Let's see your Protocols

JJR512

JJR512

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If your state or other EMS jurisdiction has an online version of its protocols, post a link to it here. Then we can all take a look at each other's protocols, see if there's anything there that makes more sense than our own or don't make any sense, and we can discuss what we find. The point is not to say "my protocols are better than yours", but to open a discussion into the reasons behind some of the differences, to get our minds thinking about why things are done the way they are, and see where that goes.

Maryland's protocols are in PDF format here: http://www.miemss.org/MdMedProtocols2006.pdf (Some other related documents can be found here: http://www.miemss.org/EMSDocs.htm)

(Please make sure not to post a link to anything that requires us to log in because we won't be able to see it!)
 
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Ridryder911

Ridryder911

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That is a great idea. My state recommends each service has their own protocols and medical directors. There is a state "protocol" for those that work under individual license, or a recommended resource.

My service has a "no" publish policy in regards to our protocols and treatment. (Not my idea) Some services feel that patients may refer to ascertain if they were treated exactly as the protocol was written for possible litigation reasons.

Again, personally I think it is a good idea.

R/r 911
 
G

Guardian

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I think it's a great idea too. I'd rather not publish my agency protocols because they are unique and would immediately identify my agency. I would rather try to remain anonymous and not risk bringing any negative attention to my agency. This will also give me the freedom to continue not having to worry about P.C. as much. Anyway, good idea, and I'll try and participate as much as possible.
 
Epi-do

Epi-do

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Unfortuantely, we do not have anything online that I am aware of. I do look forward to seeing what others post though.
 
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Aileana

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here's the BLS Standards for Ontario (our protocol is provincial for most things as far as I know). Personally really like the set-up they have. If anyone wants our ALS Standards, I can dig up a link for that too :p
 
medic258

medic258

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Mass

These are the Massachusetts Statewide Treatment Protocols and Appendix. They are scheduled to be changed this month.

***Sorry. Didn't see the earlier post with the Mass Protocols.
 
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BossyCow

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Ours are in revision and should be released soon, will post when they are.
 
Meursault

Meursault

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medic258 said:
Does your service have service treatment protocols?
Click to expand...

My service has more detailed and generally more restrictive drug protocols than most. That's about it.

I didn't know about the protocol changes. Any idea what they're implementing?
 
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JJR512

JJR512

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Thanks for the replies.

I had no idea that some states don't have a universal state-wide protocol set that applies to all providers, as Maryland does. Well, MD does allow for local variances, and some counties do have a few small changes, but these are relatively minor, with the state-wide set being the base. For example, the IV Tech certification is not recognized by the state, but some counties do.

By the same token, I'm also learning that some states do not have state-wide medical directors, that in some states, each individual service has its own? Maryland is split into four regions; with the radio, you set the channel to the one designated for your current region, and start your consult.
 
ASTMedic

ASTMedic

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I almost never have to make contact with my hospital for anything more than a basic pt report to a nurse. It makes our scope tighter but I like not having to make a phone call.
 
Ridryder911

Ridryder911

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I like the individualism of not having a "state wide protocol". This allows for indivuduality. For example, one of the largest EMS services in my state has a set of protocols that is at the least 600 pages long, and they perform the general Paramedic level care. Yet, they cannot perform real aggressive care (NTG gtts, RSI, Fentanyl) and some can be explained that their response to the ER is usually < 10 minutes. Where as in some rural areas there are some that can place chest tubes, perform thrombolytics, RSI, etc.

Again, the protocols are based upon the system needs. There would be no reason for delaying transport in the metro for a chest tube where in comparison the other service nearest hospital is 45 miles away.

Protocols should be written as suggested guidelines, not step by step procedures and policies. Either by not strictly adhering or adhering to them wrongfully, can increase risks of litigation and inappropriate treatment.

I see too many "protocol" medics. If one asks them the treatment, they can only recite a memorized version of the protocols. When in general there are multiple ways of treating a patient, not just by a written protocol. It is called "clinical decision making" or what I like to call "thinking". Knowing outside the box.

Many acclaim, "ptotocols are all you need to know". I personally hate "cook book" EMS and their type. Patient care is not a cookie dough recipe, that we can "stamp out" treatments.

If one has a thorough understanding of emergency medicine, then protocols are just there for references and informing you when one has to make contact with medical control. This might be for additional medications, or a speciality procedure not routinely performed.

R/r 911
 
Ridryder911

Ridryder911

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JJR512 said:
Thanks for the replies.

I had no idea that some states don't have a universal state-wide protocol set that applies to all providers, as Maryland does. Well, MD does allow for local variances, and some counties do have a few small changes, but these are relatively minor, with the state-wide set being the base. For example, the IV Tech certification is not recognized by the state, but some counties do.

By the same token, I'm also learning that some states do not have state-wide medical directors, that in some states, each individual service has its own? Maryland is split into four regions; with the radio, you set the channel to the one designated for your current region, and start your consult.
Click to expand...

Most areas have individual physicians as EMS medical directors. I find it a rarity to see "groupings" or regions with one medical director. Each service in my state has a medical director. For example if there are 5 EMS in one town or area, there maybe 5 separate medical directors and 5 different ways of treatment. Some maybe aggressive where as some maybe the usual standard treatment, dependent upon how progressive the physician.

We do not have "county" cert's or even state certs. When an individual tests for a license ( Basic, Intermediate, Paramedic) they tests for a State level. As well, we have basically did away with radio communications for medical control, albeit we have just placed in new radios thanks to project homeland, that now collect dust. Very few "call in" for any orders, where the majority of EMS in my state is "standing orders". Verbal orders have been outdated outside the metro area for many years in my state.

In fact, when I contact my medical control they assume there is a major problem or very unique situation. I believe I contacted them three times last year. Once NOT to administer a medication. So it is uncommon.

That is why one should understand EMS has some very common workings, yet very different mechanisms and uniqueness, dependent on the region and needs of the system.

R/r 911
 
ASTMedic

ASTMedic

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Man you want to come write protocols for california. We need some progressive thinking like that here.
 
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