Treating patients: "By the book"

[mrsmall]

Ok, this might be another newbie question. I find that in general, people seem to have the mind set that as long as the outcome is right, how you get there doesn't matter. As a new EMT I notice that everyone has their own way to doing things.. I however, (this is probly just my VAST lack of experience) am the kind of person who always follows the written directions, with just slight variation.. ( I even cook food exactly how the directions tell me... ) I have always been told this job needs lots of common sense and ability to improvise, so I suppose I will eventually run into situations where I need to make some serious quick descisions..

ok the question: At what point do you consider your self able to safely leave out steps or skip steps? Is this a bad habbit? Should guidelines that are set by my education be followed strictly?

Note: I am still very new to EMS, this might be dumb question.

[Just Plain Ruff]

for cook book followers, we have protocols.

But for the more experienced which you admit you are not, there are steps that don't really get skipped but more like meshed with other steps.

It might look like they are missing steps but in reality every thing seems to happen so fast on some calls that yes it looks like they are.

When you get more experience on the streets you will see that there are several items that can put into one big giant step.

Do the steps like you have been taught and i guarantee that you will in short order find a rhythm that will work for you and you will realize that you are really doing all the steps but they all are working together.

Good luck on your education and career.

[ERDoc]

First off, welcome to EMS and medicine. You will quickly learn that in medicine, very few pts read the textbook. The elderly lady with the RUQ pain, nope it's not her gallbladder, she's having an MI. There is very little in medicine that is black or white. Your protocols are guidelines that have been established (hopefully on the latest available evidence) to direct you on how to treat a pt. Not every pt will fit your protocols. Education is the most important aspect of medicine, but experience is a close second. As you gain experience you will begin to recognize the gray areas and how to deal with them. As a newbie it is best to use what you have learned, but as you gain experience you will see where there are variations.

[spenac]

Always ABCDE etc. But as mentioned you will get where you do many at once. Also because you always start the same way you wont get distracted by the zebras and miss the horse.

[JPINFV]

The other thing to remember, especially working as a basic, is that you will hit a critical finding on a patient that will tell you to either transport immediately or call for a medic [regional specifics [we don't do moving intercepts, for example, here] and ALS ETA/transport time will make the determination. Don't finish a head to toe exam on scene for these patients. It isn't skipping steps in this case as much as realizing the limitations of the level and providing the best care possible for the patient.

Also, a lot of times how the patient presents makes the determination of both where to start with an exam. Not every patient needs V/S taken immediately, for example.

[whit72]

NO question is dumb, just the one that isn't asked.

When I first began, I used to ask everybody questions, my partners, co-workers, nurses, doctors. I wanted to know everything. They began to hide from me

You have to crawl before you walk.

I agree with Ruff. It will take time, but you will find your way. You will learn to ask the pertinent questions. The answers you receive will lead you to other questions and so on.

As far as the ABC's you should be able to answer those quite quickly. I hope.

The steps as you say, will begin to blend together. Its like a child when he goes up the stairs he has to put two feet on everyone till he is comfortable enough to put one foot on one and one foot on the other. Soon enough he is running up the stairs. He hits everyone and dosent even realize it.

Good luck, welcome to the party

[Dustdevil]

The steps as you say, will begin to blend together. Its like a child when he goes up the stairs he has to put two feet on everyone till he is comfortable enough to put one foot on one and one foot on the other. Soon enough he is running up the stairs. He hits everyone and dosent even realize it.

Excellent answers to an excellent question!

Just be careful to watch for the differences between those who are exhibiting their own style to cover all the bases in a different way than you were taught, and those who are just skipping steps because they are lazy. Both exist in the field, and the latter will try and convince you he is the former. Don't be that guy.

There are people who don't c-collar and backboard a patient you might have immobilised because they are current and know who needs boarding and who doesn't. But there are also those guys who know a patient should be immobilised, yet has them get out of the car and walk to the backboard instead of extricating them with a KED simply because they are lazy and ignorant. It takes a little experience to tell the difference between the two, so be careful who you attempt to emulate. If somebody is doing it differently than you would have, ask them about it after the run. Do they have a scientifically sound explanation? Or is "it doesn't matter" the best explanation they can offer?

Great question! :thumbright:

[cosgrojo]

My father always told me there are no stupid questions... only stupid people. I don't know why he kept telling me this after I asked questions...

But I digress... Your observations are spot on. Any good provider is able to learn in ALL situations. Sometimes you are learning what to do, others what not to do. Listen to what Dust and Whit are saying on this one. Be careful who you emulate. Try to find someone who doesn't seem to mind answering questions. As a general rule, if they don't want to answer you, it's probably because they don't know the answer. This job is like putting together a puzzle. You start off by putting the edges up first (protocols), and then work on putting the rest of it in until you have a clear picture.

[iMac]

It has already been said pretty well but I do want to say this. I also disagree with the fact that with time you can "skip steps" because you are more experienced. As a health care provider you should never skip steps, I think it may seem that way when you look at the seasoned paramedics because they are able to use the experience they have to go straight into the assessment and treatments required for that problem (searching for that differential diagnosis).

As a brand new EMT you don't have that experience to fall back on, so you do the entire body assessment no matter the problem.With time you learn what it is you are looking for, what you can do later into your assessment, you learn what the priority is for most circumstances. Nothing is ever bypassed, you are just more efficient at what you do.

[Richard B the EMT]

Regional protocols are there for a reason, although on a couple of other strings, we have arguments as to "cookie-cutter" follow them, or vary them. Me, I follow "cookie cutter", and leave experimentation to others more qualified than me, or under specific guidance, do the experimental as directed, reporting as required my results and outcomes.

Someone determined the protocols I am to follow, and, in my opinion, admittedly not shared by all, until my medical control doctors tell me new protocols are being placed, will follow.

Also, my NYC protocols might be directly against local protocols in Grand Forks North Dakota, and both might be wrong by Quebec Canada rules and regs (not picking on anyone, using locals as examples).

Obviously, as the new basic EMT that you are, you won't be doing a cardiac bypass surgery, but there will be times you cannot and should not cross every "T" or dot every "i". You'll find out through working with more seasoned partners what "within the rules" shortcuts you can take, and when you can take them, as well as when you must toe the line exactly.

One final thing: Welcome to our crazy universe!