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Understanding the 'how' and 'why' of patient care

Editor's note: The Central Ohio Trauma System said it wants the Ohio EMS board to adjust its rules to allow paramedics to veer from protocols if they think a patient needs trauma care. Editorial Advisor Art Hsieh said the ability to clinically sleuth through a laundry list of subjective and objective findings is clearly necessary in the field environment.

I'm teaching my organization's new medical assessment education program, and having a great time discussing the differential process with very proficient, highly experienced providers.

It struck us that so little of our primary training deals with learning about decision-making, and understanding the "how" and "why" of patient care, rather than just the "what" and "when."

The ability to clinically sleuth through a laundry list of subjective and objective findings, and considering the underlying causes of those findings, is clearly necessary in the field environment, even from the basic viewpoint of how fast we should be traveling to the selection of the most appropriate receiving facility.

Therefore, it is with a bit of irony that this came across the newswire today. Now, there are some caveats with this:

1) You should know your protocols. The article doesn't imply that all decision-making is now upon the EMS provider; it merely adds a bit of flexibility to refine a decision. The legal foundation of our practice is grounded in the approved policies and procedures that guide it.

2) You need to know the "how" and "why." Anatomy, physiology and pathophysiology give us the basic scaffolding to hang our clinical findings. If we don't have a fundamental understanding of how the body works, we run the risk of misunderstanding the patient's signs and symptoms.

3) Assessment is key. It drives all of what we do for the patient, from the care plan we select, to the destination of the transport, and the information we have to provide to the patient who is refusing care.

4) Check, and check again. Often we train EMTs and medics to operate alone, i.e. make decisions on their own. In fact, we rarely ever work alone. We have partners and fellow crew members who should be consulted in the decision-making process, if only to help validate our suspicions.

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