# First medic job-- frustrated with protocols...



## jamiga (Mar 23, 2009)

Hey guys! I got hired as a Paramedic with one of the local EMS services... orientation starts on the 31st. Of course I'm really excited, and doing everything I can to be prepared.

I got my hands on a copy of the protocols (2008), and I've been studying them like crazy (they give a protocol test before you get released into the wild).

It's kind of frustrating to come across so many contradictions in the protocols (as opposed to what I learned in school). 

Examples:
 The protocols recommends Atropine for ALL heart blocks (even 2nd II and 3rd).

 It also recommends the 'cocktail' of Thiamine, D50W, and Narcan for several different scenerios (isn't that no longer common practice??).

 Also, for snakebites it talks about applying a constricting band proximal to the wound, which I'm fairly certain that was NOT indicated in my Paramedic book.



I haven't finished reading the rest of the protocols yet, but I'm getting pretty annoyed. This company is supposed to have the 'better' protocols of the two EMS services around here. 
Are all services like this? Or is this one just behind the times? 
I can't bring myself to do something to a PT in the field (that I don't agree with, and may be detrimental) because of outdated protocols.

Advice?


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## BEorP (Mar 23, 2009)

The protocols "recommend" or "require"?


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## Aidey (Mar 23, 2009)

Everywhere I've worked threw out the "give everyone with an ALOC D50" protocol when blood glucose monitors were introduced.


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## jamiga (Mar 23, 2009)

BEorP said:


> The protocols "recommend" or "require"?




Technically, they don't say either one... I suppose thats the part I'm confused on. They are just listed as bullet points under a given scenerio. I would hope it would just be a suggestion, not a requirement. Correct me?


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## firecoins (Mar 23, 2009)

I see someone has been studying cranial nerves


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## jamiga (Mar 23, 2009)

firecoins said:


> I see someone has been studying cranial nerves



I have. And you are a nerd for recognizing it! It's the only way I can remember them all, so I spread it around as much as I can. It's better than that old On Top of Olympus blah blah...


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## firecoins (Mar 23, 2009)

jamiga said:


> It also recommends the 'cocktail' of Thiamine, D50W, and Narcan for several different scenerios (isn't that no longer common practice??).Advice?



This is the NYC/Westchester protocol for AMS.


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## reaper (Mar 24, 2009)

Cookbook medicine!!

The only snakebite that requires a constricting band, does not live in your state and is hardly ever kept as a pet!


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## Aliakey (Mar 24, 2009)

Your protocols should be signed by a physician, and as such, you are working as an agent, or an extension of that physician.

The protocols should be his rules.  But, there exists the possibility that he may be unaware that something was typed incorrectly into the protocol, or that a treatment is no longer considered a standard of practice in the field.

If in your shoes, I would dig up credible information (the Wiki doesn't count, lol!) on why a certain treatment is no longer considered acceptable, or options to better treatment.  Document this on paper and also document your references.  I don't know how large your service it, but if a good size, you make want to discuss it with your QA folks first to see why such an outdated or inappropriate treatment exists.  What is the history for it?  If that's not an option (or these folks are just not willing to consider other treatment options, 'cause "we've done this for years without problems"), then I'd take this document directly to your Medical Director.  Set up an appointment and intelligently explain your stance.  

Worked for me.  Worked for that service.


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## Sasha (Mar 24, 2009)

Maybe ask for clarification from your medical director?

Maybe you are misunderstanding, maybe he is unaware of the error?


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## jamiga (Mar 24, 2009)

Thanks for the replies, I'll bring up my concerns at orientation. Then I'll go from there.


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## AJ Hidell (Mar 24, 2009)

jamiga said:


> Thanks for the replies, I'll bring up my concerns at orientation. Then I'll go from there.


I'd be very careful about that.  Organizations tend to be pretty sensitive to people who come in rocking the boat from day one.  If you go in there and start immediately implying that you know better than they do, right out of school, you're not going to last long at all.


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## Ridryder911 (Mar 24, 2009)

I agree. You are still wet behind the ears and you want to what? .. Even though you maybe right, you have no right as yet to have an opinion. Be careful and pay your dues first then if asked and only then offer suggestion(s).

R/r911


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## reaper (Mar 24, 2009)

Yes, you need some experience, before you go in telling them they are full of S**t!:unsure:


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## jamiga (Mar 24, 2009)

Haha. I'm not going to show up to orientation with a protocol book covered in red ink. I understand how that would be overstepping completely, and I'm not that brave anyhow. It's all good.


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