The Patient Assessment

[armymedic571]

So, since we have been doing a little ALS vs BLS thing lately. I thought I would throw this out there. But....

Besides diagnostics, what is (are) the differences between the ALS and BLS assessments, if any?

This might sound like a silly question. But I am kind of curious to see how peope view this. Especially after some of the more recent topics.

GO!

[Just Plain Ruff]

You should be assessing the same things either emt or medic level. But in your toolkit you have different items if you are an EMT and different items if you are a medic.

Comparison here

rapid heart rate > 200

you have on the medic side - 12 lead, cardiac monitor/defib/cardioversion, pulse ox, bp/vitals, IV, oxygen, medications

On the EMT side you have - pulse ox, bp/vitals, oxygen

It depends on what tools you have at your disposal. As a medic your evaluation should cover the same things as the emt but when you recognize as a medic a lifethreat which a heart rate of 200+ is definately something that can be a lifethreat then your toolkit is much more robust than an EMT's.

But the EMT and medic should both be able to recognize that this patient is sick and needs interventions that may be beyond the capability of the medic or emt.

Don't get into the false belief that because you are a medic that you don't use your bls skills in addition to your ALS skills they go hand in hand.

AS an EMT, your options are to get that patient to ALS interventions as soon as possible.

You work with what you are given and if you utilize what you have and your brain then you should be able to treat and help most everyone you come into contact with.

Remember, it's not about YOU!~!!! it's about the patient.

So, since we have been doing a little ALS vs BLS thing lately. I thought I would throw this out there. But....

Besides diagnostics, what is (are) the differences between the ALS and BLS assessments, if any?

This might sound like a silly question. But I am kind of curious to see how peope view this. Especially after some of the more recent topics.

GO!

[P_Instructor]

Ruff is correct with his ahhh - assessment of the situation.

All I can add is even though the assessment criteria are the same, the advance perspective of assessment also incorporates a deep understanding of what is happening pathophyiologically with the assessment findings.

Think of it this way: Basic understand the body and systems. Intermediates (some) understand the body and systems down to the tissue levels. The Medics understand all this but down to the cellular level. All it is, is an understanding of what is going on based upon the assessment taken, which is the same.

This is only a wide observation in my opinion, and others may disagree and probably will.

[Kiwiology]

Assessment should not change between BLS/ALS except 12 lead ECG

Education should be focused upon acquiring a comprehensive knowledgebase of A&P and patho at the entry-to-practice level so you can begin to consolidate that knowledge as soon as you hit the street

Where is one of those two year degree educated entry-to-practice Primary Care Paramedic's from Ontario when you need 'em?

Think of it this way: Basic understand the body and systems. Intermediates (some) understand the body and systems down to the tissue levels. The Medics understand all this but down to the cellular level. All it is, is an understanding of what is going on based upon the assessment taken, which is the same.

This is only a wide observation in my opinion, and others may disagree and probably will.

You read my mind!

I hope your P_Students who have you as a P_Instructor (lol) are made to take something more advanced than the quickie A&P overview in the Paramedic book; my A&P book (Marieb) is almost as thick as my whole Paramedic book (Bledsoe et al)

[Brandon Oto]

By and large the difference is that the medic generally has tools that allow him to more directly and precisely assess physiological states that the EMT can only either guess at ("chest pain? could be an MI") or note broadly ("tachycardia" rather than sinus, junctional, SVT, etc.). He can take a blood sugar and say a person is hypoglycemic, where the EMT has to guess based on history and general level of consciousness changes. He can throw on electrodes and tell me that the patient is experiencing acute hyperkalemia where the EMT would just know they're sick. And so on. Both sides are right, but one of them can say much more because he has the resources.

Differences based on actual clinical knowledge obviously can exist as well, but are not necessarily part of the roles, IMO. You can have a medic who doesn't understand shit and you can have an EMT with an excellent grasp from cell wall up to hairy chest. Knowledge influences what you do with your assessment; the assessment itself, if done correctly, should simply be data. (The only exception would perhaps be if your clinical impression guides WHICH things you're doing to assess -- e.g. should you be measuring ETCO2 or looking at pupils?)

[DwayneEMTP]

So, since we have been doing a little ALS vs BLS thing lately. I thought I would throw this out there. But....

Besides diagnostics, what is (are) the differences between the ALS and BLS assessments, if any?

This might sound like a silly question. But I am kind of curious to see how peope view this. Especially after some of the more recent topics.

GO!

Ok, so AM571 I have to apologize to you. I had a feeling, likely unfairly, based on some of your earlier posts that you were going to turn out to be a butthead wannabe.

Posts like this, simple and smart yet that cut to the heart of many educational subjects in one conversation put the lie to my silly preconceive notions.

Thanks for taking the purpose of this site seriously.

Who's the butthead now? (it's ok, I'm used to it.)

Dwayne

[armymedic571]

First- thanks for the replies. This was my first thread on this site, so......

So, since we have been doing a little ALS vs BLS thing lately. I thought I would throw this out there. But....

Besides diagnostics, GO!

I think some of you missed this. I am really going back to basics here.

You should be assessing the same things either emt or medic level. But in your toolkit you have different items if you are an EMT and different items if you are a medic.

Comparison here

rapid heart rate > 200

you have on the medic side - 12 lead, cardiac monitor/defib/cardioversion

On the EMT side you have - pulse ox, bp/vitals, oxygen

Remember, it's not about YOU!~!!! it's about the patient.

Diagnostics!

Ruff is correct with his ahhh - assessment of the situation.

All I can add is even though the assessment criteria are the same, the advance perspective of assessment also incorporates a deep understanding of what is happening pathophyiologically with the assessment findings.

Think of it this way: Basic understand the body and systems. Intermediates (some) understand the body and systems down to the tissue levels. The Medics understand all this but down to the cellular level. All it is, is an understanding of what is going on based upon the assessment taken, which is the same.

This is only a wide observation in my opinion, and others may disagree and probably will.

That was more for what I was getting at.

Assessment should not change between BLS/ALS except 12 lead ECG

Education should be focused upon acquiring a comprehensive knowledgebase of A&P and patho at the entry-to-practice level so you can begin to consolidate that knowledge as soon as you hit the street

Remember, a 12-lead is a diagnostic. But I like where your head is at.

Ok, so AM571 I have to apologize to you. I had a feeling, likely unfairly, based on some of your earlier posts that you were going to turn out to be a butthead wannabe.

Posts like this, simple and smart yet that cut to the heart of many educational subjects in one conversation put the lie to my silly preconceive notions.

Thanks for taking the purpose of this site seriously.

Who's the butthead now? (it's ok, I'm used to it.)

Dwayne

It's OK Dwayne. I get that a lot. At times I can have a very abrasive personality. I spend half of my time in the military, and the other half in a civilian hospital on a Paramedic unit.

some people just don't know how to take me.....

I want to see if we can get any more replies, but I have a felling that most are in the same opinion as me.

Just one Caveat to the original post. Let me know how you voted when you post. Makes it easier.

thanks

J

[CBEMT]

I think ALS providers learn about more potential diagnoses for a given symptom or set of symptoms than BLS do, so that certainly affects assessment. I know from my own experience that the number of potential causes of chest pain at least doubled if not tripled between what I got during my EMT-B school (one of if not the best in the state at the time) and my ALS course.

Edited February 12, 2010 by CBEMT

[NRPinNEPA]

If you have a quality, educated BLS provider, the assessment is no different than an ALS assessment, only without blood glucometry or EKG monitoring. All the other assessment techniques (inspection, palpation, auscultation, percussion) are well within a BLS provider's scope of practice, as is obtaining a good history. However, with your average EMT, the BLS assessment will have far less knowledge of anatomy and physiology behind it... most EMT programs train only to differentiate between normal and abnormal, not necessarily what may be causing the abnormality.

Ergo, I'm not going to answer yes or no, only state that it depends on the individual.

Edited February 13, 2010 by EMTinNEPA

[Kiwiology]

However, with your average EMT, the BLS assessment will have far less knowledge of anatomy and physiology behind it... most EMT programs train only to differentiate between normal and abnormal, not necessarily what may be causing the abnormality.

And that right there is what is soooo wrong; I call it the "top heavy" approach ie more education at higher levels rather than a foundational approach with a good solid base of education where the hardest part of learning new things is the "skill" and not the "knowledge".

That is the reason I really like how Ontario educates its Primary Care Paramedics ("BLS" if you want to call it that)