out of protocol practice

[downunderwunda]

I am having the hardest time getting this question answered.

As a paramedic, you act within protocols as guidelines for management of acute illness and injury. I got that. When you have a patient with atypical presentations or with a acute disease you have no protocol to manage but you do have a treatment option with your medications and knowledge, can you preform advanced treatments on these patients? Or, because you have not protocol for them, you just give O2 and monitor ecg/vitals and haul butt to the hospital?

You need to reread your protocols.

Every situation is in there. Even down to administration of O2. You have a scope of practice. You have to operate within those guidelines. To fall back on 'Medical Control' is an insult to intelligence. If the pt is atypical, do the basics, ABC, then treat what you see. If they are in pain, manage it, if their perfusion is falling, go the O2. EMS is not rocket science.

Or, because you have not protocol for them, you just give O2 and monitor ecg/vitals and haul butt to the hospital?

How old are you??????? Just because you have a pt with Atypical symptoms or an acute disease, your words not mine does not mean you need to haul ***. Look at your patient, any decision to 'Haul ***' needs to be looked at with extra consideration given to

1. How long has the patient been sick
2. Can i control their pain
3. How long to hospital if we haul *** Vs normal speed
4. How much stress will I put on the patient if we haul ***
5. Will their condition change that mucch in the next 10-15 minutes

The vast majority of patients, with notable exceptions for chest pain & penetrating trauma, will have little or no advantage to expidition to hospital.

Always remember, go back to basics. If a person has an acute illness, they wil tell you what they need, they will know more about t than you ever will.

Play safe

 

[daedalus]

You are obviously not familiar with my local protocols nor my original question. And done right, EMS is anything but "not rocket science". And no, administration of oxygen is not covered in my protocols. There is no protocol for it, it is used PRN at the discretion of the provider and is mentioned in some specific protocols for treatment.

My county has around 12 protocols. 12 protocols cannot possible cover the spectrum of medical emergencies that may happen to patients. For example, see above in my calcium channel blocker overdose scenario. We have no protocol in place for this particular emergency, nor does my county have a blanket protocol for procedures prior to base contact (as does LA county). So I am left wondering what the hell my county wants me to do with these patients, however I did recently find out from a local paramedic.

Also, just because I prefer to use the word butt instead of ***, does not make me twelve years old. ^_^ So I am not quite sure what your intent was here because you are anything but helpful.

EDIT: After re-reading your post, I see that you think that because a patient may have something I am not familiar with, I would run to the hospital with them. That was a figure of speech. I rarely drive code 3 back to the hospital. I used the figure of speech to convey how lost I was with the hypothetical situation.

 

[BossyCow]

I've found that contacting med control is an art. If I call and say I'm clueless about a pt, they are going to be less likely to authorize me doing anything. But, if I call and give an accurate report of what's going on, suggest what I would like to try with information that shows I'm aware of the contraindications, then I'm much more likely to get permission.

 

[Jon]

PA's ALS Protocols, "General Protocol Principles"

B. Deviation from Protocols:
1. When providing patient care under the EMS Act, EMS personnel must follow the orders of a medical command physician or, in the absence of such orders, the applicable protocols. In addition to the Statewide ALS Protocols, ALS practitioners must follow applicable Statewide BLS Protocols and Department-approved Regional Medical Treatment Protocols. Since written protocols cannot feasibly address all patient care situations that may develop, the Department expects EMS personnel to use their training and judgment regarding any protocol-driven care that in their judgment would be harmful to a patient under the circumstances. When the practitioner believes that following a protocol is not in the best interest of the patient, the EMS practitioner must contact a medical command physician if possible. Cases where deviation from a protocol is justified are rare. The reason for any deviation should be documented. All deviations are subject to investigation to determine whether or not they were appropriate. In all cases, EMS personnel are expected to deliver care within the scope of practice for their level of certification.
2. Medical command physicians are permitted to provide orders for patient care that are not consistent with the protocols when, under the circumstances, the procedures identified in a protocol are not the most appropriate care in the judgment of the physician or when there is not a specific protocol that is appropriate to the patient’s condition. Some protocols have a section of “Possible Medical Command Orders”. These are provided as a possible resource for the medical command physician and as an educational resource for the EMS personnel. These “Possible Medical Command Orders” do not substitute for the judgment of the medical command physician, and the medical command physician is under no obligation to follow the treatment options listed in this section.

A classic example of this was for crush syndrome. Prior to the November 1st rollout of the current revision of the statewide ALS protocols, there was no protocol for bicarb in a crush injury... but there was no reason a provider couldn't get orders for it.