True, but I think if someone went outside of their protocols in a big way it wouldn't take much effort for the medical director to have action taken against that employee, especially if it wasn't the first time.
This assumes the medical director actually cares. In my EMS career I can count on one hand the ones I met who actually do.
In many agencies, everything from QA to remedial training is handled by non physician providers in a position of "leadership."
It also assumes that the medical director actually hears about it. In all forms of EMS not only is the good old boy network alive and strong, but the very nature of EMS permits many mistakes and poor practices to never be noticed.
When I worked for an FD, in order to terminate an employee, the employee had to be written up 3 times for the same infraction. Unions protect the most undeserving, I know of no medical director who is willing to take on a local IAFF.
Note that the first is a problem of diagnosis, not protocol. If you said "this is a shortness of breath call, r/o sepsis", then you don't have to start on the CHF protocol at all. This example is also why Lasix is no longer a standing order in NYC for CHF, because it kept being given in patients who had pneumonia.
This is the great dilemma of our time. Do we taake things away from poor providers or do we raise the level of the providers?
I am of the mind we should raise the provider level, stop taking tools out of the box, and start teaching people to use the ones they have. I have said this many times: How many field medics actually take a temperature on every patient? It is a vital sign. SPo2 is not a vital sign. Every patient in the hospital gets their temperature taken. Why is EMS excused from even taking a full set of vitals?
One of the reasons I am reducing my involvement in EMS (except for this board it seems) is because they need to be raised up to put more tools in the box to fulfill the eventual role of being out of hospital providers as opposed to prehospital providers. Otherwise, they have no hope of being anything more than overpaid taxi drivers. With the impending collapse of the US healthcare system, I would not want to be considered overpaid, over used, or under educated. But most in EMS don't want to look any farther in the future than their next bathroom break.
The second case there was a protocol that said he could give the duoneb, so he would have been covered.
That was my point, but many providers who strictly interpret protocols only ever pick one and follow it to the point where they have to call. It is impossible to properly treat patients by picking a single protocol from a single dx. That is my whole issue with strict interpretation of protocol.
I don't deny that protocols are generally guidelines, and do not force you to do things that don't make sense. But they also tend to set limits on certain treatments. I just don't want some rookie medic reading this thread who then thinks "I can do whatever I feel like, because these are just guidelines."
Some of the more senior medics are just as dangerous. However usually not because they were making something up, but because they always do things the way they were done 10 or more years ago.
