Patient Assessment algorythm

[Adam Swartz]

Ok so here is my question. I have been transported a few times and it seems that in class they teach us a completely different algorythm than in the field. Why do they do it that way? Like they tell us don't take vitals first. What is the reasoning there? Thanks in advance.

[JPINFV]

I think that the first thing to understand is that there is the book, and then reality. This isn't to say that classwork is unimportant, reinforce the cliche that 'the real learning happens in the field' or undervalue the ideal method, but an acknowledgment that patients don't always fit neatly into the ideal. In addition, medicine is an art in addition to a science. Just because one provider does it differently than another doesn't automatically mean that either is right or wrong. Are there right ways to do an assessment? Sure. Are there wrong ways? Definitely. Is any variation at all bad? Not necessarily.

Personally, my assessment order is based in part off of the chief complaint (i.e. if the call is for hypotension, I'll move getting a blood pressure up a little further on the priority list), but largely off of what information I've been able to obtain. You don't have to be at the patient's side to start an assessment. Your assessment should instead start as soon as you can see the patient. Is the patient moving? Breathing? Is the patient having an obvious difficulty breathing? If your patient is breathing 40 times a minute with great difficulty, you shouldn't need a stethoscope.

So I think your confusion stems from not understanding the more subtle clues that can guide a providers assessment and treatment from before they even reach the patient's side as well as trying to fit all patients, and their associated assessments, in the same box.

[KSEMT122]

Adam, Welcome to the world of EMS. Your teacher will more than likely tell you on the last day "Now toss everything I've said out the window, your real education begins today". It is a fact that the way the textbook says to do things is different in part from how you do them in the field. The textbook is a good guide though, for when you first start and are still learning the basics. You will develop your own style as things progress. It doesn't mean you're not doing things correctly. It just means you've found a more efficient way to assess someone. The goal in EMS is to treat and transport as quickly as possible. So multi-tasking is big in EMS. Such as one partner conducting an assessment on the patient while the other is checking vitals and hooking up the monitor.

Just calm down and enjoy the ride. It's a fun one. And remember to always keep learning new things every day for the rest of your EMS career. Never think you've learned it all.

[Ems1997]

I do the same thing also i start my assement as soon as i walk in. Then i go from there as to what the pt is complainin about. I treat what I find then report that to med control. I call out for als if I need it. I was like you when i first got in to this feild. Now I have slowed down a little bit and learned alot from my fellow partners. I am still learnin to this very day adn i watch how others do things and ask questions when i am un sure or dont understand something. But ppl here like to train and teach others on how to do things. So sit back and enjoy the ride. After you take you nationals then through what you learned out the window that was taught in class. Now the real fun begins. BUT dotn forget your s/s that you were taught . any way god luck

[firedoc5]

What I've wound up doing is using the book as a guideline. You need to work out your own system in assessment. Make sure what you do covers anything and everything. If you work with a certain partner(s), work out a system together. That way if something comes up and either one of you get distracted, the other one can take up where the assessment was left off and finish the same way. Team work is important.

If I remember right, "The Arkansas College of Emergency Physicians" is a good book to start. I believe that is what the title is.

Anyone help me on this?

[explenture]

If you walk in and the pt. is speaking to you, you check a radial pulse it's strong and non tachy why then you've done A/B/C that fast.......seemingly in class every scenario has a real sickness ie... chest pain or sob or fremur fracture....but sometimes it is a lady who fell down moving a fan and the assesment can proceed rapidly and without as many forks as a 'classroom'sick person.

[AnthonyM83]

You've been around this site for awhile now...you know how many providers get stuck in the straight line step by step thinking...don't fall for it.

Now, my personal belief is that the classroom can teach the field way. You don't need to throw anything out. You simply teach students that this is your core algorithm and depending on circumstances/resources, these are the reason you'll deviate from them and why.

In general, I think I function pretty close to the algorithm...BSI is automatic...I always survey scene as I get out and enter a room and look around, get general impression...ABC's, etc.

I definitely combine them, but an initial algorithm helps students a lot by giving them a framework and not overwhelming them, then letting them decide how to combine different steps b/c they know the core of what they're doing.

[chbare]

This is why I think the whole NREMT psychomotor skill stations are of little use. We simply cannot expect to treat every patient the exact same way, yet you are expected and taught to treat every situation the same way.

I can see how people can have difficulty translating didactic knowledge into delivery of patient care.

Take care,

chbare.

[AnthonyM83]

I think the skills stations are of great use, personally. They need to learn a flow and a core.

The problem comes when schools don't give students a chance to be dynamic with their assessments and scenarios. With the short course times, I can see how it's hard to fit it in, though. You can hardly get students to remember pertinent questions for child birth patient in that little time, much less provide various scenarios where they can deviate from core algorithm.

If EMT had a stronger field/internship component, this is where they could practice this stuff.

There are certain things they need to remember and do early on, like recognizing a patient needs ALS or applying O2. There needs to be a way to grade these things.

[AMESEMT]

Adam-

I can relate. Really pay attention to when the medic/EMT asks questions. They will ask everything you have learned but in a different order. They have adapted what they have learned (the book way) to fit them and to fit the situation. You also have to remember that in the field if you are the medic, you might have an EMT-B partner who will take the vitals for you at the same time you are getting a history of what is going on and the SAMPLE and OPQRST. Or you might be the EMT-B for the medic so you will be doing vitals while he/she asks questions. When you do your ride-time, listen to the person asking the questions and when they ask each part, as well as how they ask in each different situation.

Good Luck

Ames