Posted by: medicblog999 | March 17, 2010

Assessment or Treatment – Continued

stethoscopeThere have been some great comments come in from my last post and another thought provoking post from TOTWTYTR.

I was going to work through a couple of those comments but I decided to put it as another post to share my further thoughts.

I mainly want to clarify what I was trying to say and for that I will quote from two of my colleagues` comments:

Jeramedic came in with the following :

“It’s great to be able to take a patient to the best most appropriate facility, but it’s even better to start therapies early and provide care before you get there”

TacMedic85 stated that :

“all of this knowledge vs skills nonsence is just that nonsence. I have worked with knowledge junkies who can accuratly tell you what is wrong with the PT before the Doc gets out the the room in the ED but can’t treat a PT worth anything. I have also worked with the skills junkies who will never miss an intubation but can’t read an ECG strip. The fact of the matter is that unless you work on both you are cheating your patients out of the care they deserve. You have to be able to do an assessment and gain a good working diagnosis but you also have to be able to effectivly act on that diagnosis. We have to dissolve this imaginary line we have drawn between the two and work on being better medics in all aspects”

Firstly, I agree that treatment and assessment are intertwined and to be an efficient and effective EMS provider, you need to be proficient at both, and whilst I agree with these viewpoints, there is, I believe another thing to think of.

Are we now getting close to the limit of what we can do with interventions for our patients?

I for one cannot see much more that would be of benefit or that would be practicable to try and perform in an out of hospital setting with our current level of technology (who knows ones we get into Star Trek land though!).

I have been on a number of courses around assessing and treating a patient suffering from traunatic injuries (ATLS, PHTLS), but there are very few advanced general assessment courses, primarily aimed at the medical patient for me to go on.

If we take it  as I said that we cannot physically do much more for our patients, then should we now be looking at where we can go to further help our patients by concentrating more on our assessment and diagnostic abilities?

Or maybe I am just barking up the wrong tree??

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Responses

  1. I'd comment directly, but I've already said it better here.My apologies for commenting with a link to something I wrote elsewhere, Mark. I'm a bit pressed for time, or else I'd elaborate here.

  2. I typed up a good responce but then my computer freaked out, so the long and short of it is I agree with what Ambulance_Driver wrote. People expect us to have both the knowlege and the skills to provide the best care possible for them. The phrase “so easy a monkey could do it” gets to me because when someone says it what they mean is “I can do this stuff in a controlled environment on a dummy and thus have no need to practice. Unfortunatly when it counts I'll screw up”.

  3. I'd say that assessment AND treatment will always be getting a refresh. In the US at least, CPAP and therapeutic hypothermia post-arrest are both relatively new treatments in the field (and still in early adopter phases in many jurisdictions). There are always new treatments on the horizon as well, such as blood replacement products for severe trauma that can be started in the field (though these things are 10-20 years from practical applications). So I think we have a lot to look forward to as far as field treatment (though these things are hardly definitive care…). As far as assessment, I agree that EMS needs to learn a lot more about assessment skills. I've read AD's post and agree that Nurses get paid better for their training in assessment, and I think if EMS is ever going to progress, we will need to adopt a similar model where assessment and skills are more balanced. As EMS moves more in the direction of being a degree instead of a “cert” I think we will be moving in the right direction.

  4. I think you are right on target. The skills are easy. Even the rarely used skills only take revisiting them every once in a while to stay competent. The ability to properly diagnose a patient and decide on a treatment modality is far more important. It's our knowledge, not our skills set, that makes us medics.

  5. “I for one cannot see much more that would be of benefit or that would be practicable to try and perform in an out of hospital setting with our current level of technology”CPAP?

  6. “I have been on a number of courses around assessing and treating a patient suffering from traunatic injuries (ATLS, PHTLS), but there are very few advanced general assessment courses, primarily aimed at the medical patient for me to go on.”Nicely, if inadvertently summing up much of the problem with paramedic education. Paramedic programs and to a lesser extent EMS programs, are so deficient in what they teach the students that a cottage industry has sprouted up to fill in the gaps. ACLS and PALS are one thing, because they address specific issues in medical education and are taken by practitioners at many levels of eduction. PHTLS, ITLS, ABLS, PEPP, NALS, AMLS on the other hand, all seem intended to teach paramedics things that they really should have learned in paramedic school. I expect that soon, if it doesn't exist already, we'll have Advanced Obstetrics Life Support or something. Add this to the EMS 2.0 list of things that need to be fixed. The paramedic curriculum needs to be longer and include more topics that are currently only addressed by these merit badge courses.

  7. “I have been on a number of courses around assessing and treating a patient suffering from traunatic injuries (ATLS, PHTLS), but there are very few advanced general assessment courses, primarily aimed at the medical patient for me to go on.”Nicely, if inadvertently summing up much of the problem with paramedic education. Paramedic programs and to a lesser extent EMS programs, are so deficient in what they teach the students that a cottage industry has sprouted up to fill in the gaps. ACLS and PALS are one thing, because they address specific issues in medical education and are taken by practitioners at many levels of eduction. PHTLS, ITLS, ABLS, PEPP, NALS, AMLS on the other hand, all seem intended to teach paramedics things that they really should have learned in paramedic school. I expect that soon, if it doesn't exist already, we'll have Advanced Obstetrics Life Support or something. Add this to the EMS 2.0 list of things that need to be fixed. The paramedic curriculum needs to be longer and include more topics that are currently only addressed by these merit badge courses.

  8. I for one cannot see much more that would be of benefit or that would be
    practicable to try and perform in an out of hospital setting with our
    current level of technology (who knows ones we get into Star Trek land
    though!). 100% agree with you
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