# How much anatomy do you need on the job?



## Dearing Baymiller (Jun 5, 2009)

hey guys, 
i'm heading into EMT-B this fall, and i'm already taking A&P, and doing pretty good so far. how much of the Anatomy classes do you actually use on the job? obviously the A&P directional terms and etc. , but do you really retain all of the carpal and tarsal bone names? do you tend to forget them over the years, or do you keep independently studying to the point you can name them in your sleep?   just curious to see what to expect in the future.

thanks!

dave

edit: i'm heading into the Medical Terminology class in the fall as well, looking forward to that. 
i pulled out of it to take in the fall, to make sure not to take a compressed summer class for that. i wanted the full semester to take my time and really absorb the material in my mind.


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## Shishkabob (Jun 5, 2009)

You don't NEED any of it.


But here's a caveat;

Just because you take it doesn't mean you'll do better in class.


I never took it and am doing just fine (knock on wood).  But I also read a couple A&P books and am a quick, vocal listener.

You can generally tell who has, and has not, taken it, but not always.


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## Ridryder911 (Jun 5, 2009)

You will use it far more than all lot of the stuff that seemed important or exciting. Anatomy & physiology is used (or should be) on each and every patient. Medical terminology is used on every chart and discussion of patient care. 

If you really learn them & not just memorize things, you will tend to retain them. Yes, review things periodically and study more in-depth to be able to increase your knowledge. 

R/r 911


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## Dearing Baymiller (Jun 5, 2009)

Linuss said:


> You don't NEED any of it.
> 
> 
> But here's a caveat;
> ...



thanks linuss, i had figured this was the case from ride alongs i had a long time ago, but i wasn't sure if anything had changed.


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## Ridryder911 (Jun 5, 2009)

Linuss said:


> You don't NEED any of it.
> 
> 
> But here's a caveat;
> ...



How can you honestly make such a remark? In what expertise do you offer as a student; yourself? If you have never taken either what type of program are you taking and what type of medic will be presented in the end that does not know what they are working upon?  So you know the Kreb's cycle and potassium pump... & please then tell me how one should not know such.

Can one imagine any health care professional in any health care profession making such a remark... better yet, a mechanic remarking you don't have know the parts of a car or how they function, to repair a car? 

R/r911


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## Shishkabob (Jun 5, 2009)

But let me make this clear--- While A&P class is not needed, a clear understanding OF A&P is needed.    It lends itself to critical thinking.  If you know how the body works, it will help you figure things out a lot more, such as why "peping" is used for pulmonary edema's.


As my instructor says, it makes the difference between a medic, and a good medic.


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## Ridryder911 (Jun 5, 2009)

Dearing Baymiller said:


> thanks linuss, i had figured this was the case from ride alongs i had a long time ago, but i wasn't sure if anything had changed.



If your ride along represented such, then this is just one of the many PROBLEMS of those in EMS. LAZY & a poor representation of health care providers or as I say pseudo providers. Then we wonder why they still call them ambulance drivers. 

R/r 911


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## Shishkabob (Jun 5, 2009)

Ridryder911 said:


> How can you honestly make such a remark? In what expertise do you offer as a student; yourself? If you have never taken either what type of program are you taking and what type of medic will be presented in the end that does not know what they are working upon?  So you know the Kreb's cycle and potassium pump... & please then tell me how one should not know such.
> 
> Can one imagine any health care professional in any health care profession making such a remark... better yet, a mechanic remarking you don't have know the parts of a car or how they function, to repair a car?
> 
> R/r911



You misread what I said. 





You don't "need" A&P class to do well in medic school.

A&P is a good idea.

You can do ok in class without A&P.

You can sometimes tell who has and has not taken A&P.





Now, as to your question on how I can comment on such?  I never took A&P and have the highest grade in class on the A&P sections.  THAT'S how, good sir.


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## Ridryder911 (Jun 5, 2009)

Linuss said:


> As my instructor says, it makes the difference between a medic, and a good medic.



He should say; it makes the difference between and idiot and a medic. 

R/r 911


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## Dearing Baymiller (Jun 5, 2009)

Ridryder911 said:


> You will use it far more than all lot of the stuff that seemed important or exciting. Anatomy & physiology is used (or should be) on each and every patient. Medical terminology is used on every chart and discussion of patient care.
> 
> If you really learn them & not just memorize things, you will tend to retain them. Yes, review things periodically and study more in-depth to be able to increase your knowledge.
> 
> R/r 911



i'm in a compressed class. skeletal, muscle, and nervous systems over four days and taking a very basic test.
i am only taking a Comp II class the second half of summer, so i figured i would go back and take my time to learn them, instead of just the cramming we're getting. 
between studying on my own idle time, and the full Medical Term. class ( i have the book and a number of the guys who are taking it say it's going to be a rehash of A&P) i think i'll absorb and retain the material much better.

thanks guys! i'm going to suck info from as many experienced brains here as i can. hopefully i won't ask too many stupid new guy questions!


dave


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## VentMedic (Jun 5, 2009)

Dearing Baymiller said:


> hey guys,
> i'm heading into EMT-B this fall, and i'm already taking A&P, and doing pretty good so far. how much of the Anatomy classes do you actually use on the job?


 
You need as much as you can get into your head by learning, not memorizing, and then some.  I've had 6 years of formal education involving the sciences, including A&P, and still learn something new almost everyday.   If you talk to medical doctors they will tell you the same thing which is why they also must train and acquire more education almost constantly.   If you do not have a solid foundation in the sciences, medicine will leave you in the dust to where you will have to rely purely on memorization and a recipe.


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## Ridryder911 (Jun 5, 2009)

Linuss said:


> Now, as to your question on how I can comment on such?  I never took A&P and have the highest grade in class on the A&P sections.  THAT'S how, good sir.



So? What does that represent in a program that does not require basic science. I am supposed to be impressed? A program that uses a 10'th grade reading level book and one makes an A? Again... please. 

As an educator, I make tests that one cane make an A or F. It all depends on the level and criteria the instution places upon the education. Sorry, if one does not even require formal basic science class for a health care profession, what accountablility does the grade represent? 

R/r 911


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## VentMedic (Jun 5, 2009)

Dearing Baymiller said:


> i'm in a compressed class. skeletal, muscle, and nervous systems over four days and taking a very basic test.


 
Are you taking a standard college Anatomy and Physiology class with a lab?  Is it transferable to all health care programs or is it an overview class for EMS?


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## Shishkabob (Jun 5, 2009)

Rid.................

I was commenting for school, not on the job.  That's where your and my miscommunication happens.


Did I say it was a good idea to go without it?  Nope.  Did I say I recommend skipping it?  Nope.  Did I say there's a difference between those who did and did not take it?  Yup.


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## Ridryder911 (Jun 5, 2009)

Dearing Baymiller said:


> i'm in a compressed class. skeletal, muscle, and nervous systems over four days and taking a very basic test.
> i am only taking a Comp II class the second half of summer, so i figured i would go back and take my time to learn them, instead of just the cramming we're getting.
> between studying on my own idle time, and the full Medical Term. class ( i have the book and a number of the guys who are taking it say it's going to be a rehash of A&P) i think i'll absorb and retain the material much better.
> 
> ...



It's not a stupid question. Part of the problem many students do not and cannot see as they are within the program. One cannot really answer truthfully, until they have practiced for a while. 

Your brain feels overloaded? Good. That means you are doing it right. As Vent describes, you will continue to build upon the foundation. You will continue to review as you learn. This is why a quick review is usually in the intro of each chapter in medical books, but one already has to have the basic understanding before attempting to go forward. 

Good luck!

R/r 911


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## Dearing Baymiller (Jun 5, 2009)

VentMedic said:


> Are you taking a standard college Anatomy and Physiology class with a lab?  Is it transferable to all health care programs or is it an overview class for EMS?[/QUOTE}
> 
> it's an Essentials A&P class, sorry i didn't tack that one on. it's a beginning class. after that there is offered Anatomy and Physiology I.
> EA&P is part of the six month EMT-B certificate program here at iowa lakes.
> ...


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## daedalus (Jun 5, 2009)

Linuss said:


> You misread what I said.
> 
> 
> 
> ...


A and P is written into the National Standard Curriculum as a pre requisite. Without it, understanding pathophysiology and pharmacology is difficult at best and impossible at worst. Without knowing pathophys, a and p, and pharm, forming a differential diagnosis and using drug therapy to treat a patient is dangerous at best.

Most teachers will lecture in manner that expects a student to have a intermediate level command of A&P. The girl next to me took an online A&P and I hear her go "Huh??!!" every day when ADH, first pass metabolism, neuroendocrine relationships, the nervous system, epithelial tissues and membranes, serous fluid, fluid compartments, etc etc etc are discussed.

If and when I become a medical director, I will not accredit paramedics to practice with out a formal anatomy class under their belts.


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## Dearing Baymiller (Jun 5, 2009)

Ridryder911 said:


> It's not a stupid question. Part of the problem many students do not and cannot see as they are within the program. One cannot really answer truthfully, until they have practiced for a while.
> 
> Your brain feels overloaded? Good. That means you are doing it right. As Vent describes, you will continue to build upon the foundation. You will continue to review as you learn. This is why a quick review is usually in the intro of each chapter in medical books, but one already has to have the basic understanding before attempting to go forward.
> 
> ...



thanks, i think i'm going to do really well. i'm confident and motivated and i absorb info like a sponge. hopefully i can put it into practice as well!

my basis for the original question was my first responder classes almost fifteen years ago. our teachers were all locals back home in my small town in Missouri, people i had known all of my life. the county got a boost in funds for our local ambulance so they hired and trained several of our local moms and summer workers, mostly guys and gals who had nothing to do but go to the quick EMT class and drive. i believe they were not trained much past the basics, just enough to get someone to a hospital alive. and the nearest hospital back home was, and still is about 30 miles away.

i honestly want to do better than that. i will be studying all i can and as hard as i can. 

thanks for the insight guys. i'll be thinking hard on this this weekend while i get ready for those tests, and when i go back later this summer to work on it again on my own.


dave


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## vquintessence (Jun 5, 2009)

Yes, knowing the systems and at least their basic functions will be paramount for your patient as well as your success in the field.  Sure, you may not need it every transport if you're running IFT as a Basic... but it will still be essential.  Wait until you become a medic (which you will... you'll see).

Case:  You are sent to the common EMS call of "altered mental status".  Pt is profoundly lethargic and not anywhere near baseline according to family.  Along with CHF, the pt has a history of CRF (chronic renal failure) and is dialyized 3 times a week.

*So, here is where the cut in quality EMS providers is:*

Will you treat this "old lady" as "every other old person" and just check their BGL and 12 lead and put them on a nasal cannula... or will you use critical thinking and knowledge of human physiology to further assess the pt?

_Clue:  Use a focused assessment and knowledge of the renal system to prompt further questions of the pt!

Focused assessment (thanks to your knowledge of physiology):  Pt was supposed to get dialysis on Friday, but missed appointment because family is visiting... well it's now Monday evening and the pt AGAIN missed another appointment to see their beloved family off at the airport.  Pt also consumes 3 bananas a day with breakfast and lunch.  Oh, and you notice that pt is prescribed Spiralactone.

Working diagnosis:  Due to missing dialysis for days, eating food high in potassium, pt is on a potassium sparing diuretic, and having an ECG tracing showing "peaked t-waves"... would it be reasonable to have a working diagnosis of a hyperkalemic pt?_  (Sorry for being dramatic and providing the silver bullet scenario... need sleep)


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## Shishkabob (Jun 5, 2009)

daedalus said:


> A and P is written into the National Standard Curriculum as a pre requisite. Without it, understanding pathophysiology and pharmacology is difficult at best and impossible at worst. Without knowing pathophys, a and p, and pharm, forming a differential diagnosis and using drug therapy to treat a patient is dangerous at best.
> 
> Most teachers will lecture in manner that expects a student to have a intermediate level command of A&P. The girl next to me took an online A&P and I hear her go "Huh??!!" every day when ADH, first pass metabolism, neuroendocrine relationships, the nervous system, epithelial tissues and membranes, serous fluid, fluid compartments, etc etc etc are discussed.
> 
> If and when I become a medical director, I will not accredit paramedics to practice with out a formal anatomy class under their belts.




I'm not debating the necessity of A&P knowledge or understanding in the slightest, I simply misread his question and answered it with my view--- you don't need A&P class to do well in paramedic school.


Do you need an A&P understanding?  Heck yea, as drugs effect physiology.   Without understanding basics like interstitial fluid, albumin interaction, and stuff like that, you won't know whats going on.


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## Dearing Baymiller (Jun 5, 2009)

vquintessence said:


> Yes, knowing the systems and at least their basic functions will be paramount for your patient as well as your success in the field.  Sure, you may not need it every transport if you're running IFT as a Basic... but it will still be essential.  Wait until you become a medic (which you will... you'll see).
> 
> Case:  You are sent to the common EMS call of "altered mental status".  Pt is profoundly lethargic and not anywhere near baseline according to family.  Along with CHF, the pt has a history of CRF (chronic renal failure) and is dialyized 3 times a week.
> 
> ...




nice. i feel a bit better that i actually understood most of that. 

question, do you do a working diagnosis like that for the ER? 
if so, what do the Dr.'s think of these evaluations?

now i'm getting very curious.  


dave


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## vquintessence (Jun 5, 2009)

Well in all honesty they will take most EMS reports with a large grain of salt... about the size of our fist.  There are just way too many poor EMS providers out there for the MD to take our word for it.

They will recognize the quality providers over time.  However their license took much more education & training to get than our certificates.  :sad:  More often than not they'll come to their own refined diagnosis.  Our satisfaction can perhaps fall into knowing that we potentially influenced their initial work up and the direction it took.


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## daedalus (Jun 7, 2009)

Dearing Baymiller said:


> nice. i feel a bit better that i actually understood most of that.
> 
> question, do you do a working diagnosis like that for the ER?
> if so, what do the Dr.'s think of these evaluations?
> ...


Varies widely between hospitals, MDs, and paramedics. Sometimes the physician will meet you at the door and ask you what you got. Others will blow you off as an idiot. Some academic attending at UCLA actually ask you what you think. One made me explain the rationale, to him and his resident, on why I wanted a glucose stick stat from the triage RN (I was working as an EMT-B)

Most of the time in community hospitals you will give the RN your report and she or he could not care less what you think, but just wants to know the size of the lock you put in.


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## boingo (Jun 7, 2009)

If  you work for a quality system, that places a lot of emphasis on con-ed, with direct physician involvement you will find that the nursing staff as well as the doc's will put a lot of stock in your findings.  Pt's will be directed directly to the OR, cath lab, CT scan etc...based on your report.  If you work somewhere that a pulse is your only requirement for employment, its likely you will be directed to triage every single time.  Incidently, the quality systems tend to hire quality people, ones with college education, a foundation in the sciences, and at the very least A&P.  Also, frequent con-ed, rounds, clinical rotations in various specialties, etc...How great would it be to spend a month with Vent dealing with ventilator management, asthma, copd, and sick ped's?  She might not even bite!  (Might )How many systems require or offer this?  You cannot perform at an advanced level without a foundation in the basics.  Two medics can have the same certification with their individual abilities being night and day.  Sorry, a bit long winded, but take a college level A&P course even if it isn't required, take a year or two of chemistry, biology and micro....some college math wouldn't hurt either, although I would argue if you are competent at algebra you might not need it for medic work, although someone might point out where I may be wrong on that.


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## VentMedic (Jun 7, 2009)

boingo said:


> How great would it be to spend a month with Vent dealing with ventilator management, asthma, copd, and sick ped's? She might not even bite! (Might )


 
Ah gee, I'm blushing.

I do occasionally teach some classes for the medics. I used to do the refreshers but found the attitude towards mandatory classess was less than poor. 

Unfortunately, at some FDs/ambulance services I may only be given an hour to teach everything you need to know about CPAP. This is actually possible at the EMS level if those being taught have a decent A&P background and I don't have to explain very basic things like how the blood goes around and around. 

I absolutely refuse to teach anything at a medic mill since I do not argree with just teaching skills and recipes without some understanding of the science behind them. 



> some college math wouldn't hurt either, although I would argue if you are competent at algebra you might not need it for medic work, although someone might point out where I may be wrong on that.


As far as alegebra is concerned, I absolutely believe it is necessary to improve one's critical thinking skills as well as an understanding of just day to day formulas for drugs and equipment. I personally would not trust anyone to touch a ventilator or ICU drip on CCT if they can not do basic algebra. 

This link provides 4 very basic equations for oxygen and acid-base.
http://www.globalrph.com/martin_4_most.htm

Few are even aware they exist although the Henderson-Hasselbalch equation is discussed at the Paramedic level. But, few take the time to understand it. There are also a whole list of formulas that should be understood to grasp the concepts that are involved in the cardiac system. 

I guess I should be happy some can calculate how much time they have in an O2 tank. This was one of my pet peeves when we used to depend on the local ambulance service to transport our CCT and specialty teams. We would tell them to make sure their main tank had enough O2 for at least 2 hours at 15 l/m with a cushion of 20 l/m and they would show up with an empty K (or J) and two D tanks. Thus, we would do the math for them until we got our own trucks. Now, the drivers from our transport pool have enough college education, even if not in medicine, to understand what we mean when we say we need enough O2.


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## MedicMorgan (Jun 15, 2009)

Ridryder911 said:


> He should say; it makes the difference between and idiot and a medic.
> 
> R/r 911



thats very Coxian of you


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## DHarris52 (Jun 17, 2009)

Dearing Baymiller said:


> hey guys,
> i'm heading into EMT-B this fall, and i'm already taking A&P, and doing pretty good so far. how much of the Anatomy classes do you actually use on the job? obviously the A&P directional terms and etc. , but do you really retain all of the carpal and tarsal bone names? do you tend to forget them over the years, or do you keep independently studying to the point you can name them in your sleep?   just curious to see what to expect in the future.
> 
> thanks!
> ...




Is an extensive A&P knowledge good to have? Sure, it doesn't hurt and could be useful while giving a report to a higher medical authority. Is it necessary? Absolutely not. Anyone who tells you otherwise probably doesn't have a great deal of experience riding a BLS rig. 

Remember - you're a basic, not a doctor. Keep it simple.


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## JPINFV (Jun 17, 2009)

Is it necessary? Well, it depends on if you want to be in the "I give O2 because it doesn't hurt and everyone needs O2 to live" crowd or be in the crowd that knows what they're doing beyond reading a protocol written at an 8th grade level. 

Personally, I like to know what I'm doing and why instead of being in the group that thinks that every patient needs a NRB at 15 l/m.


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## redcrossemt (Jun 17, 2009)

Ridryder911 said:


> pseudo provider


 <= perfect for reports, i.e. "the pseudo providers had *attempted* RSI before our arrival."


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## daedalus (Jun 17, 2009)

DHarris52 said:


> Is an extensive A&P knowledge good to have? Sure, it doesn't hurt and could be useful while giving a report to a higher medical authority. Is it necessary? Absolutely not. Anyone who tells you otherwise probably doesn't have a great deal of experience riding a BLS rig.
> 
> Remember - you're a basic, not a doctor. Keep it simple.



This is the type of thinking that prevents EMS from ever being recognized as a profession. No, do not keep it simple. Every other allied health field has a pretty decent understanding of A&P through actual college classes. 


It is absolutely necessary and I cannot think of how it would not be. You are only selling yourself short if you think that you cannot learn mire anatomy than in your EMT class.


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## VentMedic (Jun 17, 2009)

DHarris52 said:


> Is an extensive A&P knowledge good to have? Sure, it doesn't hurt and could be useful while giving a report to a higher medical authority. Is it necessary? Absolutely not. Anyone who tells you otherwise probably doesn't have a great deal of experience riding a BLS rig.
> 
> Remember - you're a basic, not a doctor. Keep it simple.


 
I really hate to say anything negative about vollies but then not everyone has the same standards for patient care that BossyCow has as a volunteer. 

This post is why many do look down on the volunteer. They don't have time for education or to even consider EMS as a profession so they want to drag it down to their own low standards and expectations for patient care. 

Those who have not taken any classes beyond the 120 hours of EMT class have no idea what they are missing. By also comparing an EMT with a doctor just further shows how removed one is in their knowledge of providing patient care and of medical professionals.


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## ResTech (Jun 18, 2009)

Anatomy & Physiology is very important to have and does a lot to make learning easier since you actually have an understanding of how the body works and enables you to think and put two and two together on your own. 

Now, will you forget a lot of it? yes you will... all the names of the bones and muscles will fade from ur mind... it all goes to the wayside. But the important stuff from A&P you will retain and expand upon. 

If I'm not mistaken, before you can take National Registry Paramedic, you have to have a college level A&P course. Is this correct? I know my program requires A&P I and II.


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## EMTrainer (Jun 19, 2009)

*Knowledge is the foundation of critical thinking*

Learn all the A&P, biochemistry, pharmacology, etc. that you can. You can really tell the medics who come from programs that teach you to pass the test and those who come from programs that strive to graduate competent medical professionals. Remember that what you need to pass the test is the legal minimum you must have before they will let you out on the street. It is nowhere near the level of education that you need to provide the best possible care for your patients.

I sometimes put it to my students this way. "When we bring a trauma code into the ER at our regional Level II Trauma Center, you are met by an ER Physician, an RN, at least two or three specialists, a few technicians from various disciplines, and probably an intern or a student of some kind. Fifteen minutes earlier you were all alone in the back of an ambulance with that same patient. Now how much do you think you need to know?"

We are lucky here, our physicians and ER staffs treat us very well and listen to what we have to contribute, often asking for our input. That didn't come overnight. Our service earned that respect by holding ourselves to high standards of education and professionalism.


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## Dearing Baymiller (Jun 19, 2009)

well next week is the last week of summer class and i'm pulling an A in my Essentials of A&P class. i see where it will be a good foundation to build on for A&P I. i'll be taking that inext spring, and most likely a biology and a chem class. 
assuming all goes well in EMT-B this fall of course.
here's hoping! 

dave


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## EMTrainer (Jun 19, 2009)

*Hang in there*

Hang in there, Dave. It's a lot of work but well worth it. B)


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## Dearing Baymiller (Jun 19, 2009)

heh. i'm actually enjoying the mental challenges so far.
years of factory work had dulled my brain. that sounds a bit dramatic but it's how it felt.

i'm motivated and i'm taking it one semester at a time, one day at a time.
looking forward to tackling what's coming down the pipe.
my EMT-B doesn't start until October, and i've got several classes and some independent studies, on top of my workouts and dieting to get my fat self into shape for the first time in my life, to keep me focused and busy.


i would like to thank everyone here, even those of opposing viewpoints. i've learned a lot here the last few weeks, in what to expect and what will be expected of me, educationally and professionally, assuming i make it.

Dave


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