JJR512,
You have a point for some systems. Where I work our protocols are basically a list of what is available for us to use. we still get to make the decision of when and how we utilize our tools.
That is why I hate algorithms in protocols. That is cook book medicine. A monkey can follow a algorithm. A human can use his brain to decide what to do.
The Maryland protocols have some algorithms. I'm not sure if I could say it's algorithm
heavy, but I have no basis of comparison. I understand your point, though. And it's worth remembering that whether the protocol is about a basic skill or an advanced skill, it only tells you what skill to use; it doesn't tell you how to actually perform it. That's where education comes in.
Actually no. My protocols are only 15 pages thick for everything. Each starts with the statement: "This protocol is a guideline or suggestion only and maybe used in its entirety or may not, depending upon the discretion of the Paramedic. The Paramedic has the education of treating appropriately depending on the state and judgement of the Paramedic. Medical control should be contacted for advice, if needed or if possible."
I suppose
all EMS protocols could be written like that. If I've been taught to apply pressure to an arterial bleed, do I really need a protocol that says "If the patient has an arterial bleed, first apply pressure"? No, one that says "You've been taught what to do in this situation so do it" would suffice.
Still, the point I was making in the post you were quoting from goes beyond the protocols. You'll notice I mentioned a paramedic's education as well. It's not just the protocols that are written and defined by the doctors, the doctors also have a lot to do with defining a paramedic's education curriculum. The overall point is that when a paramedic performs a skill in the field, he/she is doing it because a doctor wanted that skill performed in that situation; whether the paramedic decides to use that skill in that situation because it's written in a protocol or in a text book, it makes no difference. Paramedics, just like basics, are doing what the doctors want us to do; we're operating under their license, and when we screw up, we report to them.
Which brings me to...
As well, not all physicians are created equal. Many have never intubated, or even rotated in an ER more than a 8 hr shift, as well have never read an ECG. I know, I teach or attempt to the residents and physicians in ACLS.
Come on, man, we all know that all physicians are not created equal, nor are all basics, all nurses, all plumbers, or all fry cooks. But I don't think those physicians who have never intubated or worked in an ER are the ones writing the protocols, so they're not really the ones I'm talking about, are they? So they can be left out of the conversation.
JJR512-
i can't believe that you don't have a better knowledge of how those meds work... i completed my EMT-B course last spring, and we sure as heck knew how the meds worked... why would i give one witout knowing what it did...
do i know on a cellular level, perhaps not... do we learn that albuterol acts on beta-2 receptors to dilate smooth muscles of the lungs? yes... did we learn that it also acts on some degree on the beta-1 receptors of the heart? yes...
I think you misunderstood me, or perhaps I wasn't clear enough, and if so, I apologize. I know how the meds work as well as what I've been taught in EMT-B class, which sounds to be the same as you. What I meant is that I do not know
how they work how they work, or, as you said, what exactly they're doing on a cellular level, or microphysiological level.
...
It seems that some times some people are saying, or trying very hard
not to say but meaning it anyway, that EMT-Bs, because they are not trained and educated as much as paramedics, are useless and should be done away with. For example, the notion that all 911 units should be staffed with ALS providers only.
Let's remember that we as EMT-whatevers are working in the field under the license of our respective medical directors; as such, we are working out there on their behalf. If it was possible to send a physician out on every call for medical assistance, there would be no need for paramedics. If it were possible to send out paramedics to every call for medical assistance when there are no physicians available to respond, then there would be no need for EMT-Bs. Would the world be a better place if all EMS providers were trained to EMT-P level? Yes. Would the world be an even better place than that if all EMS providers were trained to MD level? Yes. But the latter isn't possible, so the world has to make do with paramedics, and by the same token, neither is the former possible, so the world will just have to make do with EMT-Bs.
