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.
“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:
Punctures / Penetrating Injury (Are they distinctly different?)
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. 😉