Critical thinking or Common sense?

[MedicNorth]

There are some excellent links to critical thinking sites at [http://falcon.jmu.edu/~ramseyil/critical.htm]

[medic_ruth]

I think I said it before, but Critical Thinking begins with examining WHY we think the way we do. A good mentor will challenge the student to examine the thought process.

Devin

Ahh... the force is strong with this one. Wouldn't mind chatting with you some time.

[tniuqs]

Ahh... the force is strong with this one. Wouldn't mind chatting with you some time.

Ok first off where did that Lithum hide :twisted: ....he started this synapse challenging thread.

Secondly medic-ruth.......come to the DARK SIDE

Personally would like to hear what other enlighghted folk have to say.....testing testing come in DUST, or AK... ++++++

You you out there?

cheers

[Lithium]

Haha ... my apologies. I do the same thing at work to. I start a conversation that gets everyone involved (you should see how touchy some of these firefighters can be) and then disappear.

It's quite fun ... but yes, this topic is doing better then I expected.

Now where did my reputation points go?

[UMSTUDENT]

The way we teach EMS doesn't allow for any type of critical thinking. EMTs are taught a specific way to accomplish something and are expected to replicate it verbatim during practical skills evaluation. Plenty of things I've seen students do during in-class evaluations are perfectly acceptable, but unfortunately many times I have to correct them. I spend a significant amount of time giving praise to students for "thinking outside of the box" only to then correct them so they don't fail the state practical.

Much of it is utter BS. Buckling one strap before the other, always securing distal to proximal...I understand many of these procedures are meant to develop good assessment and treatment skills, but many times they hinder a student's ability to truly treat the patient's unique situation. I know one student who has failed the state practical 3 times for extremely picky reasons. Now, he doesn't even "think" when he does the station he’s so scared. He just goes through a memorized procedure. I'm willing to bet almost none of the nit-picky procedures a BLS provider performs are based in scientific medicine. When was the last time a physicist analyzed the efficacy of "middle, bottom, top" when applying the abdominal straps of a KED board? If it works, and is efficient in its application, who cares how it is applied? EMS needs to move into the realm of residency-like training. Written examinations followed by oral boards for certification/licensure. The student completes X number of hours with certified preceptors in the field and hospital where he/she is deemed "competent."

How does this affect overall critical thinking skills in the profession? Very simply. If a young EMT is continuously told that EVERY TIME something MUST be done this way, he'll develop complacency towards thinking on his/her own. This is reinforced by jurisdictions that hold a constant threat of taking your license away should you deviate from a very limited, specific set of protocols. The examples are everywhere in EMS. Here is just one:

Over the summer I was working a 911 job and was called to a house about 5 minutes outside of my first due. The call initially goes out as a routine fall call. The other medic units in the area are unavailable and our unit was started to first respond. En route I begin to hear chatter about the patient. I wasn't able to ascertain specifics because the engine crew on scene was constantly talking over each other. I hear one provider get on the radio and frantically request a medic unit to the scene, but the reason was unclear. So I'm thinking "whatever," probably nothing. I get on scene and jump out to be bombarded by a member of the fire company. I was told that they had the patient boarded and that a helio was on the way for a flyout...

At this point I'm thinking, "Wait, we're 15 minutes from 3 trauma centers, one of which is a Level 0 adult specialty center." I'm told I have a crew of EMTs in the house attending to the patient. I walk into this dimly lit room to find the patient propped-up against, her face planted into a wall. She's a heavy lady and a wheelchair is found directly behind her. CLUE: She must have slid out. She isn't back boarded like I was told, and the EMTs from the engine company are just kind of standing there staring at her. The daughter, a woman in her mid-forties, looks at the mess confused. She explains to me that she found her mother like this when she arrived home today and presumes she could have been like that for as much as 8-11 hours. I notice that her neck is in an awkward position and inquire about any previous history. She explains that the neck positioning is normal because of set of fused cervical vertebrae approximately 4 years prior. In a very brief discussion it appears that her mother's neck has served as a fulcrum that has enabled her to remain in this position all day...

So, I tell the guys to board and collar her taking C-spine precautions. The patient is semi-responsive, occasionally letting out screams of pain. She was no-doubtly in severe pain from the whole ordeal. A quick look reveals some peripheral edema in the arms and legs and her obesity, age, and race (African American) suggest that she is probably a diabetic of some kind. Quick rapid assessment reveals no obvious trauma to the head or body...Differential: Probably hypoglycemia from not eating for 11 hours. Mechanism doesn't suggest traumatic injury. So after having the EMTs board her twice (first time they used pediatric spider straps), we begin to move her to the ambulance. So as the engine crew carries her to the ambulance I ask the officer on the engine exactly what happened. "Well man, we were thinking neurotrauma...so we started the helicopter.” At about this time I'm freaking out.

I said, "You did what!?!?"

"We called the trooper man...why?"

About this time I walk outside to hear the signature whirl of a Dauphin N2 spinning above me. Trooper spins around, about 200 feet off the ground, and moves over the treetops. I had assumed (my mistake) that after our arrival they had canceled the helicopter out of common sense.

"Hurry-up man, don't you need to get an IV before he lands?"

All-in-all, this patient ends up being flown out of pure idiocy. The flight medic jumps in the back and during assessment begins to ask the EMTs from the engine company the same questions. He leaves with a look of disgust and looks at me in disbelief. Critical thinking fallacies? Crew fails to determine the cause and mechanism of the call and immediately assumes the LLOC is due to trauma. They also fail to recognize that the nearest trauma center is a mere 10-15 minutes away.