Reply to comment on “That’s Old School”

This post is several months old, and I was astounded that some read that deep. Usually I don’t get many page views per visit, so I was overjoyed to see this, kinda:

BASIC NURSING IS A KEY ISSUE IN ALL ASSESSMENTS. DONT FORGET THE FUNDAMENTALS AND ALWAYS ALWAYS REEVALUATE YOUR PATIENTS. OK THERE BIG GUY FIRE CHIEF, THINGS GO SOUTH QUICK IN ANY SITUATION EITHER IN A ED, OR, CATH LAB, HALL WAY, AMBULANCE, DESERT, CAR, FIRE, OR ANY GIVEN SITUATION, BE PREPARED AND NEVER LET YOUR GUARD DOWN. ITS OUR JOB AS NURSES AND HEALTH CARE PROVIDERS TO KEEP ON TOP OF OUR ASSESSMENT SKILLS OLD SCHOOL NEW SCHOOL OR JUST PLAIN NO SCHOOL SOME ONLINE COURSE OR READ A BOOK TO KEEP UP DATED ON SKILLS.
TYPE A OR PREMADONNA NURSE

Despite a respect for proper syntax, I wasn’t sure how to take this. Was it a jab at me, personally, or just a comment on the state of providers these days? I see Type A Nurse and I share some common attributes.

So, I had my wife read it. My wife happens to be a nurse, a VERY good nurse (who also has a Type A/prima donna personality), and has spent years in critical care in some really good hospitals. So you know that I respect nurses that show me respect, since we both do very difficult jobs often on little, incomplete, or no information at all. After asking what she thought, she offered several recent cases of nurses not doing a good enough job at assessments. She commented that she has been run all over her hospital going to codes that could have been prevented with a little hands on assessment.

She stressed that technology has become a crutch for nurses to lean on. Just because you have a gadget that does something, doesn’t mean you should abandon the skills that indicate it’s use. The numbers it produces are mainly for documentation, but if the machine reads a bad number but the assessment reveals that the machine may be in error, you can see how it gets sticky. I see some of the same parallels in EMS.

How many times have you seen a medic or EMT walk into a room with a patient that was having difficulty breathing, and the first thing they reached for was the pulse oximeter, instead of the stethoscope? I have, and in my younger days I was even guilty of it. These days, when I get to a call, the first thing I reach for is a stethoscope. I had flight nurses and mobile intensive care medics teach me the basics of assessment, and one of the few cherished memories I possess from my days at CareFlight was a nurse and a medic on my crew going over NREMT skills sheets with me. For that I was fortunate. Some others, not so much.

My comment on that phrase from EMS Today 2011 was mainly one out of shock that someone would refer to basic assessment techniques as “old school.” We should not think of hands-on assessments as such, we should instead make sure these are the only skills taught before we introduce technology.

My good friend Steve Whitehead had an excellent article here about “just being an EMT.” Basic skills are an important 70% of what we do in EMS, and ALS is mainly just a compliment to good BLS care. Very rarely does an immediate jump to ALS make a difference at all.