# BTLS VS PHTLS



## Fraser.g (7 Nov 2005)

Well the standard of PHTLS has arrived in Saskatchewan for the reserve medics.

I took the Instructor pack over the last week and was impressed. What I would like is a discussion on the pros and cons as members of this forum see them.

I personally like the streamlined primary assessment and rapid decision on transport. Also the move away from the acronyms that are so prevalent in BTLS.

By the way there was an instructor from the Wing Hospital on the course as well as a civilian instructor.  I did hear some rumblings about the regular force considering a move to PHTLS as well.

GF


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## Armymedic (7 Nov 2005)

RN PRN said:
			
		

> I did hear some rumblings about the regular force considering a move to PHTLS as well.



I have also heard rumblings of making the CF an independant chapter of ITLS.... and we are still teaching ITLS courses for predeployment training, as that is the prerequisite for Med Techs.

And as there now is a French edition...well,

don't go hypoxic waiting for that to happen.


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## medicineman (7 Nov 2005)

I think that one way or the other it should be standardized - do one or the other.  In the end, they present a different recipe for the same cake.  I'm getting a little tired at the moment of having to take a new instructor package for every (BEEP) different way of delivering first aid and trauma care that there is because the CF wants to spread the wealth out to all and sundry.  Pick one program and one provider and teach that well.

     Having got all that off my chest, I used to teach for a company that was bringing PHTLS online in Ontario and they were trying to get me on the band wagon when I left there - they were finding the course easier to deliver and easier for students to digest.  But, alas, I left and never really got a chance to look into it much.  Who knows, maybe I'll have to add another card to my wallet soon... :

MM


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## Fraser.g (8 Nov 2005)

Armymedic said:
			
		

> I have also heard rumblings of making the CF an independant chapter of ITLS.... and we are still teaching ITLS courses for predeployment training, as that is the prerequisite for Med Techs.
> 
> And as there now is a French edition...well,
> 
> don't go hypoxic waiting for that to happen.



Sorry Armymedic, 

PHTLS not ITLS

The beauty of the former is that it is designed by the authors of ATLS. This puts pre-hospital and ER on the same wave length when it comes to trauma. 

I was as jaded as many of you when it came to this new system. I am a BTLS (Advanced) Instructor as I am sure you or many of your counterparts are. Now that I have the PHTLS course I believe that it is the way to go. 
It is one of those things that you see and say "why the F**k didn't I think of that. It makes so much sense".

GF


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## Fraser.g (8 Nov 2005)

medicineman said:
			
		

> I think that one way or the other it should be standardized - do one or the other.   In the end, they present a different recipe for the same cake.   I'm getting a little tired at the moment of having to take a new instructor package for every (BEEP) different way of delivering first aid and trauma care that there is because the CF wants to spread the wealth out to all and sundry.   Pick one program and one provider and teach that well.
> 
> Having got all that off my chest, I used to teach for a company that was bringing PHTLS online in Ontario and they were trying to get me on the band wagon when I left there - they were finding the course easier to deliver and easier for students to digest.   But, alas, I left and never really got a chance to look into it much.   Who knows, maybe I'll have to add another card to my wallet soon... :
> 
> MM



It seems that the tide of PHTLS is slowly moving west. The first cadre of instructors was taught last week in both Manitoba and Saskatchewan. These instructors were both civilian and military. I know that the civi medical authority in Saskatoon is reviewing PHTLS vs B(I)TLS as we speak. 

I sympathize with you about learning a new protocol. I, like yourself, have gone through many "up grades" and versions of courses.

The fact is that research changes and that drives theory (or vice versa). Theory then changs and that drives protocol. What the majority of North American and European countries is preaching and using is PHTLS.This incudes the US military as well as the British. 

Now IMHO the queston is do you embrace the change or get swamped by it?

GF


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## Armymedic (8 Nov 2005)

They are making a CF chapter of PHTLS? That would be news to us here in Petawawa.


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## medicineman (9 Nov 2005)

Pet might not have heard it yet as PHTLS is  going to be the standard for the Reserves to train to and not us in the Reg Force (as yet).

As for learning new stuff, we've noticed a real problem here - and I'm sure that other units will likely amplify this - that people coming off the PCP course are having a hard time unlearning their universal algorhythm/asessment protocol that they are taught.  The JIBC teaches one asessment protocol that works for both medical and trauma patients.  Problem is that there are still alot of old farts (myself included) that were raised on the older ways of doing stuff and haven't yet coverted over to the PCP world.  When some these people are supervising and training, what's coming out of their mouths often results in the four headed alien look from their subordinates.  These guys take the BTLS way of doing things as the Gospel according to... as opposed to what they are - a guideline that BTLS has chosen as the way they think works out well.  I'm at present learning the JIBC way of doing business so at least myself and my MCpl are singing off the same sheet (he's PCP) for when we set up training.

I'm a BTLS instructor myself (amongst others), but am also pretty receptive to other ways of soing stuff, as long as the same end result is obtained - as I mentioned previously though, all I (and I hope alot of others as well) am asking for is "One Medical Service, One Standard -  Full Stop".

MM


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## Armymedic (9 Nov 2005)

medicineman said:
			
		

> Pet might not have heard it yet as PHTLS is   going to be the standard for the Reserves to train to and not us in the Reg Force (as yet).


Nope, got that at OP Med last yr.

I hear you on JIBC protocols...

We teach BTLS to a whole bunch of PCP graduates...nobody is allowed to say one way is better. Its all tools in the tool box. Use what you are most comfortable with, and if its not working for you, change it up.

Flexibilty, with one goal.


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## medicineman (9 Nov 2005)

Flexibility - one of my middle names.  One of those things I'm sure you remember learning on the less recent 3's and 5's  ;D.

MM


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## Fraser.g (10 Nov 2005)

Armymedic said:
			
		

> Its all tools in the tool box. Use what you are most comfortable with, and if its not working for you, change it up.
> 
> Flexibility, with one goal.



Absolutely,

For trauma I believe PHTLS is a better decision algorithm than the BTLS. The decision criteria for rapid evac is simple. 

No vitals are taken for numeric values in the primary. All you need is: Airway, Breathing, Circulation, Disability, Expose/Environment. (Sound familiar to anyone who has done ATLS?)

Airway - Yes, No
Breathing- Yes, no, both lungs or just one.
Pulse- Absent, present, where, fast, slow, weak, strong.

It all you need to make the Rapid extricating/ evacuation call. 

Time is especially of the essence in the military context due to our long evacuation lines.

You may never get to a secondary survey. you treat injuries as they are found and are mindful of distracting ones.

Medical emergencies are a different matter. It is a queston of using the right tool for the job. 
A bayonet can work as a can opener and if you do not have a can opener you might want to try it. On the other hand why use the bayonet if you have a can opener?

GF


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## Armymedic (10 Nov 2005)

Argueing the merits of the two prehospital methods is counterproductive.

Both have the same goals. 

The problem we should be addressing, as medicineman suggests, is the varying standards of training throughout the medical services.

Why do RegF use one and ResF use another, for instance?


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## Donut (18 Nov 2005)

We got a brief from a CWO, lets see if I can get his title correct here, CF HS Group Res CWO ?!? or combinations to that effect.

Reportedly, the leaning in Ottawa is that both res and reg will stick with BTLS in order to maintain commonality, not only between Reg and Res, but with civilian EMS, too.

There were a number of other things revealed, too, but ths isn't the thread for that.

DF


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## Fraser.g (18 Nov 2005)

here is the rub.

I am a strong advocater for both BTLS and PHTLS. I believe they are mutually supportive. There is more practice time with the equipment on the BTLS course as well as addressing medical conditions. 

I also like the PHTLS approach to trauma and its seamless correlation with ATLS. 

In Eastern Canada including Ontario they all do PHTLS.
In Western Canada they all do BTLS.

In DND the reserves are moving to the eastern standard and the regular force is staying with the western standard.

We are only talking about two man days to teach either course every three years. What is the big deal with doing both.

As armymedic stated earlier, there is nothing wrong with having an extra tool in the bag.

GF


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## nsmedicman (18 Nov 2005)

Where I work on the civi side of things, our protocols are based on PHTLS. The course itself is not a requirement, since our treatment protocols are so well defined. We are encouraged to take the course, but it isn't a requirement.


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## Armymedic (18 Nov 2005)

Only certian regions of Ontario use PHTLS, like Guelph where Capt Bradford works. TO and Ottawa EMS use BTLS...


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## Fraser.g (18 Nov 2005)

Thanks for the clarification,

My acertation still stands that it would be more beneficial for CF Medics to have both than just one.

GF


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## Armymedic (11 Dec 2005)

One of the medics who trained in Quebec lent me his military PHTLS book he had just purchased.

what a sham. One military chapter, with a bit more info on penetration trauma, ballistics and wound characteristics. Good way to sell books though.

The 2 differences I seen as I was going thru this new book were:

a) military chapter which outlines TCCC etc...nothing I didn't know already. Directed to the US Army.
b) more indepth mechanism of injury, and theory of wounding. More prenetrating trauma then blunt

and the big one:
c) primary survey - not nearly as specific nor as detailed as the BTLS intial assesment and rapid trauma survey. If you can't see the injury, your not going to find it. But simple.

Other then those 3 chapters...the theory and medicine is EXACTLY the same.

Which is why I don't understand the push to change an accepted standard for Med Techs, esp one which works.

If the answer is only because PHTLS has a military chapter and book...BTLS has the same.

BTW, same medic, who did both courses, prefers the BTLS surveys.


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## old medic (11 Dec 2005)

Armymedic said:
			
		

> One of the medics who trained in Quebec lent me his military PHTLS book he had just purchased.
> 
> what a sham. One military chapter, with a bit more info on penetration trauma, ballistics and wound characteristics. Good way to sell books though.



I was rather disappointed with the book as well.  I haven't removed it from the shelf since it arrived.
My review from last year, for what it's worth:

http://forums.army.ca/forums/threads/26618.0.html

OM


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## Armymedic (11 Dec 2005)

Sorry never saw your earlier review as I was deployed about that same time earlier this yr. 

I concur.


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## Dale Turner (10 Jan 2006)

Where I work (Waterloo, Ont) there really is no standard of BTLS or PHTLS. It seems as long as you've graduated from a college you're good to get hired as a PCP. 
Some of us have taken BTLS courses and some have taken PHTLS. Just as long as all the steps are completed and nothing's been missed it really dosen't matter which methodology you use.

I think the only real plus about the PHTLS book is the emphasis on "scene safety" in battle conditions. So many times I'm marking scenerio's and to hear the younger medics say as they are walking up to the cas.with the jump bag slung over one shoulder..."Im making sure the scene is safe"  I ask what they would do if the cas. and themselves are taking fire.? I have to check myself to make sure I didn't grow another head judging by some of the looks I get. 

I know this could very easily shift to TCCC, thats not my point, just the fact that military/battlefield scene surveys are different than civie street scene surveys.

And I know it's a pain in the arse but to take a course that seems the same but with a different accent seems like good review to me.

DT


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