King County and Medical Direction

[Carlos Danger]

So in all actuality, KCM1 is probably one of the least progressive systems out there.

I guess it depends on how you define "progressive".

If by "progressive", you mean a system with protocols that allow the paramedics to do "lots of cool stuff" and never requires OLMC, then yeah, I guess KCM1 isn't progressive. But, if by "progressive", you mean a system that is focused on implementing evidence-based protocols in order to actually improve patient outcomes, then it sounds like KCM1 is probably one of the better ones out there.

Some systems are actually experimenting with tele-consultation with iPads and such. I suppose by your metric, those would be the least progressive systems?

Protocols should be patient-centered, not paramedic-centered. They exist to help the patient, not the paramedic's ego.

You need permission either way. One is just prewritten and the other is not.

Exactly.

Not having to ever call for orders is not the same thing as having autonomy. It simply means you've been given permission to not have to call for orders. That permission can be revoked at any time, and you are still have to stay inside the box that someone else draws for you.

 

[Aprz]

Thris thread somewhat reminds me of this article.

Culture of Silence

The article was more about negative feedback, but it is really true for getting any type of feedback I feel like.

We talked about this article in another thread here.

 

[Scott33]

If by "progressive", you mean a system with protocols that allow the paramedics to do "lots of cool stuff" and never requires OLMC, then yeah, I guess KCM1 isn't progressive.

At what point did I say that? I am in my mid 40's, and left the "lots of cool stuff" behind years ago when I became an RN.

Some systems are actually experimenting with tele-consultation with iPads and such. I suppose by your metric, those would be the least progressive systems?

You are probably going to be disheartened when I tell you that my own system's community paramedics have been using teleconferencing for about 2 years now. Treat and release / treat and refer teleconferencing is a world away from asking a doctor's permission to take a BGL or drop a line in the field. Do KCM1 happen to have a CP component?

Protocols should be patient-centered, not paramedic-centered. They exist to help the patient, not the paramedic's ego.

How about catching up with the rest of the world and binning protocols in favor of clinical guidelines with a reasonable amount of wiggle room?These 'mother may I' systems (and I am not specifically talking about KCM1) suggest one of two things to me - lack of trust in the provider, or lack of ability of the provider.

 

[Carlos Danger]

At what point did I say that? I am in my mid 40's, and left the "lots of cool stuff" behind years ago when I became an RN.

You implied it when you equated calling for OLMC with being "the least progressive".

I agree that calling OLMC on every call sounds onerous and unnecessary. But it has little to do with how progressive a system is.

 

[RocketMedic]

I disagree- it is an outstanding measure of how progressive a system is. How many of those contacts result in treatments exceeding what is conventionally found in standing orders, as opposed to how many treatments that would be appropriate and authorized under standing orders are deferred by physician preference?

I think the best place to evaluate progression in any system is pain management and field treatment of sentinel findings- ie ABX in the context of suspected sepsis, dysrhythMia correction, etc.

 

[waaaemt]

And all of them go through Harborview's program and have that "interesting" scope of practice this oft-talked about here? I see they are all fire-based but are any also firefighters?

Many non King County fire dept medic units have MEDIC ONE branded on them. I believe they buy into/receive grants from the foundation or something. Or just uae it cause it sounds cool? Idk. But you do not need to be King County/UW/Harborview trained. There are multiple Pierce County FDs, Thurston County Medic One (hard core ALS dumpers I've been told )
Central Skagit Medic One (sounds like an amazing place to work) etc. For Thurston the medics i think are provided by city and county fire depts, are FFs, and just work on a medic one rig.

Also Seattle Fire Medic One medics are FFs promoted internally after at least 3 years on the job.