Are critical point charts or algorithms not taught anymore?

[mycrofft]

Some time, sit down and do a yes/no flowchart (algorithm) for some medical condition. Use a big graph paper, like a ledger page. Start with c/o to 911 dispatch, then the on-scene presenting s/s/complaints. Follow one set of s/s/c (or "working diagnosis") through eval steps and treatments twice; once by protocol and once by "common sense". All end-point treatments in the "by protocol" version have to be in accordance with protocols, including transport. Then go back and insert little notes as to likely elapsed time.

Compare.

The disconnect between what can be done in toto, and what can be done which supports an effective treatment and outcome, will differ; the latter will usually be shorter, quicker, and may include more being done enroute.

Then review the common sense diagram and ask yourself about every measure you take, "Does this support the endpoint goal?".

Thoughts?

 

[Carlos Danger]

I'm having trouble visualizing what you are describing. Can you link to an example?

 

[mycrofft]

This is close, a modified flow chart as I was taught. Each diamond decision node should be broken down into yes/no. This type works well once basic assumptions are proven.

Just an exercise which leads to exasperating dead-ends when certain data is gathered or preparations made which do not contribute to the goal of the process and start to divert resources (including time) from the "right path".

For instance, blood glucose on every patient (looking for ALOC 2nd to elevated or depressed blood sugars). Defibrillator for every dyspneic asthmatic (SOB and potential "cardiac asthma"). Spineboard for every patient who fell down from standing. Etc.
Forcing people to break down decision trees into yes/no can also revel sidetracks in other things, like dispatch systems, encounter forms, carried equipment.

 

[abckidsmom]

I don't think many situations are that black and white. I tend to just work off of clinical judgment and I teach my students that way too.

I never could remember all the little intersections of those charts.

 

[EMDispatch]

The dispatch algorithms are in my humble opinion is too cumbersome. The IAED has attempted to expand the role of the EMD, which is an admirable goal and a logical step. but, the end results are not perfect. it results in crazy shunts, and move-arounds which force extended call taking time.

Perfect example; I had a caller last night with past occurred (9+day) assault injuries Cc of back pain.... After almost wrapping the interrogation, I'm obligated to ask about chest pain. The system takes his positive response (he had his *** kicked... of course it hurt) and shot me the beginning of the entire chest pain dispatch protocols. Which resulted in a waste of time, and quire frankly an inappropriate dispatch code that I'm not allowed to alter.

 

[socalmedic]

no, cookbook medicine is no longer taught. we teach that every patient is gray, not black and not white. unless of course you are in Los Angeles or Orange county, they get to dray cute little pictures on their 6 layer carbon copy form.

 

[NomadicMedic]

More ridiculous cookbook medicine.

 

[Carlos Danger]

"Protocol" does not = "cookbook medicine".

Protocols are used at every level of medicine, and the concept of using prompts to ensure recall of critical actions in stressful situations is getting more and more traction in the fields of anesthesia and emergency medicine. I don't think EMS is above it....

Flowcharts are also, as mycrofft points out, very useful for planning and for conceptualizing ways to streamline processes. They are heavily used in the engineering and system design fields.

Plus, let's be honest: paramedics don't practice medicine, anyway. Most of us have a minimum of education to do what we do, and we practice within a very narrow scope for a reason. We are not too smart to rely on protocols.

 

[Trashtruck]

Amen to that!

 

[Trashtruck]

Plus, let's be honest: paramedics don't practice medicine, anyway. Most of us have a minimum of education to do what we do, and we practice within a very narrow scope for a reason. We are not too smart to rely on protocols.

This.

 

[NomadicMedic]

Utilizing a flowchart is far different than following protocols. I see protocols as the accepted course of treatment for a specific issue. In my system, Paramedics are expected to be fluid with their treatment, easily moving from one condition to the next ... something that tightly constrained yes/no boxes don't allow. Patients rarely follow one protocol, often requiring bits and pieces from several to effectively treat their conditions.

It's an established fact that paramedics lack a great deal of education. You'll get no argument from me there. I like to say our knowledge is an inch deep but 50 yards wide. In most cases, we know just enough about a few things to be good for the first 10 minutes. But an experienced medic has the skill and ability to fluidly move through protocols, treating what's appropriate… not just the next check box on the flow chart.

I never said that paramedics were too good for protocols, but I do expect paramedics to be able to follow the recipe without having to have the book open in front of them, moving from checkbox to checkbox.

When was the last time you pulled out those ACLS flowcharts on a code?

 

[mycrofft]

My point was missed.

I think flow charts or algorithms are the logical outline which allow you to try to prove or disprove a flow of events. Memorizing them is hard and tends to fossilize their weak points as well as their truths (same process as that which gave us universal backboarding).

I am NOT proposing teaching people to memorize algorithms unless it suits their learning style and they understand that these are just a tool. I am proposing that a tool you can use to logically and cheaply model reality and test it for flaws and contradictions is worthwhile to teach and learn.

HAS anyone been taught how to use this sort of model, or is it passe'? They used to sell templates to use with a pencil and paper. Now you can get software, but the stuff I've seen is crap.

 

[mycrofft]

I take it the answer is:

no.​

 

[EMDispatch]

I am NOT proposing teaching people to memorize algorithms unless it suits their learning style and they understand that these are just a tool. I am proposing that a tool you can use to logically and cheaply model reality and test it for flaws and contradictions is worthwhile to teach and learn.

HAS anyone been taught how to use this sort of model, or is it passe'? They used to sell templates to use with a pencil and paper. Now you can get software, but the stuff I've seen is crap.

I've been taught their use and development outside of EMS in systems analysis and Discrete Event Simulation Modeling, though that model involved EMS. I'd go out on a limb and say that outside of a higher ed curriculum they really aren't being taught, because they just aren't deemed practical,

In my EMT course, and even in our state protocol books, the algorithms are displayed. In my class we used the them early in our practical training as a visual aid, but they quickly were phased out once we understood the flow of handling an event.

 

[mycrofft]

I've been taught their use and development outside of EMS in systems analysis and Discrete Event Simulation Modeling, though that model involved EMS. I'd go out on a limb and say that outside of a higher ed curriculum they really aren't being taught, because they just aren't deemed practical,

In my EMT course, and even in our state protocol books, the algorithms are displayed. In my class we used the them early in our practical training as a visual aid, but they quickly were phased out once we understood the flow of handling an event.

Cool!

Some people respond well to the exercise. Requiring them (forcing them) to make it all yes/no responses (at least initially) can be an eye opener...if they don't get p.o.'ed and throw it down. (Get the same response when you use it to refute someone's cherished plan. Sometimes they go "hey!" and other times they just go "!!!".

 

[EpiEMS]

Protocols: Good guide for beginners, not the worst reference tool, but by no means a substitute for good clinical judgement (which I do not quite yet possess).