Theory vs. Practice

[steveshurtleff]

Apologies if this has been asked before, or if it (re)opens a can of worms.

How different does actual field work tend to be from what is taught/learned in the classroom? I'm skeptical that the theory would even apply most of the time, much less all the time.

As a frame of reference, our text is Limmer and O'Keefe's Emergency Care 11th Ed., Brady Books

 

[usalsfyre]

I use theory and understanding of physiology in my practice on every patient. If you don't understand the theory you will be nothing other than a cookbook following protocol monkey.

The EMT-Basic curriculum is so thin on theory anyway I'm not sure how you think you could eliminate any more from it and still care for patients.

 

[MrBrown]

Not every patient requires oxygen

Those who do invariably do not require fifteen litres on a non rebreathing mask

Patients only require a cannulae inserted if they have an actual or likely need for IV fluids or medicine

Inserting a drip does not require you to hang a bag of fluid, a saline lock is sufficient

Only those patients with compromise from an arrythmia require the arrythmia terminated, unless its VT, somebody with a fast AF or slow block who is skipping around the living room is just fine for the 20 minutes you have him.

Nana who has a dishwasher for lungs might have pneumonia or a chest infection, its not automatically CHF and does not require frusemide straight away, and even if it is, probably does not require frusemide

The down and out diabetic is better served by 1mg of IM glucagon than shoving a drip in her, tissuing it and causing a black arm from that old school 50% dextrose

Somebody who is sitting down and bradycardic won't die coz thier heart stopped if you stand them up

.... and so forth

 

[Veneficus]

Non scholae sed vitae discimus

Every part of medical theory, including the basic sciences required to understand medicine is applicable to every patient you see.

When memorizing disconjoined facts which is what US EMS class really is no matter how great the program or instructor, it may be considerably difficult to understand why or how.

As well as learning the theory, somebody has to show you how to apply it, and you actually have to practice doing it.

Sadly there are few instructors who can do that as well as few programs that dedicate the time.

It is never theory that is deficent, it is only the understanding of it.

 

[steveshurtleff]

Sounds like it's kind of like the IT field's A+ rating. Earning it means you are ready to start learning.

 

[MrBrown]

Sounds like it's kind of like the IT field's A+ rating. Earning it means you are ready to start learning.

Brown, A+, N+, MCP agrees

Brown woke up one day and realised Brown did not like the IT industry

 

[mgr22]

Ideally, EMS providers would master theory in classrooms -- with the help of instructors who've already done that, and know how to communicate and reinforce what they've learned -- then start to acquire the "art" -- e.g. instinct, "big-picture" evaluation, risk assessment, etc. -- through field experience. Progress is tough to measure, because our profession doesn't do a good job of quantifying the quality of care we provide.

 

[mcdonl]

My experience is that the education in the classroom is refreshingly applicable in the field.

The problem is with the protocols. They all assume the worst case scenario and too many treatments are provided because the little book tells you too.

My chief told me something, that stuck with me and has helped save some patients from procedures they didnt need... he said... "The first 100 IV's I did were for ME, the rest were for the patient...."

Everytime I am faced with a potential IV now, I think of those words and I have passed on doing a couple because there was no clinicl merit in performing one.

 

[ZombieEMT]

In my opinion and experience, what is taught in the classroom and theory prepares you with the knowledge for the streets. Once you actually get on the street, somethings are not always as simple as what a book has printed. Sometimes you need to use critical thinking to solve an issue and really help a patient. Little things like using a KED as a pedi board when one is not available or a BP cuff as a tourniquet are things I have learned on the street, not taught in class. Class rooms also do not teach you how to talk to people, that comes with experience. Basically it all comes down to using what you learned but also having the ability to adapt when needed.