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EMS providers have long been taught that we don’t diagnose: we assess and treat. The definition of diagnosis, according to Black's Law Dictionary is: the discovery of the source of a patient's illness or the determination of the nature of his disease from a study of its symptoms. The definition goes further: a "clinical diagnosis" is one made from a study of the symptoms only and a "physical diagnosis" is one made by means of physical measure, such as palpation and inspection. This certainly sounds a lot like what EMS does. So, why are we consistently warned against using the term "diagnose" to describe what we do as if it were some hallowed ground upon which we shouldn’t enter?

Perhaps it’s because we lack key diagnostic tools such as laboratory and radiology. Certain conditions, such as abdominal pain, are very difficult to pin down definitively in the prehospital setting without the help of these important studies. However, in other situations—such as an open femur fracture—it doesn't take an X-ray to know what we have. When we find out our unconscious patient is an insulin dependent diabetic, measure the blood glucose, find that it is 58, and administer 50% dextrose intravenously, we’ve made a field diagnosis and provided appropriate treatment. While the fine points and definitive diagnoses are certainly better left to the ED physicians, in many situations we do make a diagnosis.

So, what's wrong with calling what we do a "field diagnosis"? Nurses make a "nursing diagnosis." Perhaps the real issue is what I call medical snobbery. For years, EMS personnel have been looked down upon by others on the medical team. They say our education is lacking, although my paramedic training included a full anatomy and physiology course and cadaver lab, and ACLS which many nurses and physicians don't take. Our paramedic courses now run almost as long as a two-year nursing program, although skip the part about bed changing and baths. They say that we are only "certified" and not "licensed" medical personnel, when in fact we take a national or state examination to earn the privilege of practicing in EMS, just like other members of the healthcare team. Some states, like mine (New Mexico), have grudgingly admitted us to the ranks of "licensed" health care providers. Even though some states call it "certified," the correct legal term is "licensed."

I propose that we begin asserting our abilities to make a field diagnosis, and that we start calling what we do just that. We’re the ones who are first on the scene, able to observe the patient in the environment in which the illness or injury occurred. This gives us a tremendous advantage if we use our senses to see what the environment can tell us. The presence of drug paraphernalia, alcohol containers, or trash that hasn't been taken out for a month can be significant clues to what is going on with our patient. Then we add the patient's prescribed medications to a carefully taken patient history. We take a full set of vital signs (the fact that EMS excludes temperature remains a mystery to me) and perform a physical examination (we call it a "head to toe"), including palpation, inspection and auscultation. We have then accomplished what physicians call a "history and physical" or H&P.

Yes, our examinations are limited. We often don't disrobe our patients and our exams are hurried and often performed in noisy, poorly lit environments. And we should recognize our limitations. But as EMS moves in the direction of becoming acknowledged as a medical profession, we’ve acquired better diagnostic tools designed for prehospital use. A field diagnosis has its limitations, but it’s a diagnosis nonetheless.

imagen descriptiva
Emergency Services

Emergency Room
Vital signs
Servicios que tratan con accidentes y/o situaciones de emergencias (fuegos, terremotos)
Sala de Urgencias
Signos vitales
Black out
Go under the knife
To be in the pink
Over the worst
To be/feel under the weather
Perder la consciencia
Examen médico
Operación quirúrgica
Tener muy buena salud
Recuperarse de una enfermedad
Estar o sentirse enfermo

So, why are we consistently warned against using the term "diagnose" to describe what we do as if it were some hallowed ground upon which we shouldn’t enter?
Certain conditions, such as abdominal pain, are very difficult to pin down definitively in the prehospital setting without the help of these important studies.

We use to + infinitive
To express purpose:
- He bought some flowers to give to his wife.
- He locked the door to keep everyone out.

We sometimes say in order to or in order not to:
- We set off early in order to avoid the traffic.
- They spoke quietly in order not to wake the children.

… or we can say so as to or so as not to:
- We set off early so as to avoid the traffic.
- They spoke quietly so as not to wake the children.

After certain verbs, particularly verbs of thinking and feeling: choose, decide, expect, forget, hate, hope, intend, learn, like, love, mean, plan, prefer, remember, want, would like, would love

… and verbs of saying: agree, promise, refuse
- They decided to start a business together.
- Remember to turn the lights out.

Some verbs are followed by a direct object and the infinitive: advise, ask, encourage, invite, order, persuade, remind, tell, warn, expect, intend, would prefer, want, would like
- She reminded me to turn the lights out.
- He encouraged his friends to vote for him.

Sometimes the to-infinitive gives a reason for the adjective: disappointed, glad, sad, happy, anxious, pleased, surprised, proud, unhappy
- We were happy to come to the end of our journey =
We were happy because we had come to the end of our journey.
- John was surprised to see me =
He was surprised because he saw me.

Other adjectives with the to-infinitive are: able, unable, due, keen, likely, ready
- Unfortunately I was unable to work for over a week.
- I am really tired. I’m ready to go to bed.

We often use the to-infinitive with these adjectives after it to give opinions: difficult, possible, easy, hard, wrong, nice, clever
- It’s easy to play the piano, but it’s very difficult to play well.
- He spoke so quickly it was impossible to understand him.

Common mistakes and confusing words in English.

Alone or Lonely?
Alone, can be used as an adjective or adverb and means either to be on your own or to be unique.
Lonely is an adjective and is most often used to describe the emotion of being unhappy because you are not with other people.
- I went to the concert alone as nobody else liked the band.
- His wife died last year and he’s been very lonely ever since.
- I like to be alone sometimes, but after a few days, I usually start to feel lonely.
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