Protocol Changes

exodus

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Anything new coming for you in 2012? What's gonna be different?
 

Smash

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Ketamine for all, not just the fly-boys. About bloody time! Probably some other stuff, but that is the one that excites me.
 

Veneficus

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Ketamine for all, not just the fly-boys. About bloody time! Probably some other stuff, but that is the one that excites me.

Sure...

Rub it in...

I just used versed and morphine for conscious sedation, might as well use a leech and hot poker too.
 

akflightmedic

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Sure...

Rub it in...

I just used versed and morphine for conscious sedation, might as well use a leech and hot poker too.

Why not Versed and Fetanyl?? We have heaps of it and I like it better. :)
 

DrankTheKoolaid

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Not sure if you got a chance to look at the California Paramedic proposed protocol changes but the public comment has ended already. Lots of exciting things were included. Sure hope we get moved out of the stone age. Would be even better if the rest of the state can separate itself from SoCal in the way of protocols.
 

JPINFV

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Not sure if you got a chance to look at the California Paramedic proposed protocol changes but the public comment has ended already. Lots of exciting things were included. Sure hope we get moved out of the stone age. Would be even better if the rest of the state can separate itself from SoCal in the way of protocols.

Saw it, wrote a blog post on the implication of some of the APP proposed changes that represents a lot of what is wrong with EMS.
 

DrankTheKoolaid

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That over on your page? I must have skipped past it. I'll scan it again and give it a read.

I found it
 
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JPINFV

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That over on your page? I must have skipped past it. I'll scan it again and give it a read.
Here's the link:
http://emtmedicalstudent.wordpress.com/2011/09/25/independentjudgement/

Basically I had a short rant on how the APP is specifically including "perform digital and nasotracheal intubation" and how the scope of practice for paramedics should be "intubation" and let paramedics use their professional judgement to determine how to actually proceed with putting the plastic tube in the slightly larger flesh tube. Additionally, if "digital and nasotracheal intubation" requires a specific line authorizing it for APPs, does that mean that paramedics who aren't APPs can't perform digital or nasotracheal intubation? Note, I'm not saying that those should be used as a standard, but having options open are a good thing.
 
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DrankTheKoolaid

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Yeah agreed, but then again it seem CA writes it's protocols to the lowest common denominator....... SoCAl who has so many documented screw ups it effects the rest of us in Northern California. I think what needs to happen is a standard set of protocols and then let the LEMSA directors water them down based on history of performance of the practitioners.

Not a perfect solution I admit, but at least it is a bridge to get the protocols established and give the lower functioning a chance to increase their knowledge. If that doesn't happen it's time to remove their paramedic cert and drop them to AEMT.

Digital intubation certainly is a needed skill especially for the Tactical Medics among us. ( Yay! Palm Springs in 3 weeks! ). If you look at the protocols already in use in some of the CA LEMSA's they are already practicing at the APP level and up here in far Northern CA CCP is more accurate
 
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DesertMedic66

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Yeah agreed, but then again it seem CA writes it's protocols to the lowest common denominator....... SoCAl who has so many documented screw ups it effects the rest of us in Northern California. I think what needs to happen is a standard set of protocols and then let the LEMSA directors water them down based on history of performance of the practitioners.

Not a perfect solution I admit, but at least it is a bridge to get the protocols established and give the lower functioning a chance to increase their knowledge. If that doesn't happen it's time to remove their paramedic cert and drop them to AEMT.

Digital intubation certainly is a needed skill especially for the Tactical Medics among us. ( Yay! Palm Springs in 3 weeks! ). If you look at the protocols already in use in some of the CA LEMSA's they are already practicing at the APP level and up here in far Northern CA CCP is more accurate

Stay away from anything with a rainbow flag in palm springs... Haha. We joke around and say we are Rainbow Warriors haha
 

DrankTheKoolaid

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Stay away from anything with a rainbow flag in palm springs... Haha. We joke around and say we are Rainbow Warriors haha

LOL, Yeah ill be at the International School of Tactical Medicine for 2 weeks. Don't plan on doing any sight seeing while down there though. Pretty much a business trip, but ill keep that in mind if we do get some time to venture out!
 

Smash

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Sure...

Rub it in...

I just used versed and morphine for conscious sedation, might as well use a leech and hot poker too.

Why not Versed and Fetanyl?? We have heaps of it and I like it better. :)

Versed and fentanyl has been the standard for a long time for induction, with morphine and versed for maintenance, and honestly, it works well most of the time. However, if I had to pick one drug to have, it would be ketamine. The slightly disturbing thing is they are talking about doing away with morphine altogether. While I am a fan of fentanyl, I prefer more options, rather than fewer.

And don't be too hard on leeches, I hear they have made a comeback along with maggots in wound care and the like! :D And I can certainly think of a few people to whom a hot poker could be gainfully applied...

Yeah agreed, but then again it seem CA writes it's protocols to the lowest common denominator.......

That is the way of it with all protocols, everywhere. They are essentially written to establish a minimum acceptable standard. They aren't written for those of us who get text books for Christmas and read them for fun, or who get excited when a new journal gets published, or who listen to podcasts in the car on the way to work, or who lie awake at night running through cric scenarios in their head, terrified because they haven't done one in anger yet. They are written for Joe Shmoe who got a pass mark, and turns up every (most) day(s) because the alternative is harder work swinging a hammer or something and no flashy lights.

The trouble really arises when something written as a minimum standard, becomes the maximum standard.

It took me a long time and a lot of frustration to realise this. I still have the frustration, but at least I understand why the world is as it is.
 
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DrankTheKoolaid

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that is the way of it with all protocols, everywhere. They are essentially written to establish a minimum acceptable standard. They aren't written for those of us who get text books for christmas and read them for fun, or who get excited when a new journal gets published, or who listen to podcasts in the car on the way to work, or who lie awake at night running through cric scenarios in their head, terrified because they haven't done one in anger yet. They are written for joe shmoe who got a pass mark, and turns up every (most) day(s) because the alternative is harder work swinging a hammer or something and no flashy lights.

The trouble really arises when something written as a minimum standard, becomes the maximum standard.

It took me a long time and a lot of frustration to realise this. I still have the frustration, but at least i understand why the world is as it is.


+1,
 

Veneficus

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JPINFV

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The trouble really arises when something written as a minimum standard, becomes the maximum standard.

The problem is all too often they are the maximum standard.
 

Veneficus

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R99

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Lortadine, fentanyl and ceftriaxone are new

Midazolam and amiodarone move to ILS from ALS
 

usalsfyre

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Pending finishing writing the d@mn things and OMD approval..

Propofol, ketamine, droperidol, phenylephrine, dobutamine, NTG infusions, nicardipine, fosphenytoin fentanyl and midaz infusions, arterial lines, IJ and fem lines, tube thoracostomy, retrograde intubation and escharotomy.

The only reason we're going this wide open is <10 paramedics will be credentialed at this level.
 

Veneficus

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Pending finishing writing the d@mn things and OMD approval..

Propofol, ketamine, droperidol, phenylephrine, dobutamine, NTG infusions, nicardipine, fosphenytoin fentanyl and midaz infusions, arterial lines, IJ and fem lines, tube thoracostomy, retrograde intubation and escharotomy.

The only reason we're going this wide open is <10 paramedics will be credentialed at this level.

Intending no disrespect, but when do you plan to use this stuff? I worked in a regional burn center for years and seen an escharotomy for circumferential burns twice.
 
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