Educator`s Corner: The Easy Button

This Educator’s Corner Column first appeared in EMS World Magazine in 2007. Opiate overdoses and the use of naloxone is much more common now than it was then; however, the message here is a timeless one for your students.

While in the hospital's EMS room writing a run report after dropping off a patient, I heard another rig's crew doing a call-in report for anaphylaxis treatment (epi 1:1,000 and Benadryl). The patient was unresponsive, but didn't have the classic anaphylaxis presentation. The radio report noted only a raised area on one arm, and no respiratory or shock symptoms or history of contact with an allergen.

Things in EMS aren't perfect. I suspected there may be more to it than what was being reported on the radio. The rig came in as I was getting HIPAA paperwork signed, so I didn't see the patient, but I was chatting with the medic (a sharp, dedicated medic and one of my former students) when the doctor came out.

"She's OK now," he said. "Opiate overdose. Narcan woke her right up."

With a collegial pat on the shoulder, he said the words that instantly propelled the case into this column: "Shoulda just hit the 'easy button'."

I think I'll go to a Staples office supply store and buy one of their easy buttons to mount in my classroom.

I believe the medical axiom for this is: "If you hear hoofbeats, look for horses, not zebras." But aren't our students perpetually looking for zebras as they work to sort and apply the voluminous clinical information they get in class? How do we teach clinical thinking while still allowing our students to feel comfortable with intuition? How do we show them to go with the assessment flow and allow it to take them in the proper direction while being only appropriately cautious of "zebras"?

As instructors, we offer our students axioms or guidelines. Words of wisdom. Things we would like them to remember when faced with a diagnostic dilemma or a challenging call in the field. Here are a few of mine:

• If your head-injured patient shows signs of shock, you are missing an internal injury in the chest, belly, pelvis or femurs. You can't bleed enough into your head to develop shock.
• If you are testing for orthostatic hypotension and the patient feels dizzy when he stands up, he failed. Don't wait for him to pass out to stop the test. (Yes, some students need to hear this.)
• Get detailed "Events" in the SAMPLE history-especially for altered mental status. Some of the most significant diagnostic clues reside here.

Top Tip: Shades of Gray

There are times in EMS when we must work with the information we have. No patient follows the bullet point list of signs and symptoms. Some students have trouble accepting this.

Have you ever had a student who looked for concrete answers-even when none were available? My friend, firefighter/medic and fellow Maine instructor Paul Salway, has an answer for the hardcore "black-and-white" student.

Paul had a student who looked for concrete answers where there were none, so he went to a local building supply megastore and picked up all the gray paint swatches he could find. When he was faced with the black-and-white vs. gray scenario in the classroom, he would take a swatch out of his briefcase and place it in front of the student. Gray. Case closed.

Our patients don't exactly match the bullet points in the textbooks, but this doesn't have to be a bad thing. If all our patients presented the same, there would be no challenge—no clinical thinking. Again, sometimes we just need the "easy button."

What words of wisdom do you offer your students? Leave them in the comments below to share.