Can you diagnose in the field?

[paramedicmike]

...let me question paramedic mike further on the question of a stroke patient. In essence there are a number of types of 'strokes' a person can have, but the main 2 are Ischaemic & haemhorragic. Will the patiernt not present to you clinically the same in the early stages & can you, without the use of a CT scan differentially diagnose the type of stroke the patient is having & what their likelihood of recovery is?

Fair point, Phil. Perhaps I should've clarified my position. I will sound very similar to AZCEP, Rid and Dust on this. We can diagnose to a point. However, a more definitive diagnosis than what we can adequately determine in the field must come from the hospital and the doc. I can call it a stroke and have suspicions, based on patient history and presentation, as to ischemia or hemorrhage. But I don't have the diagnostic tools to say for sure. Nor do I really want them or need them. That comes later.

As to Ruff's follow up question, I think we should take any and every class we can get in to. This includes college level classes, con-ed programs, seminars, conferences anthing that would expose us and motivate us to research a particular problem.

Of course, and pushing for an increase to the minimum educational standards is something we should be working towards as well.

-be safe.

[aussiephil]

Fair point, Phil. Perhaps I should've clarified my position. I will sound very similar to AZCEP, Rid and Dust on this. We can diagnose to a point. However, a more definitive diagnosis than what we can adequately determine in the field must come from the hospital and the doc. I can call it a stroke and have suspicions, based on patient history and presentation, as to ischemia or hemorrhage. But I don't have the diagnostic tools to say for sure. Nor do I really want them or need them. That comes later.

As to Ruff's follow up question, I think we should take any and every class we can get in to. This includes college level classes, con-ed programs, seminars, conferences anthing that would expose us and motivate us to research a particular problem.

Of course, and pushing for an increase to the minimum educational standards is something we should be working towards as well.

-be safe.

The reason I bring this point up is that we, as pre hospital clinicians are not doctors, we do not have the full picture, and, as anyone with any experience will testify, all patients lie, or at least tell their own version of the truth. We need to make our provisional dianosis & treat what we are presented with, & monitor, monitor, monitor.

I encourage us all to educate, but to consider experience of other officers, who may be clinically junior to us, as education as well. Too often do we write off the experiences of others & not learn from them. Their knowledge & experiences can be more beneficial than what is learned in a text book.

To further emphasise the point ruffems, where should we, as pre hospital care providors learn to, or should we train alongside doctors, should we make that the minimum standard? Or, more pointedly, is the education provided worldwide to those whoi want to study paramedicine, to in depth for what we are capable of doing on the street?

[Ridryder 911]

To be able to diagnose in the field, we need to "stand back" and look at proper medical evaluation and accreditation occurs. Definitely, will be those with M.D.'s , D.O.'s, PhD's, J.D.'s will make the determination of what, how, and wording of any and if diagnoses will be made. Whew... I can't imagine the bureaucracy this will be...

Legal "wording" not to conflict with medical diagnoses or even nursing diagnoses. As well, as the education level that will be required and tested for certification and license to make diagnoses. This as well would have to associated with carriers and providers of insurance/medicare representation.

I do think it would be something to pursue and will be pursued someday... when, who knows?

We have a lot of other impending issues that needs to be addressed, like EMT and Paramedics being able to read and write, and have a basic understanding of how the body works.

R/r 911

[bbbrammer]

Yes, we technically diagnose in the field. Otherwise how would we be able to treat anything? Though the legal semantics is the only thing that really seperates what we do from MD's in the hospital most of the time.

[aussiephil]

bbb,

i agree that we make a form of diagnosis, this determines our treatment, however, my point is the type of diagnosis.

We can ascertain from signs, symptoms & history a likely or provisional diagnosis, however, to truly definitively diagnose any patient requires the type of testing only available in hospital.

For those doubters, with due respect, there are a number of conditions that can only be diagnosed by a physician following extensive testing, such as stiff person syndrome (http://www.med.yale.edu/neurol/programs/neuromuscular/stiff_man.html ) and our pre hospital treatment is for a person with acute pain. Our original provisional diagnosis would probably be arthritic pain, or similar, but testing will reveal a degenerative disease that may take years to diagnose. These can not & will never be available in an ambulance.

Yes it is semantics, but we need to be aware of the difference & i will always maintain that we treat the way the patient presents, based on a provisional diagnosis, leaving final determination to those with more qualifications & facilities.

[AZCEP]

As we are not providing definitive treatment for a great many disorders, there should not be a desire to provide definitive diagnostics for most things either. A provisional diagnosis is plenty to base initial treatment on.

For the few items that we can manage definitively, our diagnosis is plenty.

[whit72]

bbb wrote:

Though the legal semantics is the only thing that really seperates what we do from MD's in the hospital most of the time.

Ummmmm.....Excuse me if I am confused here, but what separates us from MDs is about ten or so years of education.

[Doczilla]

Yes, we technically diagnose in the field. Otherwise how would we be able to treat anything? Though the legal semantics is the only thing that really seperates what we do from MD's in the hospital most of the time.

You might take care to remember that there are MDs on this site before you make a statement such as this.

'zilla

[Dustdevil]

See what I mean about girls in EMS!?

:twisted:

[emtpsaveu911]

See what I mean about girls in EMS!?

:twisted:

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