Learning DCAPBTLS (A word of advice)
I first heard the BCAPBTLS acronym sometime around 1998 while helping a group of EMT’s practice their skills. I hadn’t been involved in EMT education for several years and I had missed the whole inception of the DCAPBTLS acronym. Dutifully, each aspiring EMT moved from the head to the neck, shoulders, chest and abdomen. Each student verbalized their assessments as they went along and sounded off the acronym in turn.
“I’m exposing the chest and looking for DCAPBTLS.” “I’m checking the abdomen for DCAPBTLS.” On 
and on it went until I finally interjected, “What is this word you all keep using?”
“What word?”
“That word. The Dee Cap something.”
“Oh yeah.” They chimed in and began explaining the purpose of the DCAPBTLS acronym. If I remember correctly, there may also have been a “TIC” component added on to the end as well. If there was, the TIC part has been lost to education history. The students explained that DCAPBTLS was an acronym that was designed to help them remember the various abnormalities that they were looking for during the assessment. Then the funny part happened.
Collectively the students tried to recall all the elements of the acronym. “Deformity, contusions … uh … abrasions.” The room fell silent. “Uh … the T is tenderness.”
“Don’t forget bruising.” Another student chimed in. “Oh, yeah. Bruising.”
By the time the students collectively produced all eight elements of the acronym, several things were clear. The eight elements of DCAPBTLS was not one of them. Before we get in to that, let’s set the record strait. DCAPBTLS stands for:
Deformity
Contusions
Abrasions
Punctures / Penetrating Injury (Are they distinctly different?)
Bruising Burns
Tenderness
Lacerations
Swelling
The acronym is indeed taught as a reminder to the EMT student of what types of traumatic injuries they might be presented with during the physical exam. I can see some merit to this. Students should learn that there are many different injuries that could be present and they need to be ready for them. Point taken.
I have two issues with DCAPBTLS.
First is the issue that the above mentioned students illustrated perfectly. It’s hard to remember. If it takes a long time to remember an acronym it isn’t going to be effective in guiding real EMS care. It isn’t even a real word or based on any familiar combination of letters so there’s a learning curve to just remember the acronym itself.
The eight individual elements are even more difficult to commit to memory. Ask someone who has been out of EMT school for more that six months what the acronym means and witness the long term benefit of DCAPBTLS training.
Second, and more important, that isn’t how your brain works. It’s ridiculous to think that this is the way we think while we’re assessing people. No really, think about it. When you expose a patients chest, do you look at it and think to yourself, “OK, I don’t see any contusions or abrasions or deformity or punctures or …” Of course not.
You look at a chest and you think, ”Anything abnormal? No. Lets look at the abdomen. Anything abnormal? Yes, there’s a contusion.” Do you see my point? DCAPBTLS puts the cart before the horse. The chicken before the egg. We look for abnormality first. We find DCAPBTLS next.
If you discovered jaundice or crepitus you presumably wouldn’t overlook this finding because it wasn’t included in the DCAPBTLS acronym. Of course you wouldn’t because you’re not really looking for DCAPBTLS, you’re looking for normality or abnormality. This is why I don’t emphasize this acronym when I teach my EMT class.
I do warn them that if you’re going to throw out the DCAPBTLS acronym you’d better darn well know what it means. Every letter. Or you’re better off saying something like, “Checking for abnormalities.” and leaving it at that.
You’d be closer to the truth anyway. 
Related Articles:
5 Assessment Findings That Should Concern You
Understanding Combative Head Injuries
Remembering The Glasgow Coma Score
Tags: abrasions, acronym, Assessment, bruising, contusions, dcap btls, dcapbtls, deformity, lacerations, swelling, trauma
Very true Steve. I have seen questions on exams that ask what the
“C” means or what “BTLS” is. I think this came out when they were changing the EMT curriculum and trying to make it easier for students. But like you mentioned, it just gives them something to regurgitate. The teaching should focus more on good assessment skills.
I think though that by encouraging students to say things like this during testing, it gives them the feeling they are not forgetting anything in the assessement and the feeling that they are
“covering their a**es” for testing purposes.
In the acronym works for the student, great. But if they can’t recall it then perhaps they shouldnt be expected to use it or remember it for testing purposes.
I actually have seen this used on call reports as well. – DCAPBTLS.
FYI – TIC = Tenderness, Instability, Crepitation.
From 2008 ITLS training slides.
FYI = For Your Information
ITLS = International Trauma Life Support
“If you discovered jaundice or crepitus you presumably wouldn’t overlook this finding because it wasn’t included in the DCAPBTLS acronym.”
I too encounter EMTs stating, “I’m assessing for DCAPBTLS” who have no idea what it means. It is easier to remember the acronym for testing than the assessment technique for patient care.
Common sense of assessing life threats is easy, assessing for other injuries is, as we all know, more complex.
As the previous commenter noted, using this acronym on a patient care report is even more dangerous than not knowing what it stands for.
Great article.
I agree whole heartedly!
However, I am one of those saddo’s that still to this day, after 9 years can regurgiatate DCAPBTLS,TIC.
That was soley down to repetition and having in bored into my skull on a daily basis.
I must keep telling myself off though…… still to this day, I keep forgetting to lift both hands in the air as I enter a patients house and in a proud voice exclaim:
“GLOVES ON!!!”
oh, hang on, that’s all changed now, I’m not supposed to wear my gloves anymore, unless I am performing an intervention or dealing with yucky stuff!
As now a former EMT-B (who never even got out of the gate) we had to study DCAPBTLS until we were blue in the face and be prepared in case our instructor stopped in class and chose one of us to humilate by reciting the little ditty in front of everyone! But I have to admit less than 2 months out of Basic and I forgot the stupid thing- good thing I am getting out while the getting is good!
Oh and to Mark Glencourse, son, you’re taking your life in your hands everytime you don’t wear those gloves!
I would never use “DCAPPBTLS” on a PCR, but if you quiz me at any hour of the day, I can rattle it off without a moment’s hesitation.
The one that gets me all the time is AEIOU TIPS
… that being said, I can get that one down given a few seconds to think about it.
Acronyms are dangerous only if you forget what you’re looking for.
Which goes back to what I tell my classmates all the time when they’re trying to memorize stuff… “Understand, don’t memorize.”
Thanks to plenty of time having it pounded into my head in my Basic class from long ago… the B in DCAPBTLS stands for “Burns.” Having contusions and bruises in the same acronym would just be downright redundant. But hey, that only matters if you remember what they mean anyway!
Thanks for clearing up the TIC thing Jim. I new someone would remember it.
Thanks for the comment Happy
9 years later! Mark you must have had a more militant instructor than myself. Perhaps you were forced to do push-ups if you forgot the T.
40lizard I don’t know if I’d go so far as to say that patient care without gloves is “Taking your life in your own hands.” I’m glad to see us start backing off of the hard line, “gloves on every patient” policies to a more reasonable, “use when appropriate” philosophy. But it will be a change.
Scott, AEIOU TIPS is a good one to have in your mental library for sure. I think I’ll be addressing that one in the future. It can come in real handy.
Eric, B – Burns, of course. That’s why I’ve been unable to locate or recognize burns for the past 20 years. It wasn’t in my DCAP BTLS acronym!
I think it’s amusing that so many of the folks who claimed to be able to recite it on the spot didn’t recognize that oversight. Kinda proves the point doesn’t it?
I was wandering around the net looking for someone to back me up on my “OST Replaces DCAP-BTLS”.
Thanks Steve… LOL
http://skipatrolmovies.com/patient-assessment-and-vital-signs/osts-replaces-dcap-btls/
I am in EMT-B class now. Our book says that “BTLS” stands for Burns, Tenderness, lacerations, swelling. In your article its says Bruising instead of burns.
Andrew N. Pollak, MD, FAAOS, Emergency Care and Transportation of the sick and injured, Ninth Edition
@Greg, Nice link. Maybe we should consider just OS.
@Sarah Another great weakness of complicated acronyms. The variations go on and on and on …
I’ll second the “burns” in BTLS, bruise / contusion is essentially the same.
I think the mnemonic is fine, so long as you remember what they are. Is it good for in the field? no… but when you’re first starting out, it helps you remember a bunch of different injuries you should be looking for. Is it perfect? no, but it has its place in the learning curve. On that note, there is no perfect way to do a call, but rather many ways of achieving the same result.
I just wanted to make a note that on the arrival, it is mandatory to put on your gloves and any other BSE/PPE. Otherwise you risk your own health. That one of the first things they teach you in EMR. Secondly, the DCAPBTLS- TIC has changed slightly in most institutions now. This has been changed to DCAPBLS- TIC. Notice the difference? There’s a T missing in BTLS. Why? Cause when you look for TIC’s, your checking for “Tenderness” so there’s no need to chech for it twice after the first examination you did 2 seconds ago.
Deformadies
Contusions
Abbrasions
Penetrations
Burns
Lacerations
Swelling
Tenderness
Instability
Crepitus
Cheers!
Sorry.
BSI, not BSE. Type-O
It is just to classify and to memorize the “abnormalities.” . It think it is very helpful. If someone who is a medical student or someone in the field, and he/she don’t know what all the abnormalities are, he/she should study again. You can not blame the system, blame the student/technician. I think this acronym is very helpful, especially when you find any abnormality, you can then use the correct word to describe it. It is true that when you are in the field, you basically just need to find “abnormalities”, but this acronym is to help the student to be education. Otherwise, what the teacher should teach student in the classroom? just look for abnormalities? Then student will ask what the abnormalities are, what if you only have the bystander who is on the phone with you, how will you help the bystander to identify the “abnormalities?
The second I seen “bruising” list for the “B” in DCAPBTLS I knew that was wrong. As corrected earlier it does stand for “burns”. I can understand when somebody not familiar with the acronym or EMS not knowing that. Obviously many people overlooked that in the article. But Steve you wrote that article. Why didn’t you realize what you were writing was wrong? By the way National Registry for EMT’s require that all acronym be stated before the test. The meaning of the acronyms have to be given at that time too. Otherwise if somebody tries to use it during testing they are stopped and questioned while their time is running.
@ J. Thanks for your comment.
@ Ron Thanks for clarifying the TIC stuff. I imagine people were still identifying crepitus and instability before we updated the acronym, but it’s nice to know what the TIC folks are talking about. ..and cheers to you.
@Stephen You make a very good point sir. And I should clarify. Yes, every thing discussed in the aronym is knowledge that an EMT needs to know. What’s a contusion? What does it look like. What does instability mean? What does crepitus look like?
I spend 3 hours teaching students how to classify and treat burns. That information is essential. Combining all of those types of abnormalities into a single word that few EMTs can remember and then using that word to collectively describe “abnormalities” is not helpful. In fact, at best, it’s useless and at worst, it’s counterproductive.
@Robyn OK Robyn…you asked. I didn’t know it was burns because, as I explained in the article, I don’t find this acronym useful and I don’t teach it to my students and I don’t recomend they memorize it or use it. I also addressed my thought on the bruising / burns error in the comments section already.
However, I went ahead and corrected the error in the article, so in the future, if people don’t read the whole article or the following comments before leaving their comment, they won’t experience similar confusion.
Regarding your information on the use of the acronym in national registry stations, this may have been a particular rule that your station proctors chose to enforce, (I think it’s a good rule) but it isn’t a part of the National Registry BLS instructors handbook or any other guidelines I’ve encountered. If you feel this is a true national standard you’re going to need to site a source.
So im in EMT-B class right now getting ready to take the big one next week and you all are saying that it would be better for me to say during the skills test to say im checking for abnormalities? They have drilled DCAPBTLS in our heads forever but half the people in my class couldnt tell you what it ment if their lives depended on it. I just need to get this all straight i mean granted i know what it means and i repeat it back to myself in my sleep, but will it help at all?
I realize this is an old post but I’m going to chime in anyway. I took EMT around 1998 or 1999 and had to memorize DCAP-BTLS and actually can also still rattle it off!
Of course, a humorous classmate helped it stay in our heads: Decapitate Bottles. I can’t look at that acronym without associating it with Decapitating Bottles and the many drills we had as we all studied together for the test!
We had an excellent instructor and he made sure we knew well what we were saying at every moment, to the degree that he even made us rehearse how to give a full report, without hesitation, almost making it second nature by the time we took the test (where, of course, that wasn’t a skill that was tested). He was trying to prepare us for the real world, not just the test. I wish all EMT students had an instructor like him.