EMS Garage

If EMS providers don’t diagnosis, then they can’t call a low blood sugar hypoglycemia, a patient showing signs and symptoms of an MI with ST-elevation with a STEMI, or calling a stroke alert. All of those are diagnoses. As such, EMS providers very much diagnosis because you have to if you are treating patients without a physician looking directly over your shoulder.

As to this specific case, is there validity in including GERD in a list of differential diagnoses (DDx)? Absolutely, but STEMI and NSTEMI, among others causes, absolutely has to be considered in the list of DDxs as well. STEMIs can be ruled out with a 12 lead, but even if a crew has point of care cardiac troponin (cTNT or cTNI) testing (those tests are out there), NSTEMI requires serial troponin tests followed by a stress test. So even if you’re fairly sure that a patient might be suffering from GERD, if you can’t rule out NSTEMI (which EMS can’t, regardless of the level), you need to push for transport.

In short, if you (generic “you”) aren’t considering a list of differential diagnoses when treating your patient, you better not be doing anything short of following the protocol list like a cook book, which of course makes you a technician, not a professional. If you’re thinking that the patient might not be fitting your protocol perfectly, then you’re making a DDx and saying, “Well, gee, it could be A, or B,” which is the definition of a differential diagnosis.