help understand how the whole system works. Some with lab, some with respiratory, some with radiology, we even had a couple in PT/OT helping out. Each exposure adds to the picture that these students put together about their place in the system.
Scaramedic Posted June 8, 2006 Author Posted June 8, 2006 Have to agree with Rid on this one. If they spend the shift following a phleb around, they haven't really learned much. If they spend the time with the tech, they will discover how and why the numbers do the things they do. The students won't be happy about it, and chances are the lab techs won't be thrilled, but it would be a great learning tool. We recommend that our students spend time with each of the ancillary departments to help understand how the whole system works. Some with lab, some with respiratory, some with radiology, we even had a couple in PT/OT helping out. Each exposure adds to the picture that these students put together about their place in the system. That's what I said, maybe its a terminology problem. I am a an MLT, when I say "bench time" I mean working with the lab tech, I agree working with a phlebotomist is a waste of time. Time spent with us, learning what the results mean, and in turn learning S/S of the of the results would help them understand the bigger picture. Personally I would love the opportunity to have Medics sit in with me, there are some that wouldn't thats why you could have a sign up sheet for the techs. Rid I also agree that this should include exposure to Micro. That is my speciality, and I would love to have someone plate my stool cultures for me. Just kidding. Blood bank is also important, as well as learning the "banding" procedures so maybe someday in the future the EMS crew could have blood drawn and pts banded when they arrive. That would be a very hard sell I know, but I can dream. Sorry for any misunderstanding. Peace, Marty :joker:
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