Patient Assessment algorythm

[chbare]

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.

They should learn their core assessment knowledge from the clinical experience. They should be graded during their clinical rotations on critical interventions and assessment techniques. I do not disagree with setting up hands on station in class and running scenarios; however, I fail to see how making somebody go through a "canned" "skill station" at the end of their course is of any benefit.

Take care,

chbare.

[AnthonyM83]

I imagine part of it is due to lack of availability of different scenarios during their ride-alongs. I've been an EMT for 2 years and have yet to deliver a baby (though many newer EMTs have).

The school needs a way to know I would have a plan to follow when I encountered this situation in the field. It needs to see what kind of mistakes I might make and make sure I've corrected what I can before I hit the field.

[Asysin2leads]

Any good course should give you some good preparation for the field. Any instructor who says something to the effect of "Throw everything I just said out the window... etc. etc." taught a lousy class and you should get your money back.

In scenario testing there needs to be a standardized way of making sure key points are hit, skills are performed properly, and appropriate questions are asked. Unfortunately, at the EMT level, since understanding of concept is not able to be adequately taught, rote memorization is strictly enforced. Since a scene is dynamic and changing, so too does a provider's approach to a patient.

The real problem is that there is a big difference between a provider who adapts his assessment and treatment procedure to the needs of his patient, and one who believes that there is some kind of mystical street skill set that takes precedence over proper education and practice, and the two can be very hard to differentiate between.

Case in point. Today we had a call for through Lifealert for a person with a known diabetic history who sounded disoriented on the phone. Upon arrival we found him extremely lethargic and nodding off but able to answer questions. He responded to verbal stimuli and I placed an NRB on him. I asked him if he was a diabetic. He answered yes. I asked him if he took his insulin. He answered yes. I asked him if he felt like his blood sugar was low to which he answered yes. I then directed one partner to take a blood pressure and attach the EKG while I set up for an IV and prepped the D50.

After administering the D50 he became much more active, his skin color returned to normal and he was his old self. Everything else was normal on him. If I had run a call this way in testing I would have failed, and failed badly. But it was the appropriate thing to do for this patient. I hope this helps with your question.

[chbare]

I still think this is something that should be covered during the clinical experience. I know in nursing school, we had to be involved with at least one delivery. If we were not involved in a delivery during scheduled clinicals, we had to take OB call until the requirement was met.

Take care,

chbare.