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If you remember the "Orange Book" you are officially older than dirt.  This year is its 40th anniversary and for the 1970s there was no other source for minting an EMT other than this book and hours of hands on practice.  As I recall those men and women that blazed the first steps for us from ambulance driver to EMS I am indebted to them for what they accomplished without OPQRST.
We came from funeral home based transport, to first aid, through the national introduction of paramedics and EMTs, and landed professionally where we are now.  Not always appreciated but at least an important cog in the emergency medical wheel.  Who cares?  Well, we are heading back to our roots.  OK, not as far back as those nice riding Cadillac ambulances but far enough so it is deja vu all over again.
This year the Brady company purveyor of those things printed for the EMS community has determined, with the help of learned scholars and an update in the National EMT Curriculum, that the thing we we now call the practice of prehospital care needs to have its pathophysiology adjusted.  We came, we saw, we memorized, we neumonic-ized and we prioritized.  Yet we never got to the critical thinking phase of the care we provided.  
This update will take care of that.  Instead of treating signs and symptoms we are instructed to delve deeper into a "body systems approach."  This will create a "reinforcement of the critical thinking and differential diagnosis processes for the EMT while completing a medical assessment and developing a patient care plan." The quotes are from The Transition by J Mistovich.  So in other words gain insight into the patients condition by obtaining a patient history.  Perform a primary and secondary survey and reassess the patient during transportation.  No more initial assessment, focused history and physical exam, and ongoing assessment.
I couldn't have said it better myself, of course the orange book did 40 years ago.  How nice to have been doing it correctly for all of those years.  Thanks for confirming my unscientific 40 year study affectionately named "Shut up and listen to what the guy/lady is telling you."  Yes I do know what I'm doing...and I'm older than dirt.

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