how to fix EMS

[JJR512]

"Superior orders" is not a defense I would like to use in a court of law if the orders are manifestly wrong. That defense won't stand if the plaintiff can show that the EMS providers should have known better. All that would be shown was that there are two EMS providers who don't know how to do their job properly.

The EMS provider cannot be expected to know more than what what was taught in class, whether in an EMT-B class or in an EMT-P course. The "superior orders" are essentially to apply what one has been taught. Therefore the plaintiff should not be able to show that the EMS provider should have known better, if the EMS provider was correctly applying what he or she was taught and following protocols, even if it's the protocol that says "if you're in a situation not covered by another protocol or you can't otherwise figure out what to do, contact medical control".

Also, if EMS providers are supposed to follow protocols to a T, why even provide 1000 hours of training? If the end all/be all is symptom relief based care based on a cookbook, than very little actual training is needed. There's definitely no need for foundation sciences (A/P, pharm, etc) in that case, since there's no reason to use it. Under this concept, I can train an EMT in a week, part time.

To my recollection, nobody here is advocating following protocols to a T. Any part of my response that mentioned following protocols like a "cookbook" was in response to something you mentioned first, so you're just arguing with yourself again.

If the physician can understand that the educational background underlying a paramedic's practice of prehospital emergency medicine is not the same as the physician's educational background in emergency medicine, why can't the physician apply that understanding when providing expert testimony.

I've already answered this once, maybe twice, so pay attention this time for I shan't say it again. It is my opinion and belief that a person of higher education, training, and experience cannot think in the way that a person of lesser education, training, and experience thinks. One might be able to put one's education, training, and experience out of one's conscious mind but it's still there in the brain, influencing the way that person thinks and reasons. If the physician is predisposed to think something was obvious, then he will think it should have been obvious, and may not understand why it wasn't. Are there exceptions to this? Possibly.

Why would you administer a medication only because the patient requested it? Isn't the EMS provider the professional providing care? What other drugs are going to be administered only on patient request absent any indication for use? "Gee, Mr. Paramedic. I'm in no pain, but I'd sure like a bolus of morphine."

I would administer oxygen if the patient asks for it because my protocols tell me to. Even if I was a paramedic, I would not administer morphine if I had no reason to do so, if the patient asked for it because there is nothing in my protocols that says I'm supposed to do that. Each medication that can be administered at both the BLS and ALS level has its own protocol (in Maryland) that says when it is and isn't appropriate to use it.

For the record, it appears I was incorrect to say that my protocols tell me to administer oxygen to anyone who asks for it. What it actually says is, "Never withhold oxygen from those who need it." However, I know I have heard the concept of "give oxygen to anyone who asks for it" somewhere in some type of training situation, whether it was in an EMT class or by a field trainer I can't say for sure. But I am intelligent enough to not assume that "give oxygen to anyone who asks for it" does not translate to "give morphine to anyone who asks for it".

So you were taught that backboards weren't necessary for all patients. Was it NEXUS or Canadian C-Spine rule? What if your system doesn't support the use of it? So you were taught one standard and are now being held to a different standard based on protocol, which is right? What if the expert witness EMS provider works in another system that does the opposite (either does or does not allow for selective spinal immobilization)? Who's setting the standard of care in that case?

I don't know about "NEXUS or Canadian C-Spine rule". I do know that I was not taught one standard while being held to another, though. The standard I was taught was what our protocols currently say, which is that not everyone needs to get backboarded. So there is no "which is right" issue for me.

As for an expert witness EMS provider who works in another system...If I get sued for negligence, it's going to be for a patient I picked up in Maryland. All of Maryland has the same protocols. We don't have different protocols for each county, we don't have that each private company has it's own protocols. There is one set of protocols that applies to every Maryland EMS provider. If I get sued, it's going to be in Maryland, and it should be that the expert witnesses are providers of the same level from Maryland. Furthermore, if I'm the one getting sued, I'm going to expect that my defense attorneys pick expert witnesses who are very experienced and are familiar with the way things work in Maryland. And I'm also going to expect that if the plaintiffs attempt to use experts against me, that if they are not of the same level as me and from the same system, that my defense attorneys will attempt to have them disqualified as experts because they are not truly experts in the way things are supposed to work in Maryland at my level.

 

[Phlipper]

Basic training is a joke. And Paramedic is a crash course as well. I think a Bachelors degree should be the absolute minimum.

+1

We'll have to drag EMS kicking and screaming into the 21st century, though. Anytime I've broached the subject at the two systems I work in the old guard gets bent out of shape.

And that's why we will always be second level compared to RNs (soon to be a BS minimum, I'd bet). Well that, and the fact that too many EMS systems present Billy Bob to the patient who walks in dressed like he just crawled out of a clothes hamper and says "Hey sweetie! Whachu got goin' on tonight?". The most awesome medic on the planet comes off as an idiot with many pts, families, and peers when he's getting his Bubba on. :wacko:

More/better edumakation and a more professional attitude in the work we do will do wonders.