Lights And Pov's And Jump Kits, Oh My!

[skyemt]

Just seriously curious about this...

after having read and seen many, many posts on this forum for quite a while...

i am always struck by the fact the threads about Pov's and lights and tools and emt kits, etc get many more posts than threads about patient care, as a rule...

is it something sociological? whackerism?

many of us seem to get involved in these threads, even the medics...

and it makes me wonder what it is all about... that makes them so popular, as opposed to other topics...

 

[firecoins]

what are patients?

 

[JPINFV]

It's probably a lot of things. First off, I do believe that there is a culture of ignorance at least at the Basic level, and this culture is indoctrinated starting in EMT-B class.

EMT-B class is all monkey see, monkey do. It doesn't matter if you can explain what's going on, so long as you know how to do your "skills" ("skills" used in quotes because people honestly shouldn't be amazed that they can place a NRB or NC onto a patient. Yes, I'll admit that I was excited the first time I whipped out OPQRST, but that feeling of awe quickly wore off over the next 5 times using it). There is little anatomy/physiology/histology [I'm adding histo based on the "OMG, Albuterol dilates the lungs in CHF patients!!!11oneone" thread, conversely, there is little base for pathophysiology, thus there is little room for basics to critically think about their patient's underlying condition.

Of course this is self-reinforcing. There's no real reason to think about the underlying disease process if your treatments aren't complicated enough for it to matter (medical patient: O2 administration and... transport?), so education isn't looked up upon. Since education isn't looked up upon, there is no real justification besides the cool toy factor to increase the scope of practice. Because there isn't any toys that depend on critical thinking, education... Wash, rinse, repeat.

Since patient care/outcomes aren't really affected by discussion or education at this level (how many treatment scenarios are "high flow O2, call medics, transport?"), what else is there to talk about? Operational things (which set of blue lights or badge from Galls should I buy?) and "what if" scenarios (Which set of hemostats would go best with my neon green bag? I need to know in case I come across a crash involving a bus that was going to a hemophiliac convention when I'm off duty!).

The unfortunate thing is that this is taught, to a certain extent, in a lot of people's classes (debunked Golden Hour and how every second counts on all patients) and in their first job (trying to fit in with their new coworkers). The unfortunate part is that I can't really blame people new to the field because it is what they see, so it is what they think is important in the field. This is why we get the "OMG, JPINFV said that EMT-Bs don't get enough education/training, but my 200 hour class was both more than the minimum and great (yet I have nothing to actually base the quality of my training off of)! Why does he insist on bashing us?" threads.

 

[wolfwyndd]

Personally, I'd be considerably more interested in patient care, or at least MY patient's care, if I actually knew WTF was wrong with them or their outcome after they got to the hospital. For me about all I do is glorified taxi service it seems like. Even on a GOOD call (medical or trauma) where I actually get to do something as a basic like backboard or NRB or (heaven's forbid) give aspirin or nitro I have no idea what happens to my patients once they get to the hospital. We fill out the report and leave. If we try calling the hospital later on to check on them we get the 'HIPPA' riot act read to us. So I have no incentive to find out if I helped or hurt my patient. I assume since no one has talked to me about 'patient care' and 'maybe you should work on X' then I haven't killed anyone.

 

[Hazmat91180]

So I have no incentive to find out if I helped or hurt my patient. I assume since no one has talked to me about 'patient care' and 'maybe you should work on X' then I haven't killed anyone.

That's unfortunate in your case, because where I am, I can stop by anytime or even fill out a request to get the information on the condition of the patient and outcome. Paper-cut to pre-mature delivery it hasn't failed. Perhaps you should be blaming your relationship with the hospital and your service rather then the fact that we are basics. I haven't run into any roadblocks, especially seeing as there was transfer of care. Am I alone in this?

 

[skyemt]

Personally, I'd be considerably more interested in patient care, or at least MY patient's care, if I actually knew WTF was wrong with them or their outcome after they got to the hospital. For me about all I do is glorified taxi service it seems like. Even on a GOOD call (medical or trauma) where I actually get to do something as a basic like backboard or NRB or (heaven's forbid) give aspirin or nitro I have no idea what happens to my patients once they get to the hospital. We fill out the report and leave. If we try calling the hospital later on to check on them we get the 'HIPPA' riot act read to us. So I have no incentive to find out if I helped or hurt my patient. I assume since no one has talked to me about 'patient care' and 'maybe you should work on X' then I haven't killed anyone.

actually, i have done much work on HIPAA in my state... if you are involved in patient care on a call, it is not a violation for the hospital to give you follow up afterwards.. actually, they are required to do so under HIPAA, provided it is part of your QI policy.

the deficiency probably has more to do with your own agency, i'm sorry to say. under the law, the hospital would do it if presented correctly by your QI policy.

i used to think similar to you, until i researched it and had our policy changed with the state. now we get patient follow up.

instead of the self-pity, why not see what can be changed so you feel you are learning more.

 

[daedalus]

A lot of EMTs coming out of school think that they know enough to handle patient care. JPINFV is correct, and really we are taught little that matters. Why learn all about CHF when all you have to do is place on o2, get billing information, and transport. I bet very little basics know that we have a very useful drug at our disposal for CHF other than O2. And IF they knew what it was, they wouldn't know why it worked. So now, because we know very little, it helps to have lights and sirens and badges to make us look and feel more confident and official.

My first month as a basic, I bought and paramedic textbook, took an anatomy/phys class and paramedic prep class, and tried to learn all I could about disease process. But than I realized there was no incentive to learn any of this. Now I decided I have to go to medic school ASAP.

 

[BossyCow]

It's probably a lot of things. First off, I do believe that there is a culture of ignorance at least at the Basic level, and this culture is indoctrinated starting in EMT-B class.

EMT-B class is all monkey see, monkey do. It doesn't matter if you can explain what's going on, so long as you know how to do your "skills" ("skills" used in quotes because people honestly shouldn't be amazed that they can place a NRB or NC onto a patient.

Another case of someone applying globally what they see locally. EMT classes are as varied as the instructors and the systems that support them. While there is a minimum standard set, some instructors and systems go beyond that.

Personally, I think in response to the original "Why" in the starting post... those who are more into the gear, lights, patches and catchy t-shirts are those with more time on their hands to respond to those kinds of posts. The rest of us are not interested in the topic and skim it and move on.

 

[JPINFV]

Another case of someone applying globally what they see locally. EMT classes are as varied as the instructors and the systems that support them. While there is a minimum standard set, some instructors and systems go beyond that.

Too bad that there are plenty of courses nationwide that's willing to teach the minimum. Too bad that cultures are based on the average person and scopes of practice based on the lowest common denominator. Honestly, how many emergency physicians carry a full set of resuscitation gear in their car because they might come across "the big one" while off duty?

You know, I just tried something that, to an extent, validates my theory. If anyone should be stopping and rendering aid on their off time, it should be emergency physicians. After all, they are the one's with an unrestricted license to practice medicine, right? Well, I just ran a search for "POV Lights," trauma bag, and "jump bags" in the Emergency Medicine residency forum on Student Doctor Network. "Jump bag" and "trauma bag" turned up nothing. "POV Lights" turned up this rather humorous, yet off topic, video.

[YOUTUBE]http://www.youtube.com/watch?v=7iBY7Yirq60&eurl=http://forums.studentdoctor.net/showthread.php?t=502113&highlight=POV+light[/YOUTUBE]

On the other hand, there is an interesting case report complete with an ultrasound video and video from the OR of an AV rupture post 3 story fall.
http://forums.studentdoctor.net/showthread.php?t=504377

Apparently there is a direct and inverse relationship between years of education and discussion over which trauma bag color matches your POVs emergency lights (gotta be fashionable, after all).

 

[MikeRi24]

Personally, I like reading about it all. Since I'm new, I'm still learning a lot about not only the practices we do, but the tools we use as well. I have already found a couple "tools" that I carry with me when I am working that have been recomended to me and they have helped me out a lot,.

 

[Jon]

JPINFV - your video is broken. Can you fix it?

 

[JPINFV]

I would fix it if I could tell what's wrong with it, but the video (Bud light "Who Cut the Cheese" commercial), works fine on my computer.