ALS.... Forgetting the Basics

[spenac]

Please don't let this turn into a ALS vs BLS, there is not even dust left from the remains of that dead horse.

Like everyone else said much is done w/o actually making a show of it. Has anyone here actually entered any EMS competition? Do they require verbalizing everything like at national registry skills exams or what?

[Rezq304]

Every patient gets the ABC's done on them. It's a matter of if you catch the manner in which I assess them for the ABC's. Do I walk up to them and physically check a pulse? Look for breathing? Not always. If I walk in and a patient is upright and talking to me, then their ABC's are in tact. If they're unresponse, then I do the "look, listen & feel" approach...or part of it. Sometimes I can check these by visualization alone. The inital assessment of a patient should be a matter of seconds. A quick "hello, how are you?" is sometime's all that's needed. You can gauge a lot by a patient's answer to the most basic questions. Couple that with a quick pulse check and you'll have an idea of if they're rate is fast or slow, and if they're pulse is normal, bounding or weak. But yes, every patient gets the ABC's done.

Don't compare a competition to what happens in real life. People act differently when they know they're being scored. It's easy to get worked up in the competition and leave things out. Gauge someone instead by how they conduct themselves when working with real patients.

Shane

NREMT-P

Same approach I take.

[JakeEMTP]

Has anyone here actually entered any EMS competition? Do they require verbalizing everything like at national registry skills exams or what?

I have not entered one, but witnessed the NC paramedic competition last year. One most definitely needs to have their proverbial sh!t together to compete in these. I did not see any of the competitors verbalise every step. Of course, there was communication amongst the teammates, but that was the extent of the chatter.

I found it to be a great experience and will be attending again this year. It might be slightly whacker, but I think of it as a learning experience.

[paramedicmike]

Iits sometimes hard to take the focus away from the trauma that your patient has recently suffered. Its also sometimes hard to notice something that is hard to see. But as I have learned, on EVERY patient that you come in contact with, no matter what the illness/injury, take a step back and go back to the basics... Airway.... Breathing... Circulation. I watched a ACLS competition one time and noticed that the medics were so focused on the scene and number of patients, that not one when through the whole ABCs on any patients.

Just take it back to basic... A-B-C's

Interesting. So tell me again, how old are you? How long have you been an EMT? And your years of experience?

As Dust mentioned, just because you don't see something happen, in competition or on the street, doesn't mean it's not done. In a solid provider, experience breeds proficiency. In a good provider, that proficiency is such that things are done and people don't even realize it's happened until afterwards.

What's more, just because you witnessed a few medics in a competition doesn't mean that you have a wide expanse of knowledge in how other medics operate with real patients in real situations. You mentioned in another thread that you work in a hospital. Have you had real street experience?

-be safe

[PRPGfirerescuetech]

Iits sometimes hard to take the focus away from the trauma that your patient has recently suffered. Its also sometimes hard to notice something that is hard to see. But as I have learned, on EVERY patient that you come in contact with, no matter what the illness/injury, take a step back and go back to the basics... Airway.... Breathing... Circulation. I watched a ACLS competition one time and noticed that the medics were so focused on the scene and number of patients, that not one when through the whole ABCs on any patients.

Just take it back to basic... A-B-C's

...and now that you have moved to your second week of your EMS career, you should learn that just because these experienced medics didnt stop the "competition" and say " A....airway....airway is patent with no obstructions....B....breathing.....patient is breathing adequately at 18 times a minute with good tidal volume....clear lung..." didnt mean they didnt do it.

Get the idea? Your first glance at a patient identifies a good majority of this "ABC's" and the next 5 seconds identifies the rest. A common statement of EMS providers is the first glance at a patient defines if they are ALS, or BLS.

When you get to this level or proficiency in medical assessments as many of us have here on these boards, please feel free to repost your recant of this thread. Til then, your experience level has shown. Smile, nod, and learn from the people here,...you wont regret it, and you might begin to understand what we mean when we discuss this level of proficiency.

[Redcell19512]

I'm not always conscious of the fact that I'm doing it but yeah, I do it on every patient.

ME: Hi sir, how are you today?

Patient stands up and shakes my hand: I'm in bad shape buddy. If we dont get this catheter unblocked my bladder's gonna blow!

Now, druing this exchange am I thinking "ABC...ABC...ABC...". No, but I'm still checking, even though it's not running through my brain.

I've never enjoyed practical skills stations and these competitions. I dont do well in that kind of environment. I was involved with an Explorer program years ago and we would run them through little scenarios. They'd do the whole, "is the scene safe?" and I'd reply, "I don't know, is it?" We threw a little curve ball to them. On first glance the scene was safe. But when they ran through their assessment they found a toy gun tucked in the patient's pants. In the real world there's no instructor at the door telling you that the scene is or is not safe, you gotta figure that out for yourself. Guess what, sometimes a safe scene becomes dangerous and you need to react accordingly. Sadly this is an area of prehospital training that is lacking (not an ALS vs BLS thing...it's found in all aspects of EMS).

[Ridryder 911]

The difference between experienced competent health care providers is we perform across the room assessment. From experience and education, I can surmise within 1-2 seconds, the condition my patient is in without stopping and assessing airway, checking for pulse, etc.. etc..

As well, one should be able to identify poor circulatory and hemodynamic compromised again immediately.. by looking at the patient when you first enter the room. Not actually having to perform each step by step. Of course we check for perfusion levels.

I do not know the last time I did a head tilt and put my ear down to see if the patient was breathing, and personally I would look poor on someone whom is supposed to be experienced and knowledgeable doing it in the field. Hopefully, they would have experience enough to be able to detect respiratory movement , amount of Vt and perfusion, just by a quick assessment. If they don't they better have either be in training or new.. otherwise we will have a talk back at HQ.

Can one imagine a physician assessing ABC's on each patient?....... I see Mr. Jone's you complain of oozing fluid from your urethra, but first I need to assess your ABC's......

As well, the MCI drill... not all patient's get ABC's... Sorry there are the mortally wounded and the walking wounded... If they have a fence post through their head or chest.. their dead or yellow prime (soon to be dead) in a large MCI.. and if they are up walking around.. they are green to go.

So the question in the post is misleading and appears to be from inexperienced student, that is attempting to make textbook material as a functional step. Remember, like protocols they are to develop from and use as a reference. Medicine is just as much as an art as a science, that is why physicians practice at it.

R/r 911

R/r 911

[beccabotkin2002]

Of all of the paramedics and EMTs i work with, as well as myself, we assume if the patient is talking to you, their airway, breathing, and circulation are good if they are talking to you. the only time that we actually stop to check a pulse is if they are unresponsive, but yet, you can tell even then if they are breathing and have a pulse... we don't overlook these things, it's just noticeable without going through it the way it teaches in a textbook.... Have you worked in the field? Textbook doesn't necessarily apply to the real world... I very seldom think back to something from my textbook, it's mostly common sense, and protocols that I use to make my decisions.

[iMac]

I would like to assume 100% of paramedics out there check their ABCs. I dont know of any of them, myself included who will make it vocal but I ALWAYS do my ABCs. Do I make it obvious?? NO, not always. All depends.

If I arrive in someone's home and patient looks at me and says something I will already know what I need to know, just check for the quality of the pulse once I actually make physical contact. Someone's general appearance will usually tell you what you need to know in the first few seconds you meet someone. If on the other hand I arrive on a scene with a patient hunched forward in the driver's seat and appears unconscious, you can bet you will be able to watch me check the ABCs.

All situational.

[spenac]

My new goal is to verbalize my ABC's on every call. :twisted:

We knock Patient says come in. Then I'll say very loudly for all to hear:

A Airway is clear because patient spoke to me

B patients breathing as was able to speak to me

C blood must be circulating for patient to speak me

Then dispatch calls and says patient has requested you leave cause your freaking them out. WOW another way to get out of transporting.