MARCH versus ABC

[EMT Foose]

I would argue this says more above a provider's common sense and critical thinking than the mneomic itself. As it would be, an ED RN and myself were talking about this very thing on a flight to Phoenix.

I don't really see a problem with teaching any one method vs. another; the problem is not the method itseld but those using it.

If my patient is bleeding profusely and profoundly hypovolemic I'm sure as hell going to bust an artery clamp or tourniquet on that bleeder before I piss around counting respirations and applying oxygen! My side is that these aids and tools are helpful but if we worry that by teaching MARCH instead of ABC (for example) will create people focusing on things out of order (e.g. controlling a shaving cut before clearaing a FBAO) does that say more about what we are teaching or who we are teaching it to?

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I think this whole thing says more about us as providers than the system itself.

You fully grasped the point I was alluding to, and illustrated it quite nicely. Basically, I've seen some shoddy paramedicine....and I hate it. Even with the amount of hoops to jump through, it's still not enough to weed out the types that shouldn't be paramedics.

I won't even go into detail about some people that have their path to a P-card facilitated in ways that either make my jaw drop, or shake my head in shame...or both.

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The examining entity should make their testing methods very clear to the testees beforehand.

You said testees. haha

[Kiwiology]

I like the acronym just because it's more encompassing. The classroom way should be like the field way, otherwise it was a poor classroom way. Even if someone with common sense would disregard the order of ABC's, it's more satisfying to have the "ABC's" actually fit the situation.

I agree there must be standardization and a uniform way of doing things both in theory and in practice; I'm not saying don't teach MARCH/ABC/SAMPLE etc because I use them and find them good tools. I'm not knocking the tools themselves because they do work and quite well but I'm troubled by the fact some say "oh if we teach this method it'll have people look for and/or control bleeding before looking at the airway" I would take the position of .... well, that to me says that we're not teaching these people enough about the body and what it can handle or how to use that knowledge and think critically. I was once called out for doing ECG analysis before OPQRST on a chest pain; well I explained to the Advanced Paramedic (ALS) if I get a patient who is ashen, grey, sweaty and doubled over in pain clutching his chest struggling to breathe I think it more appropriate to have my partner apply oxygen and gain a quick history while I look at a strip to determine rhythm and if we need to cardiovert or get this guy on the stair chair and burn rubber to the hospital.

Evaluate the bleed. Is it "MASSIVE"? Evaluate the level of hypoxia. Is he blue and about to lose consciousness? I would then make the decision.

There's a few steps to that process. Depends on the scenario. I can't bring back ischemia brain cells (whereas I can get patient to a hospital for a blood transfusion). BUT if he can handle the choking for 30 seconds while I slap on a TQ, then I might do TQ first. Depends.

I agree

That's one of the classic problems with testing in EMS. Do we test to see if they know and can do the baseline order of procedures? Or do we test to see if they can treat a patient?

The latter scenario might be very incomplete. He might be able to save the patient, but barely, but not show knowledge of other things in the scenario because they weren't applicable.

The examining entity should make their testing methods very clear to the [test takers] beforehand.

Hmm .... I would argue twelve of one, a dozen of the other.

[FormerEMSLT297]

I just went thru refresher at UMBC and they touched on this topic, basically saying that it would soon be the "new standard" CBA,,,,, you know EMS always changing. I understand the rationale, and it kind of makes sense. Stupid to start pumping and blowing if you're just forcing the blood out to the vitim faster.

Take 1 minute to stop the bleeding, then do the breathes and pumping if necessary.