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

Comments

  1. 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

    🙂

  2. “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.

  3. 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!

  4. 40lizard says:

    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!

  5. 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.”

  6. Eric Bergersen says:

    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!

  7. Steve Whitehead says:

    Thanks for clearing up the TIC thing Jim. I new someone would remember it.

  8. Steve Whitehead says:

    Thanks for the comment Happy 😉

  9. Steve Whitehead says:

    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.

  10. Steve Whitehead says:

    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.

  11. Steve Whitehead says:

    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.

  12. Steve Whitehead says:

    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?

  13. 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/

  14. 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

  15. Steve Whitehead says:

    @Greg, Nice link. Maybe we should consider just OS.

    @Sarah Another great weakness of complicated acronyms. The variations go on and on and on …

  16. 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.

  17. 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!

  18. Sorry.
    BSI, not BSE. Type-O

  19. Stephen says:

    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?

  20. 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.

  21. Steve Whitehead says:

    @ 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.

  22. Steve Whitehead says:

    @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.

  23. halfpint says:

    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?

  24. 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.

  25. robRNmedicNP says:

    I have been an RN for 20 years, a medic for 6 years, and an NP for a year. With that being said, I DO recall DCAPBTLS, and I think about it every day. For me, the acronym is not useless. It is not only a prompter for assessment, but also documentation. And, unlike the person (Steve) who prefers to LOOK at one area, and then LOOK at another area, and etc., because our brains supposedly work that way, I quickly (really quickly) look (inspect), listen (auscultate), and feel (palpate) as I move along, so that I do not fall victim to the “well, it looked ok, so I didn’t do anything else” syndrome, consequently missing important assessment data. I agree that it is important for me to know an acronym if I am going to use it. As a student, if an acronym is part of the class material, it is my duty to know it; but, as an instructor, which I sometimes am, it is my job to make sure that students know what they are talking about when they say “DCAPBTLS,” hence questioning students about the individual components of acronyms.

  26. A far easier to remember mnemonic is a modified ITLS version: CLAPS-TICS [look for CLAPS, feel for TICS]
    CLAPS=Contusions, Lacerations, Abrasions, Penetrations, Swelling/Symmetry
    TICS=Tenderness, Instability, Crepitus, Subcutaneous Emphysema

    It can roll of the tongue in 5 seconds when you’re asked what it stands for during a timed test (I use CLAPS-TICS, and throw in Deformity).
    ITLS is actually CLAPS-D, TICS-D (D=deformity/distension), and you could throw in Burns (BD-CLAPS-TICS).

    DCAPS-BTLS-TIC is one of the worst acronyms I’ve come across – unorganized and difficult to spout off quickly.

  27. When learning my trade (EMS), back when the T-Rex roamed, this acronym would have proved helpful while I learned about the abnormalities of the human anatomy. To those who feel it is useless, you have been in the field for quite some time and you know what to look for and where/how to look for it. By using the acronym, you are force to assess the patient more thoroughly. For the soon-to-be EMT, that has never encountered a patient, it WILL help her/him do an adequate prehospital exam and be able to give an informative, fact-based report to the receiving facility.
    To say that DCAPBTLSTIC is useless, think about OPQRST, MOI, SAMPLE, and AEIOU. There are more, but the point here is that they ALL serve to remind us of an aspect of our examination procedures. If the meaning of each letter is understood when the acronym is stated, or thought of, then the intended purpose for using it was achieved.
    Lastly, if the use of acronyms is useless, time-consuming, unproductive, or whatever the negative rant-of-the-day is, then maybe the authors, editors, and/or publishers of the materials that are used to teach the trade should stop including it in their instruction material. I for one will continue to use and teach DCAPBTLSTIC.
    Have a great day everyone and be careful out there.

Trackbacks

  1. […] Whitehead lets off a little rant about DCAPBTLS and its gross overuse in both teaching and testing patient assessment skills. Admittedly, I have […]

  2. […] my post/rant about the overuse and misuse of the DCAP BTLS TIC acronym in EMS education, I was asked the question, ” Well, are there any acronyms that you do find […]

  3. […] For those who haven’t yet encountered this mess of consonants, it’s intended to be an aid to examining a patient, reminding you of various maladies to look for. In its full glory, we have Deformities, Contusions (bruises), Abrasions, Punctures, Burns, Lacerations, Swelling, Tenderness, Instability, Crepitus. It also comes in an American version of DCAPBTLS, which just covers the soft tissue stuff and was covered neatly by the EMT Spot here. […]