ACLS Teaching Experience

[Guest guest]

WARNING! This post is not about any clinical problem. It is philosophical

in nature. For those of you who think such things shouldn't be on this

list, please hit DELETE now!

For the rest, I'd like to share something that happened over the weekend

involving an ACLS course I taught with two very knowledgeable paramedics.

The audience was first and second year medical residents. They were from

Jordan, Pakistan, India, Peru, and the Philippines.

Only four of them had ever intubated anybody.

They all spoke admirable, if not perfect English.

Almost all of them will go back to their home countries to practice. About

half of them are already licensed physicians in their home countries.

They were the best class I can ever recall having the privilege to instruct.

The only " attitude " they had was wanting to learn as much as possible.

There was no hint of condescension to the instructors because we are mere

paramedics.

They asked many, many questions, engaged in lively discussion of many points,

and were happy to engage in give and take both with each other and with the

instructors. We learned from them, and they learned much from us, at least

that's what they told us.

When we practiced skills and did scenarios, they all participated to the

maximum. They couldn't get enough intubation practice, and they tried every

single technique I showed them, over and over, and finally I had to tell them

that

I had to pack up the manikin and leave; otherwise, they would still be

practicing.

They chose to continue class through the lunch hour so that they could get

more practice.

The other instructors recounted the same experiences at their stations. The

students were well prepared on pharmacology, but didn't know much about RSI,

and they devoured every bit of information we provided them. They had

absorbed the information in the ACLS handbook and knew it well.

Contrast that with the last class I did for a fire service EMS group.

(STOP! Don't read anything into the fact that it was a fire service group.

The

same comments apply to private service medics.)

Some of them slept through the lectures; there was no interest in

participating in the class or offering information, asking questions, or

discussing

points. When we broke out into the skills stations, we had to prod them to

even

try intubation once with the advanced techniques we tried to teach. They

already knew it all and didn't need no stinkin practice.

I have more recently taught ACLS to some nurses, LVNs and RNs, and even a

couple of CRNAs at a hospital, and they were more like the physician residents

than they were like the paramedics.

What is going on with paramedics who don't want to learn? Where did we get

the arrogance to think that we know everything we need to know, when some of

us don't even know what we don't know?

How is it that most paramedics in practice in this country would not

recognize the names Tintinalli, Rosen, on, Goldfrank, Hurst, Goodman and

Gilman's, Barbara Bates, Jarvis, Netter, Henry Gray, and similar names?

Ah, I can hear the thundering herd of dissent already. What does any of

this have to do with what we do on the street? Why should we know about

obscure

medical problems? It's been shown that we don't make a difference, hasn't

it? So why bother to learn about rashes and myxedema? Why should we bother

to understand what happens when we give Cardizem to a patient who is taking

flecainide or metoprolol daily? Why do we need to know the generic names of

Tambocor and Lopressor?

I know I'm whipping a dead horse. Nothing will change. But why? Where

did we lose it? At one time we were the foremost prehospital care system in

the world. No longer true except in some isolated areas. The Brits, the

Aussies, the New Zealanders, the Israelis, and maybe some others have either

passed us are or about to.

We have no system, do we? EMS is NOT a system in the U.S. It's a

hodgepodge of crazy quilt responses to a universal problem. We're better than

this,

aren't we?

I started out talking about physicians who are in a residency program in this

country, but who are from other countries. I contrasted their attitudes and

work ethics with our paramedics. And it's not a good contrast.

It's not physicians vs. paramedics I'm talking about. It's about the work

ethic, the dedication to one's profession, and it's about quality and

professionalism in medical care. It's not about public safety vs. pure

medicine,

although I have the sense that the public safety arm of prehospital care

approaches its mission in a more professional way than the medical arm does.

Where do we stand?

Gene G.