IV, O2, and Monitor

I get amused when I watch some bright eyed bushy tailed medic student or field trainee. The excitement to be moving into the fun phase, or the next career phase makes me a little happy to be their guide on the way to a higher level of being, assisting them in their transition from technician to clinician.

Then we get our first run.

Then that excitement fades a little.

I watch our competent, entry level paramedic deploy their skills for the first time which usually results in a rehash of an old saying they learned in school:

“IV, O2, monitor”

C’mere junior, let me tell you how this REALLY works…

It’s not really their fault though, some schools (all but one that I’ve seen) don’t teach clinical decision making starting with the basics first. They teach paramedic students paramedic stuff, and predictably they over-emphasize the ALS. But it’s not EVERY run that we use ALS skills, so should we be teaching paramedic students how to use basic skills?

I think so. I think that yes, even though paramedic students should have a strong foundation in the basic before becoming paramedics I realize that this is often not the case or even desirable by many organizations, paramedics should be strong EMT’s first.

In another thread, paramedics are often held to organizational standards or perceived standards (read “culture”) that promote over-kill, inappropriate treatments, or “cookie cutter” medicine that results when adherence to the protocol book is placed above good (and appropriate) care.

The primary cause of these situations is called “reduction of liability” but in the same line don’t see that when we make an attempt to reduce liability we cage effective providers and praise poor providers. Personally, my protocol compliance statistics suck, but I deliver excellent care. Does my stat reflect my care? No. Do I make mistakes. Of course.

Somehow though, as in any organization that attempts to reduce their liability, when quantifying what “quality care” is ineffective providers are often the highest in the statistics for compliance. Why?

IV, O2, and monitor

I’m getting at that we should get away from such instruction and actually raise our bar. I would say that we don’t teach to skill sheets which promote checklist medicine and give the knowledge of what certain procedures are and why they are necessary. If we are going to use skill sheets, we should rate skills that require a checklist and not starting it with “given a scenario…” Any person with a pulse can perform a trauma and medical assessment, they teach it in the most basic of CPR and first aid classes.

It takes a real clinician to prescribe a procedure and know why.