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

[Jn1232th]

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?

Compared to other states, definitely not vague, but from my experience in neighboring counties it is haha. But then again I work in a state that medic protocols a very limited and not supported.

Base is medical control along with notification. Few years ago they stopped allowing base physicians from ordering additional medications/interventions to ground crews but I am not sure reasoning behind it

 

[mgr22]

Compared to other states, definitely not vague, but from my experience in neighboring counties it is haha. But then again I work in a state that medic protocols a very limited and not supported.

Base is medical control along with notification. Few years ago they stopped allowing base physicians from ordering additional medications/interventions to ground crews but I am not sure reasoning behind it

So, you can deviate from protocols on your own if "truly justified," but you can't ask medical control for an opinion?

 

[Jn1232th]

So, you can deviate from protocols on your own if "truly justified," but you can't ask medical control for an opinion?

Pretty much yeah haha. Make no sense I know

Example, I had prolonged transport and maxed out of fentanyl dose. Contacted base which stated cannot give more due to already giving max amount per protocol.

But if I were to give an additional dose and justify it in PCR and with medical director if he were to inquire, there wouldn’t be an issue.

 

[mgr22]

Pretty much yeah haha. Make no sense I know

Example, I had prolonged transport and maxed out of fentanyl dose. Contacted base which stated cannot give more due to already giving max amount per protocol.

But if I were to give an additional dose and justify it in PCR and with medical director if he were to inquire, there wouldn’t be an issue.

When you contacted base for more fentanyl, whom did you speak with -- an MD? If not, could you have asked for one?

 

[Jn1232th]

When you contacted base for more fentanyl, whom did you speak with -- an MD? If not, could you have asked for one?

It’s a MD resident and a MICN, both in room at same time.

 

[mgr22]

It’s a MD resident and a MICN, both in room at same time.

So, you the paramedic could decide to give extra fentanyl to your patient real time, but a medical control MD couldn't.

You're there and I'm not, but my spidey sense tells me something's missing.

 

[MEDicJohn]

clinical safety should be taken as a priority over the coolness being a free thinking paramedic

yes free thinking is a huge part of being a medic. situations develop and you need to be able to adapt to everything without calling a base for everything. obviously some skills require bho which is maintained. clinical safety is always priority.

 

[WuLabsWuTecH]

Nope. My agency does not call them protocols. They are “Patient Care Guidelines” and they are treated as such.

That's what I call my written standing orders - "Patient Care Guidelines." I have a section called "Administrative Protocols" and those pretty much have to be followed to the letter, but they are for administrative things and there is very little (if any) patient care in there. Things like mandatory notification of medical director for run sheet review within 72 hours for certain cases (pediatric death, failed advanced airway, etc), and what to do if you accidentally break a vial of a controlled substance. There are a handful of spots in the PCG's that indicate NEVER or ALWAYS but like in most of medicine, things that are ALWAYS or NEVER are quite rare.

 

[johnrsemt]

FT. Half of our response area (sparsely populated in most cases) we have no radio or phone communications, sometimes for 40-50 miles: so yea we think outside the box (protocols).
PT. we cover 8,000 square miles and probably 3,000 of it has no radio or cell coverage so the same thing.
We have dead spots on the way to the hospitals, which makes it interesting too.

Never been questioned by doc's at the hospitals. Nurses: oh yea, all the time.