On EMS Treatment Protocols

Protocols are intended to be an organized framework for delivering care.

Written well, they are a floor, ensuring that even the least competent medic in your system delivers the same basic care as your best medic.

Written poorly, they are a ceiling, forcing the best medic in your system to render care on a par with the least competent one.

That is why you should always question poorly written and overly restrictive protocols.

Restrictive protocols are not written to do the patient the most good.

They are written to do the patient the least harm, because the people who wrote them doubt your ability to think, and use your brain to make good decisions in rendering care.

And as long as you continue to follow those protocols blindly and without questioning their wisdom, those people are right.

  • http://emtmedicalstudent.wordpress.com/ Joe Paczkowski

    I’ve always wondered why paramedics in restrictive systems (like the systems that require the “machine interp must be “STEMI suspected” to go to a cath lab) didn’t take it personally that their system is saying that they’re too stupid to do their job competently.

    • Ambulance_Driver

      All you have to do is read a Facebook EMS comment thread to know that those kind outnumber us.
      Although, I have noticed more of us over the past couple of years.

    • mpatk

      Yes, good paramedics in restrictive systems take it personally when they’re treated like that. The problem is, it’s hard to determine how upset good medics are at that when they’re also upset that the same leadership tells them that (1) they’re expendable and (2) if they want a career, they should have gone into nursing.

  • http://www.facebook.com/profile.php?id=1088829873 Skip Kirkwood

    Joe – they probably DO take it personally – then they whine, complain to each other, and submit. Because DOING SOMETHING about it requires commitment and the expenditure of effort to make EMS and the local system better. Unfortunately, most in EMS consistently refuse to commit and expend effort to make it better. If a local association of paramedics, with 100% representation of the paramedics in the system, demanded better protocols – they would get them.

  • Too Old To Work

    I must disagree. Most protocols seem to be written to maximize risk management for the medical director and the manager of the system. Just as any card based phone triage system is designed to be defensible in court as opposed to match resources to need.

    I think Skip Kirkwood is indulging in wishful thinking. Or maybe indulging in Egg Nog. mpatk is very close to the truth. I’d just add that most paramedics these days don’t think of paramedicine as more than a way point on their career journey. They do what they need to do until they can move on.

    I had a running debate with my medical director about the computer based 12 Lead interpretations. She insisted that we had to have them on even though she knew that they were inaccurate. That’s when we didn’t get a “data quality prohibits interpretation” message. So, I told her that I would just blindly follow the interpretation and if it didn’t give one, I’d just ride in with the patient and do nothing because the machine wasn’t able to tell me what was wrong.

    For some reason, she didn’t like that.

    And 100% of the medics I worked with agreed with me. Still, nothing happened.

    • Ambulance_Driver

      And was she the only medical director that had this attitude?

      Or have you had other medical directors in the past who were willing to listen to and trust their medics?

      • Too Old To Work

        Yes and yes. The person who trained her to be medical director was one of those doctors who trusted his medics and stood up for them. She apparently didn’t pay much attention to what he taught her.

        Twenty years of his leadership spoiled me, I guess.

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Kelly Grayson

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