Thinking versus Doing

[AZCEP]

Considering most medics only know to use NTG/Lasix/Morphine for CHF from rote memorization, we really shouldn't be so quick to criticize.

We had a discussion this last week in class about the proper management of a trauma patient. Standard issue multi-systems, unresponsive, airway compromised, blah, blah, blah.

One of my students spouted out RSI shortly after finding out that the patient had a gag reflex, but their airway was full of fluids/foreign bodies. The room went deathly silent when I asked him, "Why?" His ego got bruised, but he was able to work his way through the minefield that was layed before him.

Figure if we don't question them now, they won't be prepared for someone more important to question them later.

[TerrfyinFlyinSrvc]

I could imagine part of it esp for new paramedics is after learning all the new skills, to sit there and do plain old BLS feels like they are doing nothing for the pt. So they wind up looking like Liberace at the organ running through every drug and procedure they can think of.

Also sometimes, they are running scared. You older hands know that sometimes nothing is the best thing to do. But to a new guy he feels like he's somehow failing if he ain't throwing everything he got at the pt.

Or in the worst case, he's just showing off.

Without the aggressive instruction, most students will never question the WHY of any subject in any field.

I've seen pilot classes where if the instructor said the proper answer is "c. Fly directly into the cliff." everybody would nod, jot it down, and not even blink. I think it is because the modern educational system is pretty much "Sit down, shut up, here's the answer, don't think."

Oh, the nurse was a new grad. She came up to me and apologized for her mistake. She said that she was nervous because this was her first "critical" pt., although it is the norm for us anymore.

Well, she did apologize and explain. So there is room for hope. Maybe you can "train" her to have more confidence in EMS and win a friend instead of an enemy.

I've been involved in other professions that were extremely "turf-conscious." I always try to lead off on a friendly basis. Competent and firm, but friendly. Even when I couldn't change an organizational mindset, at least I always had a few friends 8) in the "enemy's" camp.

Besides, I can always piss everybody off later.

[redwolfef6]

As a "baby medic" I have to agree. Thinking is more important than blind acting. The program I went through (HealthOne, Instructor Dennis Edgerly) one of the major areas was critical thinking. Yes we got all the cool techniques, but we were taught to think through our tx and prepare for what was next. I have told my medical director during my clearing interview that I wanted to be the best BLS paramedic I could be. Now before you all jump down my throat for my last comment, let me explain.

I have continually strive to think about the bls tx before I get all gungho on the als. I think as a paramedic it is more important to treat a pt with fewer drugs and shock them until they glow (unless warranted). Does the o2 relieve the nausea or alleviate the air hunger feeling, if so great!

I hope I explained this well enough.

[Just Plain Ruff]

Hey Lithium, here's a thought. This nurse apologized and tried to make amends. Why don't you invite her on a ride along so she gets first hand exposure to what you guys do. Who knows, you might just make her an RN/Medic. It sounds like this could be a good experience for you and for her. The beginnings of a beautiful friendship.

[Lithium]

Oooooo, me? What nurse? There's a nurse who wants to date me? what?

I completely forgot about this post ...

[mediccjh]

Treat your patient, not the protocols.

This pisses my Education Director off.

[Dustdevil]

Oooooooooh! How did I miss this topic before?

Plus five for an excellent topic, and for the excellent replies! This should be the number one point stressed in paramedic school. EMT school too, for that matter.

[Michael]

"One must not put a loaded rifle on the stage if no one is thinking of firing it." ~ Playwright Anton Chekhov in 1889

Which is to say, the temptation to play with every available toy tends universally to overwhelm itchy fingers. In Ideas Have Consequences, Richard Weaver wrote that the mere development of atomic power made the prospect of its eventual use simply inevitable. Why? "Because we can."

[Lithium]

Very good point Michael ...

[Nate]

There are very few calls that I will not do anything more then just transport to the ER with nothing other then a phsyical assessment. My monitor is a tool, and most seem to think it is a treatment (which it isn't). It doesn't take buy a minute to put someone on the monitor and check things out. I have found problems there that I wouldn't have if I hadn't have done that. Granted they might not have needed to be treated right then or there, at least I knew about the problem (or was able to eliminate a cause). The other thing I usually do is secure an IV, even if the patient doesn't need fluids and all I put in is a lock. The ER is most likely going to draw blood, give pain meds if there is pain involved, or possible a medication for something else. Around here it is generally expected that if your a paramedic with a patient, they should have an IV in when you arrive at the ER.