Do you have to follow your Agency's clinical protocols exactly as written?

DrParasite

DrParasite

The fire extinguisher is not just for show
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I'm not a fan of cookbook medicine, but I am a fan of flowcharts when it comes to treatment protocols (if you see this, do this), because it give clear guidance on what should be done under certain circumstances, as well as gives criteria for what to look for.

However, providers in my system don't HAVE to follow them as rigidly as written, provided they can properly justify why they didn't. and Paramedics can bounce around if they feel it's justified. For example, do you really need to start an IV on a pediatric asthma patient, if you don't intend on giving steroids (which I am told aren't as effective as once thought)? And if you can justify your actions, no QA flags, and the medical director will back you.

Is that common elsewhere? or are you expected to follow the protocols word for word, and will get called into the boss's office if you deviate?
 
Since the paramedics around here don’t need to really know any protocols, they kind of just do what they feel. If in doubt, they GTS for Tx guidelines...
 
Nope. My agency does not call them protocols. They are “Patient Care Guidelines” and they are treated as such.
 
DrParasite said:
However, providers in my system don't HAVE to follow them as rigidly as written, provided they can properly justify why they didn't. and Paramedics can bounce around if they feel it's justified. For example, do you really need to start an IV on a pediatric asthma patient, if you don't intend on giving steroids (which I am told aren't as effective as once thought)? And if you can justify your actions, no QA flags, and the medical director will back you.

Is that common elsewhere? or are you expected to follow the protocols word for word, and will get called into the boss's office if you deviate?
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All three EMS systems I've worked in allowed that much flexibility in practice, although not necessarily in writing.
 
Everywhere I've worked, they've been flexible with their protocols. That being said, I work in California where the protocols are very limiting and you essentially are just an EMT that can start an IV and give oral Zofran, lol! Even flight is technically restrictive where we can only RSI, use a ventilator, and intubate kids. The "expanded" scope of practice for flight paramedics (aka "unified scope") also include using supraglottic airway, IOs, and using video laryngoscopy. Still limited on drugs we can give, drips, and procedures we can perform. California.
 
Depends on the medical director, experience and performance. I’ve limited providers to only certain protocol steps and others have free reign.
 
Guidelines; mainly because very few patients fit in the flowchart boxes
 
It is called a protocol here however they are guidelines if you have a justified reason for not following them step by step and it is not dangerous to patient care our medical director and Qa will back us
 
We cover ~1200 square miles and have plenty of cell and radio dead zones. Our Doc has made it clear we can use our best judgement based on our training and existing protocols if we can't reach a doc for an order. Just document well and justify based on needs of the patient and follow up with an incident report.
 
A clinical/protocol variance report can save your bacon if you’re in a spot where protocols are mandated with an iron fist. Clear documentation to cover yourself is your best defense.
 
Yep, our protocols are specifically written rather vague and open ended in alot of places. And you certainly dont HAVE to start an IV on someone, hell, alot of areas dont even specify IV access, its just sorta implied.

as long as were not doing gross medication errors or something thats a danger to the pt then theres no issue. We just started QA reviews with a new CCT Nurse / manager that was hired though and im wondering how well she actually knows paramedic protocols in this county and how strict she'll be....So im staying curious on that one.
 
Yes the best I can. If you have a disagreement with a protocol; the best rout is to contact medical direction. You can also talk to your medical director about changing things or you can go to medical school and become a medical director. The range of competency and proficiency in EMS is far to broad to allow autonomy outside of protocols.

Thats what I think
 
guidelines here. New employees are given the guideline book and expected to work in that until they can free think
 
MEDicJohn said:
guidelines here. New employees are given the guideline book and expected to work in that until they can free think
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How many months does it take for a new paramedic to feel like they can free think?
 
clinical safety should be taken as a priority over the coolness being a free thinking paramedic
 
my protocols are very vague. so alot of room for clinical thinking, but we cannot go outside of what is stated in protocols unless truly justified also we cannot ask base station for additional orders not listed in protocols, which makes having a base station kinda useless other than for trauma/stroke/stemi alerts.
 
Jn1232th said:
my protocols are very vague. so alot of room for clinical thinking, but we cannot go outside of what is stated in protocols unless truly justified also we cannot ask base station for additional orders not listed in protocols, which makes having a base station kinda useless other than for trauma/stroke/stemi alerts.
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Could you give an example of a very vague protocol that you can't "go outside of...unless truly justified"?
 
mgr22 said:
Could you give an example of a very vague protocol that you can't "go outside of...unless truly justified"?
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Example will be our copd/respiratory distress which states: perform BLS maneuvers/interventions. Consider albuterol/atrovent, consider CPAP, consider versed, consider intubation.

As for going outside of, We can intubate and such if indicated without issues but cannot give additional medications or doses. Such as for albuterol and atrovent states 2.5/0.5x2
Also if gag is intact we cannot sedate or RSI, though I have heard of medics sedating and then justifying it later to medical director
 
spimx said:
clinical safety should be taken as a priority over the coolness being a free thinking paramedic
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It isn't as if there are balloon pumps or burrs for craniotomies on ambulances....pre-hospital care in the US is pretty rudimentary in the grand scheme of things...if a medic is going to get into trouble with the limited tools he has available to him because of 'free thinking', he'd get in trouble without it. Don't know what your role is in ems, but it sounds like you have an axe to grind and it's better to let the medics do their jobs in the spirit of their guidelines than lose a finger...which you will...
 
Jn1232th said:
Example will be our copd/respiratory distress which states: perform BLS maneuvers/interventions. Consider albuterol/atrovent, consider CPAP, consider versed, consider intubation.

As for going outside of, We can intubate and such if indicated without issues but cannot give additional medications or doses. Such as for albuterol and atrovent states 2.5/0.5x2
Also if gag is intact we cannot sedate or RSI, though I have heard of medics sedating and then justifying it later to medical director
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That doesn't sound vague to me. You have options for specific interventions (I'm assuming the Versed dose is stated).

Is "base station" your medical control, or are you just calling them to make a hospital notification?
 
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