What % of Calls Require ALS?

[triemal04]

Not to pick on your education but you should have learned that all patients need a complete ALS assessment to rule out or in for a proper diagnosis. .

Veneficus allready started to address this, but what the hell, it seems to be one of those hangups that so many people at all levels have, and something that may be contributing to people constantly argueing the same tired crap without getting anywhere.

What exactly is a "complete" ALS assessment? Or plain old assessment for that matter? Is it:

A: Every pt get's a full st of vitals taken (pulse, BP, respiratory rate/depth/quality, lungs sounds, SpO2, ETCO2, skin color/temp/hydration, blood glucose, temp) along with a 12-lead ecg and complete physical exam. Only after this is done can a pt be said to have had a "complete" ALS assessment.

B: Every pt has a medically qualified person look at them, ask pertinent questions, evaluate their responces, ask the appropriate follow-up questions to those responces, and based on that info, checks or does not check the things in A. Despite the lack of using the ALS skills or toys, this is still considered as having a "complete" ALS assessment done, even if nothing more than pulse, BP and respirations are checked due to the knowledge base that is required.

I sincerely hope that everyone with more than the education of a first-grader realizes that the correct answer is B. Otherwise no paramedic should ever be refusing a pt care or even treating a pt...after all, they need a CT, MRI, blood test, x-ray, bronchoscopy, ultrasound etc etc before they can be properly assessed.

 

[Ridryder911]

It is not the letters of the assessment but rather clinical knowledge of the person performing the assessment. Yes, treatment and other clinical tools assist in making a better diagnostic clinical impression.

Sorry, but the EMT is not clinically trained nor educated enough in accordance to their certification or license to be able to accurate screen and make such judgements. I don't care if they have a B.S. or PhD, if using the sole criteria of the level of being an EMT. I even question the Paramedic level as well, although better it is still very, very lacking.

I hoping that the next decade we can see a shift of increasing assessment and quantifiers to clinical impressions and diagnostic capabilities to the Paramedic curriculum. It will be already understood that to be able to do such one will have to have a well thorough academic understanding of medical science.

Now, let's correct the statement :

after all, they need a CT, MRI, blood test, x-ray, bronchoscopy, ultrasound etc etc before they can be properly assessed.

To be correct a thorough assessment should be made prior or in concurrent with those procedures and tests.

R/r 911

 

[triemal04]

To be correct a thorough assessment should be made prior or in concurrent with those procedures and tests.

R/r 911

That's my point more or less. This arguement happens over and over again, often with the same people making the same arguements with no resolution. All I was trying to get across is that it doesn't matter what extra tests are done if it can't be determined that a pt needs them to confirm/rule out a potential diagnosis. And the only way to do that is to have the knowledge to ask the right questions and accurately interpret the answers. As well, giving everyone under the sun every test we can just because we can is ridiculous.

 

[firecoins]

B: Every pt has a medically qualified person look at them, ask pertinent questions, evaluate their responces, ask the appropriate follow-up questions to those responces, and based on that info, checks or does not check the things in A. Despite the lack of using the ALS skills or toys, this is still considered as having a "complete" ALS assessment done, even if nothing more than pulse, BP and respirations are checked due to the knowledge base that is required.

I sincerely hope that everyone with more than the education of a first-grader realizes that the correct answer is B. Otherwise no paramedic should ever be refusing a pt care or even treating a pt...after all, they need a CT, MRI, blood test, x-ray, bronchoscopy, ultrasound etc etc before they can be properly assessed.

B is what I had in mind.

 

[Veneficus]

Yes, because there are NO EMT-Bs on the planet who can form a provider impression based on history, patient's complaints/symptoms, baseline vital signs, mechanism of injury, etc. because all we're taught is a pathetic pnemonic. Hell, I guess I should just forfeit my spot as a full-time EMT-B on a medic unit that I worked my hindquarters off for over a year to get simply because I am incapable of making any clinical decision simply because I don't have those nine magic letters on my shoulder. I'll give it to a paramedic, since we have an overabundance of them. There's no reason I should even exist in healthcare.

Provider impression as in stable or unstable? How about compensating vs. not compensating?

First off, there are medics who cannot perform a decent history and physical exam because all they know is a mnemonic at a mill somewhere so let us not compare ability to title as that can be quite faulty.

Additionally there is more than one basic in the world who is working towards higher education in several fields who are formally educated to things such as physiology, pathophysiology, biochemistry, and many other basic sciences that have medical relevance. (above some medics I should add) However, the national standard curriculums for EMT-B as well as certification bodies does not incorporate or allow for advanced practice based on coursework from other disciplines.

It is a mistake to equate experience with education. With experience you know and learn only from what you see. With education you can learn from what hasn’t been seen yet or can be deduced.

Permit me to explore making dx based on:

History: How many providers have you regularly seen ask a patient a social history, sexual history, or family history? All of these are pertinent to any complaint to rule out or include for possible dx.

Patient complaints/symptoms: Such as referred pain? Vague statement like “difficulty breathing” that falsely implies a mechanical problem? Abd pain? How much time did spend in class learning how to differentiate abdominal findings? How much time in continuing education or under a mentor in the field?

Baseline vitals: Do you think that baseline is what is printed in text books? What about baseline for different stages of chronic diseases? What about multiple diseases?

Mechanism of injury: By itself is unreliable. It is also influenced by all the above topics.

There are 959 pages + 30 pages of index in Brady Emergency Care,(the very title is generous compared to the content) detailing everything from What an EMT is to skill sheets. There are 12 pages devoted to history. Of those, 2 have less than ½ page of print devoted to the topic. I just did a brief review of chapter 28. (musculoskeletal) At no point in the whole chapter did it even mention the major life threatening orthopedic complication of an injury. That would seem kind of important for that chapter don’t you think? As there is only 1, you think they could have fit it in. But I will accept that some may have picked that up during a year of employment. But how many? 5% of basics?(it is not that common) Let’s call it 25% to be fair. That would mean 75% of basics do not even know it exists, that makes it hard to identify a life threatening complication. That is all I care to look up to illustrate.

You may be the best basic to ever walk the earth. I have no intention on getting into a pissing contest about what we both know or don’t. In fact I have made special effort to make sure I did not call your knowledge into question with this post. Having offered some miniscule amount of evidence on the lack of knowledge any given basic might have compared to the vastness many do not. My opinion still stands. The certification level as a whole is not capable of making sound clinical decisions, even if a few individuals who are of that level are. BLS and ALS assessment should be stricken from any further discussion in favor of “assessment” by those who can incorporate basic understanding of medical science, not just perform a skill check sheet. (no matter what level they are at)

 

[Shishkabob]

This is the part I think some of you are failing to understand, and yes, I mean FAILING.

We all understand that Basics are taught less, and less is required to be certified as one. We understand that, you don't need to bring it up in every single thread.

But what YOU fail to understand is not all basics can be grouped together in lack of knowledge. Just like you would throw a hissy-fit if someone compared you to being akin to a medic from a medic mill, I detest anyone ignorant enough to make assumptions about me and my level of intelligence simply because of the B that follows my EMT.

You can attack the requirements all you want, but you insult my own personal intelligence, and my own hard work, then you will be corrected and put in your place.




I might personally think that MFR's don't have any real use, but I don't talk down to them or about them. I don't insult their intelligence. That's something some of you medics have yet to get through your heads.


You're adults, and you arrogantly proclaim your intelligence every chance you get. Well, here's your chance to use it, and use it to discern those that have limited intelligence from those that have an abudance, not because of the letters of their certification, but based on their actual intelligence.

I have yet to meet an EMT that says basics are taught enough. But I've met more then enough medics who make it their mission to bring it up every chance they get to belittle basics.

 

[EMTinNEPA]

Veneficus

I fully admit that the bare minimum educational requirements for EMT-Basics are pathetic. That is why I am getting into education myself, to make sure that at least SOME students are taught more than the bare minimum. Thank you for being cordial with your last post. It doesn't bother me when you say that the educational requirements for EMT-B are lacking, because this is a matter of fact. What bothers me is statements made by would-be "paragods" that imply that all EMT-Bs are unfit to be in medicine. Just like all blanket statements bother me. I appreciate the effort you made to be non-confrontational.

To answer some questions....

I routinely take a family and social history, as well as inquiring as to whether or not the patient uses or has ever used any complimentary or alternative medicine.

Roughly 50% of our class time was dedicated to assessment and/or clinical decision making.

We were taught only to distinguish between stable and unstable baseline vitals. I have taken it upon myself, through self study and continuing education, to learn specific vital signs for specific diseases, conditions, and disorders.

Now I admit, I'm not a paramedic, and I certainly am not a doctor, but lumping all basics under the same umbrella is an injustice to the work some of us have put into being a huge asset to our paramedic partner.

As someone once told me, semantics are important on internet forums. Your words are all we have to go on. If you say "Basics" without any kind of qualifier in front of it instead of "most Basics", it is likely that many will assume you mean "all Basics.

 

[ffemt8978]

It's time for a thread time out....