Protocols

BossyCow

BossyCow

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Okay, I'm starting this because of a pattern I'm seeing in many different topics and threads.

How many of us are unaware of the laws and admin. codes that apply to our position. You should be able to find the answer to any question that comes up in your local SOPs, Department Guidelines or Bylaws, Employee handbook, Union Contract, State laws, District Protocols.

Not knowing these are what gets you into trouble everytime. Yes they are generally forbidding looking boring documents but you know what? Not knowing what is contained in that spider web covered dusty 3 ring binder kicking around the floor of the rig can get you sued!

How do I find a job? What do I need to practice? How do I put on a splint? What's allowed in disinfecting a wound? All of these questions have recieved at least one post telling them to look it up in their protocols.

I don't pretend to know everything about the best way to respond to each and every incident that is going to come my way in the back of the ambulance. But I know where to find it in my protocols. I know where the bylaws governing my volly district are and I know where to find the answer to my questions in that document. I'm pretty familiar with the state RCWs regarding EMS and how to use the search feature on their website.

How many of us have actually attended a meeting where the protocols are being updated in your district? I'm sure that number is going to be a much smaller show of hands than those who are willing to gripe about what was put in them! How many of us know what the do and do not section of our agencies liability insurance contains?

There is usually some geeky, grizzled, old timer in the department who can tell you what the SOGs say regarding the application of a traction splint, but what happens when that person retires?

Get out those protocol books. Use your SOGs. During a training, open the protocols to the section being discussed and follow along. Instructors may not be aware of a recent protocol change. I'd rather find that out in a classroom than on the witness stand or during disciplinary hearings. Wouldn't you?

I know a forum seems like a nice easy way to get your questions answered and it can be. There are a lot of ways to do most of the procedures we do and its sure nice to learn a new way to perform an old skill. But people, come to the party armed with a knowledge of what is legally required of you first.
 
im with you 99.75%(i dont see anything regarding how to gain employment anywhere in my statewide tx protocols). other than that, yes knowing your protocols is arguably the msot important aspect of the job.
 
Your very right

You are very right. I used to work for a ambulance crew in my hometown that sounded like Earl/Jethro Ambulance....(get it?) I, maybe once, peered into my protocol book during the 6 years I served there. Now, I work for a much larger and better service here in OKC. We are required to go to team meetings every month and get updates on new protocols and training on the old ones. Every two years, we ALL have to take a test over the protocols and if we fail, we get taken off the streets.
 
Ooooh.. I like that idea!
 
My new position is to review PCR's and how the crew either followed or did not follow general medical care and/or protocols. If not; then they should be able to give a description or clarification upon why not or where they received orders to perform the treatment that was performed. In other words justify their treatments.

I am not for one that every thing has to have a written protocol. Protocols should only be written for suggested guidelines for medics to follow. Medics should be held accountable on general knowledge of emergency medicine.

We not only have a written protocol test but I have developed a scenario that tests the newer Paramedics. They must pass this after the orientation phase. This is graded by a panel consisting of FTO's, Supv, Director and of course the Medical Director. It is not just to be sure they know the protocols but the scenarios are designed to use their critical thinking skills.

I believe protocols should be developed by working medics of course along with the medical director. Forming committees allows input from the medics and discussing with the medical director for oversight, allows active discussion and education. It is much wiser than just having a physician to write "what to do".

R/r 911
 
Ridryder911 said:
I believe protocols should be developed by working medics of course along with the medical director. Forming committees allows input from the medics and discussing with the medical director for oversight, allows active discussion and education. It is much wiser than just having a physician to write "what to do".

R/r 911
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I agree with this. I also have to say that you should get a copy of your local protocols everytime they are updated. It scares the crap out of me that at my squad no one ems side had a clue where the protocols were I had to ask a rescue member. Yes they are huge and its alot of reading to do but honestly its all worth it. Im glad I asked before I got into seroious trouble alot of things Im allowed to do in md Im not allowed to do here in nc. Ive also gotten a copy of marylands protocols that are effective until july 09 so when I retun in a few short months I can study them. Im still trying to figure out a way to get my hands on onslow county's new protocols when they come out so I have my own private copy. I wish they would make the pocket version here I like to keep them on me incase I have a "brain fart"
 
There was no written protocols where I used to work for the EMT-B level. I have, how ever, knew the policies that affected me forward and back (cough DNR policy cough) and have taken a gander a few times at the section of California state law that covered prehospital providers. Of course, to be honest, I shouldn't need step by step instructions on how to use a pulse ox (there was step by step instructions for the paramedics), how to apply oxygen, how to control bleeding, or a whole range of other basic first aid interventions. Do we really need a protocol on how to apply a splint?
 
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JPINFV said:
There was no written protocols where I used to work for the EMT-B level. I have, how ever, knew the policies that affected me forward and back (cough DNR policy cough) and have taken a gander a few times at the section of California state law that covered prehospital providers. Of course, to be honest, I shouldn't need step by step instructions on how to use a pulse ox (there was step by step instructions for the paramedics), how to apply oxygen, how to control bleeding, or a whole range of other basic first aid interventions. Do we really need a protocol on how to apply a splint?
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Good point but let me show you one of the guidelines (designed for hospital or CCT personnel but can be applicable for all) for the Pulse Ox from which many write their P&P from.
http://www.rcjournal.com/cpgs/pulsecpg.html

Based on the many questions we have on the forums concerning something that should be relatively simple, many have either not been very well trained or educated on this device and/or they don't read their manual.
 
VentMedic said:
Based on the many questions we have on the forums concerning something that should be relatively simple, many have either not been very well trained or educated on this device and/or they don't read their manual.
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Well, there's yer problem. Of course I have a strange draw to read the documentation that comes with my equipment. How many people have read, even once, the paper that comes in the bag with the NRB mask?
 
The company I'm riding with gives all their paramedics pocket protocols books and considers it part of your uniform. Not that they have a way to know but if you don't have it with you, you can be sent home for the day. It's a condensed version of the protocols they work on that is designed to be an easy reference like the hundreds of other pocket guides that are out there. I rarely see the medics using them but they gave me a copy and I am always checking it when I'm not 100% sure about something.
 
Our region issues copies of protocols to everyone and they are required to carry them with them at all times. I have to have a signed record that each EMT rec'd a copy of their protocols which I have to forward to the region.

Unfortunately, carrying the protocols and actually using them are two different things. The last class I taught, with the protocol book open in the class, I was challenged on how a certain call should be handled. I'm telling the student to open his protocol book and see what it said and he can't even find the section that related to his particular question.

Familiarity with the protocol book should be a basic skill. But beyond healthcare protcols, how about employee conduct, state laws.... Most of the questions asked on this forum can be answered by looking it up in at least one of the above documents. Many answers to questions on this forum include "check with your local protocols" or "that depends on your state regs" and it amazes me how many are absolutely clueless about that process.
 
Im sure our protocols are "in a book" somewhere, but on protocols are contained on our Toughbooks.

During orientation we are given a CD of them We are given a test at the beginning of orientation (before reviewing the protocols) which contains general knowledge type stuff, as well as specific protocol type questions. The same test is administered at the end. Our orientation period is fairly extensive (as compared to the surrounding area.) During the ride time portion of the orientation, the FTO's require the orientees to find the protocol for each call as it is dispatched. If meds are "expected" to be given, the orientee is expected to find the medication the drug section and do a quick review. If at anytime during the call, the orientee has a question as to something can be done, they are directed to their protocols (as time allows of course). The method does a good job and teaching the orientee to become intimately familiar with them, as well as not to be afraid to pull them up and take a quick look.

As a QA process, all the FTO's are required to QA a predesignated number of charts each month. ANY protocol deviation, not accounted for in the report, gets the chart kicked back to the attending Medic for clarification.

We are expecting an update to ours in the next week or so. I imagine the Protocol file on the Toughbooks will be getting an even bigger work out, as we have already been made aware of some "Big Changes"
 
reaper said:
MP,

Is Dr. L your MD there?
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Not for the service I work for now, but he is for the one I just left. I am now under Dr. N.
 
Just wondering. He was over the service I just left. He is a decent MD and gets involved on calls.
 
I'll admit i'm bad at this. My super told me he'd get me a copy of the rpotocols, but I still have not seen them! Granted he was my partner for a good number of my shifts, I REALLY need to get a copy and read through them.
 
WuLabsWuTecH said:
I'll admit i'm bad at this. My super told me he'd get me a copy of the rpotocols, but I still have not seen them! Granted he was my partner for a good number of my shifts, I REALLY need to get a copy and read through them.
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Yes you do and be a pest until you get them
 
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