josh rousseau
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how does what we learn in the classroom vs what we do in the field differ do you guys remember each system and the parts to it?
Classroom vs field
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charliefox42
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When I moved to SC I had to take the NREMT test. I’d been an EMT for almost 30 years at that point, so I was a bit worried that my street experience would cloud my book knowledge. I kept that in mind while studying and taking the test and I passed it with a 97%. I tell you this to say it’s all about the basics - never forget them. Throughout my career I’ve learned a bunch of really cool and useful stuff, but it always boils down to ABC’s, 206+ bones and keeping the pump going.
Josh, I'd say the classroom and the field are two complementary, equally important parts of an EMS education. You need the foundation you get in class as much as you need to continue learning on the job. Whenever I see book-learning belittled, I consider how dangerous we'd be in the field if we only ever learned from our partners. We need a frame of reference, based on vetted literature, that helps us distinguish fact from opinion.
You don't follow such a strict assessment path and you don't blanket treat things like you do in class.
SAMPLE and whatever else are good starting places, but my line of questions for a breathing problem will differ than compared to a chest pain. I know what I want to figure out first with each. Sometimes those two overlap, but I am trying to reach what is usually a different point.
As far as treatments go, not everyone gets a non rebreather, back board, long board splint, etc. You actually get to use your judgment, not a score sheet.
The people who say the streets are completely different aren't right though. You need the foundation of the classroom to be knowledgeable in the field. A provider who can't bag, place an NPA, tourniquet, or other important skills is fairly useless just like one without a knowledge base to effectively treat a patient. How you apply your knowledge in the field though is different.
SAMPLE and whatever else are good starting places, but my line of questions for a breathing problem will differ than compared to a chest pain. I know what I want to figure out first with each. Sometimes those two overlap, but I am trying to reach what is usually a different point.
As far as treatments go, not everyone gets a non rebreather, back board, long board splint, etc. You actually get to use your judgment, not a score sheet.
The people who say the streets are completely different aren't right though. You need the foundation of the classroom to be knowledgeable in the field. A provider who can't bag, place an NPA, tourniquet, or other important skills is fairly useless just like one without a knowledge base to effectively treat a patient. How you apply your knowledge in the field though is different.
Gurby
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I think the big difference is that in real life, the most difficult part of the job is logistics - how efficiently does the call flow from start to finish?
What equipment do we bring in to this call on the 3rd floor? The book answer is to bring everything piece of gear imaginable to every call - but consider that you'll be walking backwards down a windy staircase while carrying that 300lb patient in addition to all the gear you brought in, so choose wisely. The book says start treatment at the bedside - now in addition to all your gear and 300lb patient you have wires and tubes going every which way with a monitor precariously strapped to the patient's lap, and also you've been on scene for 25 minutes now when you could have been halfway to the hospital already otherwise.
It's much easier to walk in, scoop them up, and start treatment in the truck - this is what your partners will likely be used to doing. You get patients to definitive care faster this way. But there is a risk of this burning you/killing the patient. God forbid you show up to that "diabetic emergency" on the 3rd floor thinking you'll scoop and screw, and it turns out it's a cardiac arrest and you didn't bring the airway bag.
Sometimes the best way to approach a call is to take the time to sit on scene, hit every checklist item on the protocol, gently wrap them up in a blanket before extricating. Sometimes you need to pick them up, toss them in the truck, drive fast to the hospital and you barely have time to write down their name and age.
The vast majority of what you learn in the classroom won't be "wrong"... But it takes finesse to learn how and when to apply it.
What equipment do we bring in to this call on the 3rd floor? The book answer is to bring everything piece of gear imaginable to every call - but consider that you'll be walking backwards down a windy staircase while carrying that 300lb patient in addition to all the gear you brought in, so choose wisely. The book says start treatment at the bedside - now in addition to all your gear and 300lb patient you have wires and tubes going every which way with a monitor precariously strapped to the patient's lap, and also you've been on scene for 25 minutes now when you could have been halfway to the hospital already otherwise.
It's much easier to walk in, scoop them up, and start treatment in the truck - this is what your partners will likely be used to doing. You get patients to definitive care faster this way. But there is a risk of this burning you/killing the patient. God forbid you show up to that "diabetic emergency" on the 3rd floor thinking you'll scoop and screw, and it turns out it's a cardiac arrest and you didn't bring the airway bag.
Sometimes the best way to approach a call is to take the time to sit on scene, hit every checklist item on the protocol, gently wrap them up in a blanket before extricating. Sometimes you need to pick them up, toss them in the truck, drive fast to the hospital and you barely have time to write down their name and age.
The vast majority of what you learn in the classroom won't be "wrong"... But it takes finesse to learn how and when to apply it.
josh rousseau
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Thank you guys for the input
IamNomad
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so you don't yell out SCENE SAFETY and BSI on every call?
they were critical fails with my class room calls
lol.
I exchanged parroting that stupid phrase for keeping spare gloves in my radio strap and actually being observant on scene lol.so you don't yell out SCENE SAFETY and BSI on every call?
they were critical fails with my class room calls
lol.
josh rousseau
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I appreciate all the feedback I’m talking like a guy has right upper quadrant pain is peptic ulcer disease gallstones all that **** running through ur head or is keeping him stable the main thing
Suppose you were absolutely certain it was gallstones or a peptic ulcer. How would that change your treatment?
josh rousseau
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I guess it wouldn’t
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Here's the thing: RUQ pain could very well NOT be peptic ulcer disease... could be gallstones, could be pancreatitis, could be colitis, and more! Would it change the treatment you do? From a certain viewpoint, it very well could! This is where the classroom stuff comes face to face with the field. You have to know the clinical stuff to be able to think through the patient assessment and determine what's important and what isn't to the immediate tasks at hand. In a sense, the actual care you provide by doing hands-on stuff may not necessarily change with your assessment findings but if you consider transport (and ultimate destination decision) as a treatment, then you very well could consider that a particular facility isn't all that good at dealing with certain problems and another one is far better equipped to deal with the problem at hand.
For instance, should your patient be pediatric, and your choices are between a hospital that can handle peds workups but doesn't have a peds service in the hospital and you know there's one that does and you think this patient is likely to need to be admitted, knowing "stuff" suddenly becomes important. Your assessment may indicate the patient is more sick than they think so transporting to the hospital that has a peds service might just shorten the time to definitive care considerably.
The more you know and the better you get at doing assessments, the more likely it is you are able to make appropriate decisions about what to do, when to do them, and where to transport for best patient outcomes.