Who here uses the Glascow Coma Scale?

[paramedicmike]

Only what I have learned through the courses that I've taken, and reading EMS mags and such. I don't have very much "real experience" with the GCS score, so all of this information is really helpful in finding out if I'm on the right track with the idea that I had. Since the only way I have to experience how medics actually USE the GCS is in my local area, I figured this forum would be a great place to gain more knowledge of how it is actually used by many different people in different parts of the country so that I can make a more informed decision on wether I was on the right track with a good idea, or just pissing in the wind. All of the comments have been great and very much appreciated, and I can respect your opinion on the EMT provider level. I do not take it to heart.

Your honesty is both refreshing and appreciated. Thanks for that.

That being said, I can't complete a chart without adding the GCS. However, do I think about it on a call? Nope. Do I calculate it on a call? Nope. Do I have docs routinely asking me what the patient's GCS is? Nope. Generally, I don't think about it until I sit down to do the chart and enter the data into the program.

On the rare occasion that I am asked about it the scale is posted in so many different places it doesn't take much to find it. The docs don't seem to really know what the numbers mean, though. They do much better if I just tell them, in plain English, what the description is for each category (e.g. "opens eyes to voice, uses inappropriate words and withdraws to pain" instead of "3/3/4").

Good luck.

[DwayneEMTP]

Wow finally a thick skinned new member. Seems to be a rarity in these parts these days.

Yeah, Kudos to JTS for not bailing. That was pretty hardcore, as being a Basic doesn't mean that that is all the tools he brings to the task. I happen to know at least a half dozen basics with BS degrees and several with Masters, two at this location with PHDs...so perhaps the criticism was a little premature.

Good on you brother. If you choose to continue with your idea, or choose to bail on it, I'd be curious to hear what it was. Perhaps it can be applied to something else EMS or non EMS related?

Dwayne

[EMS49393]

I have to do it as a requirement for my PCR. Honestly, I could care less about GCS. IMHO, we have too many little systems for determining a patients mental status when it's much easier to say "they're alert, oriented, with normal mentation" or "they're responsive to voice, garbled speech, no movement on the left side." Those are much better descriptions of what is going on then "en route with a 60 year old male, rule out CVA, GCS of 9 (maybe 10 or 11, who knows, his verbal doesn't fit any of the numbers)."

The trauma bay here asks for a GCS breakdown, but it's the only place I've ever transported to that does. Most ER's want to know if they're acting normal, and if not, what is abnormal.

[NYCEMS9115]

http://www.brainandspinalcord.org/recovery-traumatic-brain-injury/glasgow-coma-scale.html%20 Edited April 2, 2011 by NYCEMS9115

[Timmy]

I incorporate a GCS (separate values) into my standard vital signs survey, I also comment on there alertness and orientation in the notes. When I’m working ED Peads or on the Peads Unit we us a PGCS scale which is tailer to infants and younger kids, it covers smiling, orientation to noises, orientation to objects, crying ect. A GCS is just one tool to help form an assessment on patients, there’s a lot to take into consideration when doing a patient assessment. I wouldn’t base any treatment purely on a GCS.

[Lone Star]

Reading all the replies to this topic, I'm seriously wondering just how 'redundant' I am when writing the narrative portion of my PCR. Maybe I'm just being too verbose while trying to 'paint the picture'? My typical narrative starts out like this:

Arrived to find age/gender, position found/location (supine in bed, sitting upright in a chair). Chief complaint is:_________________. Patient is CAO x (insert orientation level 1-4 here). I normally use alert to day/date/place/self as qualifiers. CAO is an acronym for 'conscious/alert/oriented'.

In most PCR's I've filled out, the GCS is required; and I normally include it in my radio report to the receiving facility. The rest of the narrative will include information about past medical history, meds, allergies, treatments and results of treatments performed on scene/en route; with obvious responses to treatments. I note how often vitals were checked as well.

I try to stay away from symbology and acronyms (unless relevant to the narrative, AND are universally accepted). These can be found here:Medical terms/symbols.

[Paramagic]

I read the original post and had a little chuckle, thinking to myself "Who uses the GCS? LOL! That's like asking who takes a pulse, or who takes a blood pressure! Everyone does, silly!"

Then I read the rest of the "Don't know/Don't care" posts and became sad, scared and angry in equal measures at the abysmal education that must be reqired that people not only don't understand, but don't care to understand about fundamental patient assessment.

[DwayneEMTP]

I read the original post and had a little chuckle, thinking to myself "Who uses the GCS? LOL! That's like asking who takes a pulse, or who takes a blood pressure! Everyone does, silly!"

Then I read the rest of the "Don't know/Don't care" posts and became sad, scared and angry in equal measures at the abysmal education that must be reqired that people not only don't understand, but don't care to understand about fundamental patient assessment.

So you're saying that to ignore the GCS is to be ignorant of basic pt assessment skills? Not trying to put words in your mouth, but it sounds as if you are one of the few here defending it's value..I'd love to hear your justification.

Dwayne

[paramedicmike]

I'd be interested in hearing the justification as well.

You're also assuming way too much in terms of "abysmal education".

[DwayneEMTP]

I'd be interested in hearing the justification as well.

You're also assuming way too much in terms of "abysmal education".

I've got a 2 year medic degree preceded by a year and a half of prerequisites...how long does it take to understand this friggin' thing?

Dwayne