EMS is essentially an art form. Unlike clinic or hospital based medicine—even medicine practiced in the Emergency room—EMS is a balancing act. We go into a call with a few tools:
- Protocols–Whether you see this as an advantage or a hinderance, they are here to stay. Protocols allow EMS providers to fall back on guidelines to help them during difficult and challenging patients. They also allow providers to hide behind a shield when they do something for no other reason than “my protocol said so”.
- Assessment skills–Some medics have them… Some don’t. All of us go to a medic school of some sort. All of us had to pass National Registry. Does this make all medic’s assessment skills equal? Nope. I solve problems. I have a classmate that does less “problem solving” and more pulling the answer from his ass like he is a walking Taber’s Medical Dictionary. Because of the varied assement skills of providers, many protocols are written in a manor that eliminate the need to even assess a patient beyond the ABC’s.
- Diagnostic tools–From a stethescope to pulse oximetry, capnography, and cardiac monitors–these diagnostic tools can help you to obtain a more clear image of the present problem–they will not diagnose a problem though.
These things together are the basis of our profession. They allow us to do what we do, day in and day out. Without any one of them, we would, in all reality, be out of business. Sure, we need to be able to make due without pulse ox or capnography, but without a defirilator I am unable to convert V-fib, without my drug box there are a great deal of things I just can’t do. Without my protocols I won’t have the authorization to do what I do. Without my assessment skills I won’t know when and where to use any of the above.
That is all true–unless we practice lowest common denominator(to quote RM), “It can’t hurt” medicine. “It can’t hurt” medicine refers to oxygen for no specific symptom, drugs down to tube in an arrest, etc. Just because we don’t have “proof” that something causes harm, doesn’t mean it helps.
Our job is simple. We are called to help in our patient’s emergency–whether we percieve it as one or not. We are to treat each patient as though their emergency is the most important thing going on–at that time. We are to spend the time needed to determine what THAT patient needs, and give it to them.
Now, some might say we can’t afford this time–but lets be honest. How much time does it take to decide if someone NEEDS oxygen. It is usually rather apparent.
How about if someone NEEDS nitro or ASA? Not all chest pain is created equal. If we are afraid to train our medics to differentiate between cardiac and muscular-skeletal pain we might as well throw new Basics on the truck and skip the training for medics. It would save EMS systems around the country loads of money(though depressingly not enough!)
When did we decide that paramedics where no longer qualified to assess and THEN treat patients. When did we decide that just because we haven’t been told that something could HURT our patient, it is ok to do every time (oxygen, drugs, spinal immobilization, prophylactic IV therapy, etc)?
When will we bring assessment back into EMS? What would YOU do? What freedoms and
limitations does your system place on the providers it employs?
Dr Bryan Bledsoe has a great article out right now about “The Oxygen Myth“. It dicusses the issue
with using oxygen on EVERY patient, rather than patients that actually need it.
Check it out and let me know how you feel.
