Do you question those that make your protocols?

[spenac]

Do you question those that make your protocols? On another post someone brought up how confusing the wording on some of the protocols were. Concern of how they would view you if you approached them for clarification was voiced. In my former service I had medical directors cell phone, house phone, office phone etc on speed dial. I was able to call and discuss concerns, make recommendations, and help implement changes. But based on other posts and even my new job that is not the norm. So are you allowed to contact those in charge of your protocols? Can you make suggestions for changes? Or are you just voiceless, unable to give or get input?

[paramedicmike]

Yep. I can and have questioned. Sometimes things have even been changed based on my speaking up.

-be safe

[JakeEMTP]

As I stated in the other post, our Medical Director is extremely approachable. I can call his office and ask a question or receive clarification on anything. I have talked to him many times in the ED on various subjects and he answers e-mail quickly. Changes to protocols have come about through this type of communication.

Just lucky I guess. Or, is this how all Medical Directors should be? I understand were not NY or LA. However, we're not exactly Podunk USA either.

[kitkat]

We have a review board made up of our training officers and street paramedics, our Med. Director and the assistant Med director, this was specially made group that would be able to bring better clarity to the old protocols, and bring new ones forward. Has been a great working group.

The intent being that we have the protocols ready and basically present the protocols ready to go, to the Medical Advisory Committee, which our MD is chair of.

[CBEMT]

Out of 21 total members of our state governing board, 11 are members of fire departments, with 3 spots specifically reserved (by state law) for IAFF representatives. Of the slots reserved for a representative from each county, ALL are members or chief officers of fire departments. Then there is a slot reserved for a volunteer FD representative, and a representative from the state Association of Fire Chiefs.

Of course, there is also a private ambulance representative, but whoever happens to occupy that spot is solely interested in A) the profit of his company, and by extension, voting against anything that involves him spending money.

Currently there are no paramedics on the board, just our own homegrown ALS licensure level below Paramedic.

Sensing a pattern yet?

In any event, I know that it is very possible for me to submit ideas, suggestions, and problems, moreso because I've met the state EMS medical director and see him frequently when I transport to his hospital.

However, nothing makes it into policy without the approval of the afore-mentioned special interest groups.

[p3medic]

Actually it is much easier to apply for a "special project waiver" and leave the water fairies out of the discussion entirely.

[captainstandup]

Why in the hell would anyone want the volunteer fire departments involved in ALS protocols? In our area of NC the local fire chiefs are a bunch of rednecks, three of them never graduated high school and one is virtually illiterate. I realize you said STATE Fire Association, but practically speaking I feel Fire should focus on putting out fires and leave caring for sick and injured people to the pro's. With this said I realize there are fire agencies, such as FDNY EMS who are responsible for ALS, and their involvement in scope of practice / environment of care decisions is crucial. I honestly can’t name a single VOLUNTEER agency that is the primary provider of ALS services. For those agencies with ALS (Paramedic level) and Transport responsibilities I feel their input is appropriate. For those who merely dabble in ALS care, leave the decision making to the educated providers.

CBEMT's example defines one of the key reasons we are still considered ambulance drivers. The decision makers in his / her area are for the most part untrained and seemingly uneducated. Their motivating factors are likely greed, power and keeping things "the way we have always done it" Its really difficult to outlive a system that by design is ignorant, if not stupid. And the comedian Ron White says it best "you can fix stupid". Its no mystery as to the reason our best and brightest simply give up and move on to disciplines with professionals in them.

[Richard B the EMT]

Not knowing the specifics of the geopolitical areas being discussed, I feel I must mention something.

In their respective areas, a number of full time and part time/volunteer fire departments,on their own initiatives, took on the responsibilities of providing EMS, at either BLS, ALS, or both levels, to the service district's residents, and to cover their own personnel at fire scenes. They seem to be good, at least what I have observed in my 34 years in this crazy biz.

Also, in their respective areas, a number of full time and part time/volunteer fire departments were requested, or ordered, by the politicians, to take on the responsibilities of providing EMS, also at BLS, ALS, or both, to the service district's residents, and to cover their own personnel at fire scenes.

Some blended successfully, others, successfully but with rough spots. In others, there is almost a battle of the badges between the Fire Fighters and the EMS crews. Some agencies are cross-trained, others have fire fighting and EMS as separate "specialities".

As you have heard me mentioning ad infinitum, and ad nauseum, in 1995, Rudy Giuliani, then the newly elected mayor of New York City, pushed and got passed, legislation to move EMS away from management of the NYC Health and Hospitals Corporation, and place it under the management of the FDNY. This happened at Midnight, into Sunday, March 17, 1996.

Numerous long timers from both sides took exception to this. However, as more and more long timers retire, and as more personnel are hired, it is becoming the norm for FDNY to be the primary 9-1-1 EMS provider in NYC.

Yes, there is still some friction, but we (in the FDNY) seem to be getting it all together.

[CBEMT]

Why in the hell would anyone want the volunteer fire departments involved in ALS protocols? In our area of NC the local fire chiefs are a bunch of rednecks, three of them never graduated high school and one is virtually illiterate. I realize you said STATE Fire Association, but practically speaking I feel Fire should focus on putting out fires and leave caring for sick and injured people to the pro's. With this said I realize there are fire agencies, such as FDNY EMS who are responsible for ALS, and their involvement in scope of practice / environment of care decisions is crucial. I honestly can’t name a single VOLUNTEER agency that is the primary provider of ALS services. For those agencies with ALS (Paramedic level) and Transport responsibilities I feel their input is appropriate. For those who merely dabble in ALS care, leave the decision making to the educated providers.

CBEMT's example defines one of the key reasons we are still considered ambulance drivers. The decision makers in his / her area are for the most part untrained and seemingly uneducated. Their motivating factors are likely greed, power and keeping things "the way we have always done it" Its really difficult to outlive a system that by design is ignorant, if not stupid. And the comedian Ron White says it best "you can fix stupid". Its no mystery as to the reason our best and brightest simply give up and move on to disciplines with professionals in them.

Some of the VFDs here have been providing EMS since the 50's. Likewise with the paid departments. The ones that transport (90%) are all ALS. There are a few that don't transport, and EMS is provided by either volunteer or municipal third services, but those you could count on one hand.

Hence why the fire representation is so large- they are responsible for 90% of the population, and have been for almost 60 years. They're not just going to go away because we think it's a good idea.

[rdenman26]

There is evan an address on the front of out national clinical guidelines to write to for questions, challenges, suggestions etc. The medical director of the service encourages sensible questioning (rather than obvious moaning and winging) as a way of learnigng.