EMT - wants to improve assesment skills

[TXguy9]

I am an EMT... have been so for about 8 months. I usually work on a BLS rig slugging transfers with the occasional scene call.

The company has an ALS division that runs mostly scene calls... and I am beginning to do more of that as my seniority increases.

After working a shift on the ALS division... I realized I have a lot of improvement to make in the realm of pt assessments.... My assessments are slow and missing a lot of pieces.... I can usually handle the critical stuff (i.e. no problem managing an airway or skills wise)... it is the calls in between that get me... abdominal pain, generalized weakness, or more middle of the road non-critical calls...

Obviously more experience is important... but, what I am wondering is if you know of any resources to help me improve...

I have seen a few assessment guides....
1. Sick Not Sick: A Guide to Rapid Patient Assessment
2. The 60-Second EMT: Rapid BLS/ALS Assessment, Diagnosis & Triage (Paperback)
3. The street medics handbook

I think the first two look promising as far as reviewing and improving my assessments.... just wondered if you had any recommendations?

[MedicInLA]

Thats rather interesting. The only thing you really have to remember for a pretty detailed scene assessment is your SAMPLE and OPQRST neumonics. I highly doubt you have to read an entire book. Like you already said experience is definetly a key. The more comfortable you get with the questions the faster you get. Don't kick yourself if you forget some little obscure question. Just get comfortable with the core questions first (the ones that will determine what treatment will be rendered) and worry about the finer details later.

[Lump532]

The best suggestion is to make sure you are assessing every patient you transport. Its really easy to be lazy and not do a full assessment on a BLS transfer but its one of the best ways to get comfortable with it. Either way, as said before, the best way to get better is practice. When you do work ALS rigs take initiative on scene (if its cool with your medic) and assess the patient first, even if its an ALS call. Then talk to your partner later about what your doing well and what you could do better.

You will learn a lot more with good patient contact followed by some constructive feedback than any book will ever teach you.

[VentMedic]

I have seen a few assessment guides....
1. Sick Not Sick: A Guide to Rapid Patient Assessment
2. The 60-Second EMT: Rapid BLS/ALS Assessment, Diagnosis & Triage (Paperback)
3. The street medics handbook



These books do not give you an understanding of what you are assessing.

EMTs and some Paramedics have too little A&P education to adequately assess and understand what they have assessed.

Go to a college and start with the 2 semester entry level A&P classes. Then, pick up one of those books and see how differently you will view that assessment format. These classes will also better prepare you for Paramedic school rather than relying on just the paramedic text or another quick fix manual. No other healthcare profession allows entry into their eduational programs without at least 2 semesters of basic college A&P.

Mnemonics are not useful if it is just memorization and not knowing why something is done in that order. EMS has used mnemonics as a crutch because the educators know there is not going to be time in the course, either EMT or Paramedic, to teach the hows and whys. Sorta like the Sidney Sinus and Abby AV node format to dumb down a subject for those that don't have a solid foundation to build on.

[dr-exmedic]

While VentMedic is right about some A&P courses being the nice long-term solution, I read The 60-Second EMT after my paramedic class, but before any of my med school prereqs, and it's a nice bridge in the short term to more long-term learning.

[TXguy9]

You mentioned the OPQRST and SAMPLE. I know those mnemonics... I am used to the basics... I can run through a list of questions and answer all of those but it is not enough....

Such as with a abd. problem... you ask other things like:
-last bowel movement
-blood in the stools/urine
-associated nausea or vomiting
-possibility of pregancy (for females)

I think maybe that is where I struggle... questioning about the right signs and symptoms effectively, pertinent negatives and associated symptoms... I think when it comes those I am really lacking.

I am used to BLS where you just try to get the info and drop them off and let the hospital worry about it... as I look more at some of the good medics they are really trying to diagnose (or at least r/o as many things as possible) (and not that they actually diagnose and tell the pt the problem, but they really want to know what is going on... and are good at figuring it out).

The good medics I have worked with gather all the necessary information with a 10-12 minute scene time.... they are very effective in asking questions and get a lot of information really fast.... that is where I would like to be.

[EMS914]

You mentioned the OPQRST and SAMPLE. I know those mnemonics... I am used to the basics... I can run through a list of questions and answer all of those but it is not enough....

Such as with a abd. problem... you ask other things like:
-last bowel movement
-blood in the stools/urine
-associated nausea or vomiting
-possibility of pregancy (for females)

I think maybe that is where I struggle... questioning about the right signs and symptoms effectively, pertinent negatives and associated symptoms... I think when it comes those I am really lacking.

I am used to BLS where you just try to get the info and drop them off and let the hospital worry about it... as I look more at some of the good medics they are really trying to diagnose (or at least r/o as many things as possible) (and not that they actually diagnose and tell the pt the problem, but they really want to know what is going on... and are good at figuring it out).

The good medics I have worked with gather all the necessary information with a 10-12 minute scene time.... they are very effective in asking questions and get a lot of information really fast.... that is where I would like to be.

I would have to say that 'experience' in the medical field is they key to getting where some of the medics you are talking about are at. What I mean for example is when I started out as an EMT there was such a slew of information I had not encountered yet it was very difficult not understanding what was going on with my patient. I had a lot of trouble asking the pertinent questions and putting all the pieces together. Many years later and much more education, there are still medicines/diseases I encounter that I have not heard of before or I just plain don't remember. The critical patients are the easiest because the algorithms are there for you to follow. My biggest tool was researching information after the fact (ask MD, partner, or look it up). It will come don't worry, 8 months is a relatively short period of time, just stick with it and continuously try to learn.

[RicanMedic78]

I always try to look at it not from a textbook point of view, but from a presentation point of view since that is usually where your skills will come to an end and therefor, can be judged. Cant do much more abd pain can you? Since u don't have a portable CT scanner or a blood lab, u just have to be a good reporter, get a good SAMPLE hx, o2, vital signs, location of abd pain and type, and know how to report to medical staff so they welcome your imput as opposed to brushing u off and just talking to the patient instead!

My advice is just to not overthink things and just imagine what doctors would want to know, so that way you dont **** anyone off and look compitent.

As for "true" life saving skills, thats a different story. I think the patient will be the true judge of that one ;)

And remember... CUSTOMER SERVICE!!!!

[Sam Adams]

Lump532 has an excellent point. Assess every patient, because they are just that, patients. Use the transfer calls as learning tools. Become competent in assessing vital signs in the back of a moving ambulance. Auscultate breath sounds of every patient. Read their charts. Start noticing what medications go with their PMH. If the patient has a complaint and can communicate, explore it, run through your assessments. But most importantly talk to your patients. There is no book, no website, no whatever that can replace or compare to face to face interaction.