Technician to Clinician

Critical Thinking
!e 8eeson
LMS 1oday 2014
The Medical and
Ethical performance
of EMS professionals
has never been
more important than
Today.
The End of the Beginning
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We ho|d these
truths to be
se|f ev|dent
All Paramedics
are
Created Equal
REALLY???
All certified by the
state

All have passed
Registry

clinical skills
and a written Exam
Therefore
Theyre
ALL EQUAL!
The State doesnt
differentiate
between them!
What about
phys|c|ans?

Are 1nL a|| equa|?
Licensed by the state
Passed national boards
Residency program
Board certied
Lveryone knows a
hys|c|an you wou|d not
|et treat your dog.
Let a|one your fam||y
The point is
maybe we are not
all created equal
How do we deal
with this
inequality?
Leve| 7
- 8ase SLauon hyslclan
Leve| 6
- Crlucal Care aramedlc/nurse
- Crlucal Care MlCu
Leve| S
- rlmary aramedlc
- MlCu
Leve| 4
- Lead Secondary aramedlc
- ALS Ambulance
Leve| 3
- Secondary aramedlc
- ALS-8aslc Ambulance
Leve| 2
- LM1-lnLermedlaLe
- lLS Ambulance
Leve| 1
- LM1-8aslc
- 8LS Ambulance
Credenuallng:
AssessmenLs
rocedures
Cllnlcal ueclslon-Maklng
Compllance
rofesslonallsm ls
1he pracuce of a professlonal,
as dlsungulshed from an
amaLeur.
What Makes a Student 8ecome
a Great aramed|c?
Solld foundauon of knowledge
AblllLy Lo perform skllls
AblllLy Lo Lhlnk crlucally
The process of determining the
authenticity, accuracy and value
of something; characterized by
the ability to seek reasons and
alternatives, perceive the total
situation and change one's view
based on evidence.
Critical Thinking
Critical Thinking involves
clinical decision making
using the medical inquiry
and clinical reasoning.
WhaL Causes Lrrors?
Most result from incomplete
or poorly performed patient
assessments
MlsLakes We Make
LMS educauon focuses on manual skllls
by algorlLhmlc proLocols
We should focus on
Ponlng our AssessmenL
Cllnlcal 8easonlng
Crlucal 1hlnklng
"re-Loss" Strateg|es


1hlngs we can do before a loss
occurs.
neur|sncs
8ules LhaL explaln how people make declslons,
come Lo [udgmenLs, and solve problem
Can predlspose a speclc response Lo cerLaln
slLuauons.
1he goal ls Lo unmask
cognluve errors ln Lhe
pauenL assessmenL
process for Lhe
developmenL of
deblaslng Lechnlques.
Conhrmanon 8|as
"Cherry |ck|ng"
Look for ev|dence that
conhrms the assessment
we've made BC)+6#1:
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We fa|| to cons|der
persuas|ve ev|dence that
changes that
assessment.
D|agnos|s Momentum
1he auached a label
Lends Lo suck-
Lven lf lL's
erroneous.
Aur|bunon Lrror
8ecomlng [udgmenLal and blamlng
pauenLs for Lhelr lllnesses raLher Lhan
fully examlnlng Lhe clrcumsLances
sych-CuL Lrror
We overlook serlous
co-morbld medlcal
condluons ln
psychlaLrlc pauenLs
Cender 8las
1he bellef LhaL gender ls a
deLermlnlng facLor ln Lhe
probablllLy of a dlsease.
Anchorlng
1he Lendency Lo lock
onLo Lhe pauenL's lnlual
presenLauon
Cvercondence 8las:
1he Lendency
Lo belleve we
know more
Lhan we
acLually do.
Search Sausfylng
1he Lendency Lo call o a search
once someLhlng ls found
(comes from noL belng meLhodlcal)
Half of Litigation
brought against
Emergency Providers
Results from
Delayed
or
Missed Diagnoses.
Technician vs Clinician
1echnlclans
roLocol drlven
8espond ln a speclc way Lo slgns and
sympLoms.
Cllnlclans
CaLher perunenL lnformauon
Carefully evaluaLe LhaL lnformauon
uevelop a LreaLmenL plan
There is a difference
between a
Technician
and a
Clinician
The primary difference
involves training and
experience.
The second, and most
important,
is the mind-set.

The most dangerous thing
in EMS today is a
TECHNICIAN
trying to be a
CLINICIAN
without the training or
experience.
8educlng Lrrors
8ecognlze our blases
Work wlLh Lhe lnslghL galned.
Always conslder alLernauves.
Ask whaL else mlghL be golng on.
Learn Lo sLep back.
8educlng Lrrors
Scenarlo-based Lralnlng
Slmulauons
locus less on algorlLhmlc
proLocols
locus more on crlucal Lhlnklng
and reasonlng skllls
lL ls hard Lo abandon
reLesL robablllLy

We have to stop assuming
that
Paramedics have all the
training that they need
fresh out of school
ALL THAT YOU HAVE
fresh out of school
is a
LICENSE TO LEARN
We have Lo sLarL
educaung aramedlcs
for whaL Lhey wlll be
dolng on Lhe [ob, noL
whaL's on Lhe LesL.
We spend 93 of
our Lducauon for 3
of our Calls
ulerenual
ulagnosls
vlnulCA1LS
Slck unul roven
CLherwlse
lleld 1ralnlng
The only care that has
shown to make a
difference in survival is
Basic Life Support.
8LS
ls
ALS
46)&# -"# H))>
knowledge
racuce Lxperlence
We musL become
Cllnlclans
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