As I prepare to possibly take on the responsibly of training new paramedics, I have spent some time looking back on the days of my internship. I really got to thinking about how much technology has advanced (at least in my service) since I was a student. Granted I have only been a medic for 5 years now, so I’m not exactly going to give the story about how I had to walk to work uphill both ways in the snow, but I have noticed some good and bad changes.
The following story should give you idea of how I was trained:
Preceptor – So what do we have so far?
Sean – Sinus tach with occasional PVC’s on the monitor, O2 Sat is 98% on 2 liters.
Preceptor – Ok, but what about the patient?
Sean – Well, I don’t see any elevation…..I don’t think he’s having an MI.
Preceptor – Ok, well go ahead an place this mask on the monitor at 15 liters and spray 1 nitro on the screen.
Sean – Ummmmmm, what?
Preceptor – Sounds like you got the monitor figured out, so I’ll go ahead and treat the patient from this point on.
I wasn’t allowed to use the Sp02 for the majority of my internship, because my preceptor was adamant that I need to rely on a physical assessment to determine how well someone is perfusing. All these “numbers”, “squiggly lines”, and “waves” were only tools to help confirm what we already knew from our assessment.
It now seems that the tides have changed. We are discouraged from going against the 12-lead monitor’s interpretation as it is “supposed” to be more accurate than the average paramedic. We can no longer “confirm” tube placement without the use of a capnography device. The NIBP is supposed to be more accurate than our ears and the almighty Sp02 never lies.
Don’t get me wrong, these are all great tools and they have certainly improved patient care for the providers that use them appropriately. But I continue to see more and more people rely on technology as a means to assess and treat their patients.
Perhaps watching the terminator series has left me paranoid, but I see a change and I don’t like it.
