How can you decide what treatment path to go down without forming a differential diagnosis? ... EMS doesn't diagnose is bull:censored::censored::censored::censored:.
I agree EMTs aren't going to do a whole lot but there are plenty of rural systems that give them a wider scope than many are used to. Ask TransportJockey about his protocols at his old agency for EMTs...
It may
seem like BS, but that is also what every EMT brought up on malpractice says ("This is buh:censored::censored::censored::censored:, man!"). It's like your 12 year old driving the family car to and from the 7-11 on Sunday mornings for a pop and chips, s'all good til something real happens.
Actually, to make a
medical diagnosis with only a technician certificate in most states is illegal. Protocols which are organized under medical diagnosis rather than organ systems or complaints/symptoms (which demands a medical diagnosis in advance) are inadequate. Same for nurses' standardized procedures, by the way. Best yet, ask your EMSA.
Open your EMT text and find the word "differential diagnosis" anywhere in it. Look at your textbook's chapter titles.
Flip to the table of contents of your protocols. If it says "CHF", "COPD", SPIRAL FRACTURE OF THE ULNA", then it is out of bounds. If it says "INJURIES OF THE UPPER EXTREMITY" or "BLUNT TRAUMA/HEAD" or some such, then it is working.
Now,
if the pt gives a history of a medical condition (e.g., "I'm a diabetic and I didn't eat supper"), the protocol may allow or dictate some divergence, but again as a technician you are bound by protocol except the situations where the protocol just doesn't make sense.
I remember the days of being an EMT and proudly turning over patients with our diagnoses to the ER staff. Later, I worked as a RN in an ER. We would watch the EMT's walk off and we would sit and talk about their armchair diagnoses which did them nothing except lead them to the brink of treatment error.
Yeah we make a mental or provisional diagnosis in our head to help focus assessment, but when it comes right down to it you give oxygen, traction splint, and
do anything above basic first aid
on the basis of a protocol and protocols must be based upon symptoms and signs and history, not your making a professional diagnosis.
Rural folks need a much wider scope of training and protocol due to delayed arrivals and longer return times. (What they need are more hospitals). University of North Carolina is working on a two year bridge for Special Forces medics to become PA's to serve rural and underserved areas, but you can bet some MD will be countersigning and overseeing their work. If your protocols' authors (typically includes medical controller unless they are really negligent and derelict) choose to take you out of the NHTSA guidelines
and your EMSA approves it, get and document the training, and go for it.
Cry as we might, that's the basic truth.
PS: Some people will find their protocols work fine, others always find items to except them from following them. Remember that as soon as you step off that path, your employer and your EMSA have washed their hands of you. You may be "allowed" to go off-protocol when something goes sideways, but if the protocols are any good, that won't be often unless you are an armchair physician.
