Protocols, standardized procedures...get it right, no matter which.

[mycrofft]

I have seen protocols (we use "standardized procedures") referred to as "a guideline". I often read questions which are talking about what to do when the protocols aren't applicable, or when and how you can get around them.

Medical care is ordered by a physician. In the case of a medical service where a physician cannot be present to evaluate the pt then order and evaluate treatment (such as field EMS), then your physician (medical director), in accordance with standards and current prudent practice, approves and signs off on a set of actions you can do in his absence but meeting certain strict guidelines. Your certified training presumably allows you to assess and characterize the pt's condition, then make a decision about which protocol applies, do it, and document it.

Probably your medical director has to review a percentage (maybe 100%) of your company's's documentation and approve it to assure that his orders are being carried out.

If you are writing your own protocols on the fly, or cannot follow those you are given to follow, you are in for some legal hot water because you are practicing medicine without a license and almost cetainly breaking company policy.

If you need help, you call your medical control. If you can't, your company should have an internal protocol for that occasion. If your company does not have medical control, get out. Doesn't matter if they are using the protocols from the Mayo Clinic, if there's no doc doing the "top cap" for you, you are ON YOUR OWN.

Thoughts?

 

[KEVD18]

my thoughts are that if i called my olmc doc everytime i needed to improvise, he'd beat me senseless at rounds.

 

[Ridryder911]

One of the first things I ask to see (after reviewing my pay) is the services protocols. I have quit so called ..." excellent EMS service"..... all because their protocols basically sucked!

I will always attempt to avoid an ALS service that has more than 50 pages of protocols in length. The reason? Protocols are a double edge sword. It may protect OR it may be able to prosecute you. Think about it.. because you did such and such you were okay or because you did not or did something in conjunction, may have violated protocols.

Protocols should only be general suggestions. The EMS personnel following them should be smart enough and tested, have continuous education and documentation they know general medical care. Protocols or not. Hopefully, a Paramedic will not have to rely upon page 124 on what to do in case of a MCI. God forbid, that we will actually see one looking up in the protocol book of what to do. ( I actually have witnessed this).

Sometimes "protocols" develop cookie cutter medics. Thou shall do this ... and thee shall not do that...Sorry, one should be have some integrity and accountability as being required to be smart enough to know what to do.

I know if I was a physician I definitely would want to be involved in the EMS activities protecting my malpractice and license. Testing and getting to know the weakness and strengths of each individual medic, or at least making sure each has met a certain criteria.

R/r 911

 

[JPINFV]

I have seen protocols (we use "standardized procedures") referred to as "a guideline". I often read questions which are talking about what to do when the protocols aren't applicable, or when and how you can get around them.

Riverside County protocols are prefaced by the following section:

It is important to note that these policies are intended as a thought process or decision tree, not as an absolute plan. Every situation is unique; a policy could not possibly be written to cover every circumstance. We expect paramedics to use their training and good judgment when treating patients in the field and to document situations that vary from the norm. In the policies, the treatments that appear in the non-shaded areas tend to be the treatments of choice for that set of symptoms. Therefore, it made sense to include those treatments in the “prior to contact” realm. Paramedics have the option to perform procedures or administer drugs in the non-shaded areas on their own counsel, or to contact the base hospital for consultation. Not all treatments need to be done prior to base hospital contact.

Emphasis added.
http://www.rivcoems.org/downloads/downloads_documents/Protocol102904/7000.pdf

my thoughts are that if i called my olmc doc everytime i needed to improvise, he'd beat me senseless at rounds.

When I worked in So. Cal. online medical control wasn't even set up for EMT-Basics. If a basic felt that they needed medical control then they either needed to transport to the local hospital (which was a stone's throw away) or call for paramedics (which were about a stone's throw away as well).

 

[mycrofft]

I agree that protocols can breed mediocrity, but the legal basis still stands.

Companies and municipalities can write all the "rules" and forewords they want, but you are allowed to perform medical actions by meeting a sanctioned set of criteria approved by a medical authority, who is in effect your ordering MD. The protocols should describe and sanction your excellent practice, not dictate your moves like a cheap mail order dance class.

Sometimes you have to make the call and go for it, I do all the time. I keep in daily touch with my doc so we are sympatico, and afterwards since I have to have him sign off everything and I can get feedback. When I was on the street, we had no medical control, just the ER doc getting on the phone and screaming at the company's owner once in a while.

They used to have this mythical beast called "nursing judgement". Whenever they wanted one of us to take the risk or leave them alone, they would say "Use your nursing judgement". Whenever something went wrong, they asked how come the protocols weren't being followed. Booger that, and booger any time they try to make you the patsy.

Point is, protocols and standardized procedures are not like rope divides between lines at the bank, more like electgric fences with unknown amounts of current between zero and "Yikes!". Violate them at your own risk.