Fresh Meat

shiroun

Forum Lieutenant
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Hey everyone! I'm in an EMT-B Accelerated course that finishes up in the middle of August. I'm getting into a volunteer fire department near-by in the next few days (family friends are getting me a ride-along for as long as I want).

Now, I just have a few questions and statements to make, and would love some reflections on them.

I feel like this class doesn't prepare you at ALL for the job. Everything is step-by-step in class, when in reality you do multiple things at once. BSI, Scene size up, and the rest of the inital assessment only takes a few moments in a lot of cases (i.e, when I came up on a scene where a guy was tossed out the front windshield of his flaming car, right into a tree), whereas in class it takes minutes on end to do.

The same applies for everything else, barring CPR. We would do rapid trauma assessments in class, and it could take upwards of 4 minutes to do, meanwhile we should already have the pt packaged up, atleast mostly, and get ready to go.

And for that matter, why does it seem that tension pneumothorax and flail chest are the only two real trauma scenarios we're given to deal with. Are they that common in MVAs and falls?

My point mostly is, does this class actually prepare you for what you're going to deal with? Or is it mostly just teaching you what gear is, and what its for, and then experience shows you how to use it?

Appreciate the reading guys, sorry if it's a bit scattered.
 

joegrizzly

Forum Crew Member
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Posting from my phone so my reply is going to brief. Not to be harsh but in my opinion you seriously need a new perspective on your current course. There is brilliance in the basics. The EMT course is designed to give you the knowledge and the steps by the numbers so you can properly assess then treat your patient within your scope of practice. It should take you 5 minutes to do a by the book, full assessment right now. I'm time you will get the expierence and skill to cut that time but can still rock out a solid primary and secondary survey. My two cents, please do not write off the class as a joke because it may not be the way you are seeing it done in your ride alongs right now. In time it will all make sense. Just because the class isn't addressing all the "what if the PT hit a tree at 100 mph, then burst into flames, with a compound femur fracture, and then was attacked by a bald eagle" questions, does not mean it is not giving you the basic skills to properly perform your job, as an EMT-BASIC.
 

bigbaldguy

Former medic seven years 911 service in houston
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Give it time. It will all start to come together. The basic course is just that, basic. Continue studying, continue learning, and continue growing as a provider during and after class. If you find the information you learn in the class insufficient take it as an excuse to follow up and research the areas you feel are substandard yourself. You have already taken an excellent first step in coming here to EMTLIFE where you will find many of the answers.

Welcome to EMTLIFE.
 

DesertMedic66

Forum Troll
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I feel like this class doesn't prepare you at ALL for the job. Everything is step-by-step in class, when in reality you do multiple things at once. BSI, Scene size up, and the rest of the inital assessment only takes a few moments in a lot of cases (i.e, when I came up on a scene where a guy was tossed out the front windshield of his flaming car, right into a tree), whereas in class it takes minutes on end to do.

The same applies for everything else, barring CPR. We would do rapid trauma assessments in class, and it could take upwards of 4 minutes to do, meanwhile we should already have the pt packaged up, atleast mostly, and get ready to go.

And for that matter, why does it seem that tension pneumothorax and flail chest are the only two real trauma scenarios we're given to deal with. Are they that common in MVAs and falls?

My point mostly is, does this class actually prepare you for what you're going to deal with? Or is it mostly just teaching you what gear is, and what its for, and then experience shows you how to use it?

Appreciate the reading guys, sorry if it's a bit scattered.

You have to start off learning everything step by step before you can start multitasking. Did you learn to talk and walk at the same time or did you first learn how to talk and then learned how to walk?

In class it takes time to do the scene size up and scene safety because you are just learning about it and what somethings are to look out for. You also take time in class on scene safety to make sure you actually grasp the concept.

A trauma assessment does take a little bit of time. It's not just "there is the patient, let's strap them down and go". You have to find out what is wrong with the patient. It's not a good thing to show up to the hospital with a trauma patient and say "I don't know what's wrong with the patient because I didn't do an assessment". The assessment may also change some of your treatments.

As for your class only having tension pneumos and flail chest is all based on your instructors. Ask them to change it up. Sometimes classes will have set scenarios that they us. (my college has these set scenarios so I am in the process of writing out new trauma and medical scenarios).
 

JPINFV

Gadfly
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I feel like this class doesn't prepare you at ALL for the job. Everything is step-by-step in class, when in reality you do multiple things at once. BSI, Scene size up, and the rest of the inital assessment only takes a few moments in a lot of cases (i.e, when I came up on a scene where a guy was tossed out the front windshield of his flaming car, right into a tree), whereas in class it takes minutes on end to do.

...because it's easier to test that way. A lot of things are subtle clues. I've never walked on scene and said, "BSI, scene safety, twiddle dee, twiddle dum" but that doesn't mean I wasn't thinking about them and continuing to think about it. Similarly there's a lot that you can pick up just by looking at the patient (I call it a "doorway assessment"). However without forcing you to specifically ask about the breathing status, how is the proctor to know that you thought about it. After all, it doesn't take much time to qualify breathing as too fast, too slow, or about right, labored/non-labored, and high, low, or about normal tidal volume.

And for that matter, why does it seem that tension pneumothorax and flail chest are the only two real trauma scenarios we're given to deal with. Are they that common in MVAs and falls?
Because "77 y/o female with Alzheimer disease fell 2 hours, was helped back to bed or wheel chair and currently denies back pain or tenderness, but the facility wants you to transport anyways because it's their policy" is rather boring, repetitive, and generally requires no intervention. It's, however, much more likely of a scenario to be faced.

My point mostly is, does this class actually prepare you for what you're going to deal with? Or is it mostly just teaching you what gear is, and what its for, and then experience shows you how to use it?

No, it doesn't prepare you for what most EMTs do, and at the level actually expected of most providers. However it is what it is, which is what's important to a student. After all, you can't effect EMS if you're on the outside looking in.
 
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AnthonyM83

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The reason everything takes so long in class is because you have to verbalize it all. Why? There's no other way to know if you're actually observing and processing each thing. If instructors could "hear" your inner monologue, they could tell that you acknowledged the patient had an open airway due to speaking without difficultly (etc).

Without knowing your inner monologue, you might assess a patient, but it's luck that you passed, because the patient didn't have a life-threatening airway condition in that specific scenario.

Toward the end of class, a lot of programs start throwing in more realistic scenarios and sometimes cut out the verbalization of each step. But if that was done at the beginning, the assessment would turn into a mess.

This comes to light when students do their ride-alongs. Put students in front of a patient with some sort of exciting/distracting/worrisome condition for the first time, and EVERY time (that I'VE witnessed), the patient care algorithm and ABC's go out the window. The student gets sucked into the patient's panicked reality and considerations for pausing to take a general impression, c-spine, airway, oxygen, go OUT the window!

You also must have the "order of operations" ingrained in your head. While you might multi-task or even switch orders based on judgement, you MUST know your baseline order of importance, so that you REALIZE when you're deviating, so you remember to get back to baseline at some point.

Also, with limited hours in an EMT class, we have to triage what we teach. Believe me it's a LOT more fun to give you more complex and realistic scenarios, even acting as patients who are too anxious to verbalize a chief complaint, BUT it would be doing you a disservice.

You'll get taught how to multi-task when you start in the field, either by your field training officer, your partner, or by yourself through experience. **But RARELY will people take the time to teach you the more conservative basics once you're out of of school. This is your best chance to truly get them down.**

Does this make sense?
 

Sandog

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...because it's easier to test that way. A lot of things are subtle clues. I've never walked on scene and said, "BSI, scene safety, twiddle dee, twiddle dum" but that doesn't mean I wasn't thinking about them and continuing to think about it. Similarly there's a lot that you can pick up just by looking at the patient (I call it a "doorway assessment"). However without forcing you to specifically ask about the breathing status, how is the proctor to know that you thought about it. After all, it doesn't take much time to qualify breathing as too fast, too slow, or about right, labored/non-labored, and high, low, or about normal tidal volume.

Exactly. Well put.
 

AlphaButch

Forum Lieutenant
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Slow is Smooth
Smooth is Fast

Get the processes down first. Your class should be teaching you the skills and fundamentals required of the job, not how to do the job. You'll learn the multi-tasking and the process will be faster with good training officers and experience (hopefully, some never get it down).

Crawl before you walk. Walk before you Run.

Learn the basic knowledge and steps well enough that it's second nature to you. As Anthony said, and I see it alot myself, if you don't know your baseline order of operations, you will get sidetracked and deviate.

I have new recruits verbalize to me their thought process during calls all the time. I'm not psychic and it's the only way to know that they're on the ball.
 

Veneficus

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I feel like this class doesn't prepare you at ALL for the job. Everything is step-by-step in class, when in reality you do multiple things at once. BSI, Scene size up, and the rest of the inital assessment only takes a few moments in a lot of cases (i.e, when I came up on a scene where a guy was tossed out the front windshield of his flaming car, right into a tree), whereas in class it takes minutes on end to do.

I have said it many times, speed does not build accuracy. Accuracy builds speed.

You do it step by step in class at a slow pace to make sure you are doing it right.

Eventually the proper way will be trained into you.

You definately do not want to build habbits that are not correct that you will have to unlearn later, it is much harder that way.

Slow down, even on ride alongs. It is much more important to be right than fast.

And for that matter, why does it seem that tension pneumothorax and flail chest are the only two real trauma scenarios we're given to deal with. Are they that common in MVAs and falls?.

They are actually not that common at all. But that is the point, so in the rare chance you see it, you know what you are looking at.

These 2 things ad control of bleeding are the few life threatening trauma conditions that can be dealt with at the EMS level.

My point mostly is, does this class actually prepare you for what you're going to deal with? Or is it mostly just teaching you what gear is, and what its for, and then experience shows you how to use it?.

The simple answer is: No it doesn't.

It was designed in a time when people didn't know as much as we do now about medicine.

In the modern western world, the only 2 things that don't take years to kill you are poisoning and trauma.

Most of what you will see in the real world is chronic conditions that are momentarily exacerbated. That is the reality and forseeable future of human disease.

Your class basically trains you for emergencies and not for what a majority of your patients are. That is why it is so short compared to nursing, medicine, etc.
 
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shiroun

Forum Lieutenant
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I'm going to give a general reply, since quoting all of you is going to be a bit overcomplicated.

I didn't mean to come off as saying the class is useless. I failed to state that we've done patient assessment, both medical and trauma, quite a bit. To the point where the instructors don't need to stop us every step, and instead only bridge a few hiccups in the process.

It feels as though we should be focus on efficiency with our time with it. Granted, medical can take more time (as someone who's got a broken wrist is still going to have a broken wrist in 5 minutes), but trauma (i.e. bleeding out) should be sped up.

I don't know, I just have some concerns with it I guess. It might just be nerves about this, and wanting to be better trained.

Regardless, I appreciate the insight you guys are providing.
 

DesertMedic66

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It feels as though we should be focus on efficiency with our time with it. Granted, medical can take more time (as someone who's got a broken wrist is still going to have a broken wrist in 5 minutes), but trauma (i.e. bleeding out) should be sped up.

You will learn to become more efficient as you spend time being an EMT. Like others have said the class is just to teach you. It's to make sure you are doing it right. Things will become quicker the more you do it.

I notice a huge difference in time with trauma assessment in students. From the first time they are actually able to do the whole assessment it takes 10+ minutes. By the time they graduate the course (16 weeks later for my college) their times are down to well under 5 minutes but still meeting and exceeding the NREMT standards for the trauma assessment.
 

STXmedic

Forum Burnout
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Don't get too focused on speed and going fast. EMS isn't as dramatic and time sensitive as its made out to be. There are very few time-critical patients. I have to teach far more new providers to slow down than I have to nudge to speed up. As vene said previously, speed does not build accuracy.
 

Veneficus

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It feels as though we should be focus on efficiency with our time with it. Granted, medical can take more time (as someone who's got a broken wrist is still going to have a broken wrist in 5 minutes), but trauma (i.e. bleeding out) should be sped up..

A broken wrist is still trauma.

There is far more orthopedic trauma than vascular trauma.

I think that you may have been given an oversimplified understanding of trauma.

While hemostasis is definately an important part of it, there is much more.

Think about how long your response is, from first report to at patient side. Now you have to identify the source of major hemorrhage, which is not always easy to do. Particularly with multiple wounds, in the dark, and all manner of environments EMS finds bleeding people in.

As well, somebody who has suffered major blood loss may self stabilize. Simply there is more to it than showing up and applying some pressure.
 
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