Things in your protocols/CPGs/scope that your hospitals don't like

[medicdan]

Entertaining for you but maybe not for the patient or their family. EMS and the hospitals need to coordinate their stuff better. You agency should also consider conducting an inservice for the hospital staff. If they don't use the equipment, how do you expect them to know anything about it? Paramedics also fumble with PICCs, PA catheter, Port-A-cath and dialysis catheters if they haven't been trained. Not offering to help right away with equipment you know they don't know much about is not being a good patient advocate.

I absolutely agree. I would never let this get in the way of patient care, and generally work to make anything I can a learning moment (for myself or others). The theme of this discussion in general seems to be communication and misunderstandings, either between those of us here, or EMS-Hospital

 

[the_negro_puppy]

I. Last time I brought a pt in like this, I had a full blown argument with the triage nurse about whether or not I should have transported.

We get this a bit sometime, and its more due to the staff at the hospital not wanting to do work/seeing us as creating work for them. Too bad, they are a hospital. Their job is to receive sick and not so sick people at both ends of the spectrum, assess and release. If you leave the minor OD patient at home and it turns out they have had more or go on to kill themselves, I can tell you it will not be the triage nurse sitting at coroners court. I've only had a handful of nurses ask why we brought someone in, but I always have a handful or responses ready. Particularly nursing staff trying to tell us how to do our job, what we should have done, how much of a drug we should have given. I usually respond with "I don;t work for you" "You cannot give this drug without physician approval" or "This treatment was within our protocols, if you have an issue please call our medical director to discuss"

 

[NomadicMedic]

I see the problems that most of you guys write about, and it seems to be almost like a pissing contest between The ED and the field paramedics. I don't experience any of that where I work. Maybe it's because there's only a few more than 400 paramedics in the entire state and the docs trust us. Not every doctor that works in the ED can be a med control doc. They're trained in our protocols, know our mindset and a majority of them have written in the field, work as just a medical directors or have been paramedics themselves.

I guess if I worked a larger system with 20 hospitals to go to, I'd run into this problem more. However, in my system I travel to four, maybe five hospitals, know all the docs and have found all the docs are familiar with our protocols and are set up. There's no fumbling around with the IO, we know what hospitals can do hypothermia and PCI and the only occasional disagreement is over a medication. And it's certainly not unheard of for the paramedic to walk up to the doc after the call and ask, "why didn't I get orders for x drug?"

It seems like communication is the key... that, and building relationships.