Do you question those that make your protocols?

[captainstandup]

In all of your statistics you didn't mention how many of those volunteer agencies provide Paramedic level services. Also when I mentioned primary provider, I was speaking about the agency responsible to the "authority having jurisdiction" not just those who, as I said in my earlier post, dabble in emergency medical care when they dont have a fire to put out. I'm not slamming volunteers, I'm just saying that those trained to the highest level of pre-hospital care must be the decision makers. Fire departments in NC normally operate at the First Responder or EMT Basic level with some offering EMT-I but all of these are in actuality a function of "delegated practice" through the EMS System Plan.

As an EMS Director I and the Medical Director essentially complete authority over who provided ALS services in our county. We also implemented a franchise ordinance to help weed out the parasitic private ambulance companies from attempting to move in.

[AZCEP]

I've got to mention that if you don't question the protocols that you are given, you are not adequately advocating for the patients you will be delivering care to.

Many times medical direction will assume what is, or is not available in a community. If the protocol isn't written, we should take the responsibility to suggest it.

[captainstandup]

I've given this thread a lot more thought today. Perhaps input from other stakeholders is OK, but too often this becomes a political platform for the most uneducated and biggest trouble makers in emergency services. In volunteer organizations there is little that can be done to require leaders to have higher certification levels.

I personally feel it to be counterintuitive to permit anyone to lead an EMS organization that isn't currently credentialed as a Paramedic. My reasoning is; how can a leader that has no understanding of even paramedic level pharmacology, A&P, Medical Emergencies, etc be effective in advocating for necessary equipment or supplies? How can they negotiate reasonable salaries, when they have no little understanding of what it takes to do the job? Most important would be their inability to have meaningful input or influence on scope of practice / environment of care issues.

Four years in university business school and an EMT card is not enough! Leadership must have the education and BACKGROUND in Paramedic level care in order to be effective leaders and patient care advocates.

[Kaisu]

We are extremely lucky in our county. Their is a tremendous level of cooperation and mutual respect between the head of our paramedic program, the medical director, the FD and the privates that run in the county. This is a spirit of innovation and improvement that has risen up over 35 years. A lot of the credit can be laid directly at the feet of one paramedic. He received the first EMT-P license in the state (taught the class and got licensed in it), was the 5th NREMT in the country and has maintained the longest continuous license in the country.

The medical director is totally approachable (through the right channels) but you better know what you are talking about if you challenge the protocols. Its not a perfect system by any means, but darn I'm proud to be a part of it.

[EMS49393]

No, there is no input from providers here regarding protocols. It's difficult to push ahead when you have a medical director stuck in 1978. I think I saw mast pants on my ambulance the other day during check off. It's also partly the fault of many of our paramedics who are simply too tired and over-worked to imagine proposing any changes, let alone doing the research to back one. When you mix these two, you have a system unable to progress forward, and paramedics that are often confused when a new item appears on their truck.

I've attempted to effect changes a few different times when I was new and not tired. I was ignored despite the research I provided. I don't like it, but it is what it is, a battle one person can't win. I still read, I still participate, and I still treat my patients based on my education, which as a much higher level then the protocols. I rarely deviate, and I rarely require medical control, but when I do I'm confident enough in my assessment and tone of voice to be afforded what I ask for.

I do the best job I can with what I'm given.

[captainstandup]

The best you can offer with what you are allowed to carry in your bag of tricks is all anyone can ask. This isn't an excuse to stop gaining education and perfecting your craft. If the situation is as bad as it sounds you should change jobs if possible. Even if you must drive 20 or 30 miles to a service that meets your desire to practice in a better environment of care.

Although it's not always possible to do so, its sometimes best to leave services that are as backward and stuck in the past as it sounds like yours is. Hopefully over time the mutts and looser idiots in power will either quit, die out or get sued into progressing to the new millennium. Don't waste your time and intellect waiting on it to happen though.

Some communities Don't deserve any better than second rate services since by default thats what their community culture wants.

[spenac]

The best you can offer with what you are allowed to carry in your bag of tricks is all anyone can ask. This isn't an excuse to stop gaining education and perfecting your craft. If the situation is as bad as it sounds you should change jobs if possible. Even if you must drive 20 or 30 miles to a service that meets your desire to practice in a better environment of care.

Although it's not always possible to do so, its sometimes best to leave services that are as backward and stuck in the past as it sounds like yours is. Hopefully over time the mutts and looser idiots in power will either quit, die out or get sued into progressing to the new millennium. Don't waste your time and intellect waiting on it to happen though.

Some communities Don't deserve any better than second rate services since by default thats what their community culture wants.

Wow 20-30 miles no biggie. I travel 150+ 1 way to get to my new full time job. Caps right sometimes you have to sacrifice in order to get out of a bad situation. Hopefully leaving may help your old service re-think how it works and in the future it may be a place worth going back to. I have hopes my old service will improve.

[mstovall]

Why in the hell would anyone want the volunteer fire departments involved in ALS protocols?

In many rural areas, if you want ALS intercept, it is the off duty paramedic that is jumping aboard. These off duty paramedics are all members of the volunteer departments. There are 4 medics out of the 20 that are volunteer medics in their areas. They can get there in under 10 minutes and it takes us 15-20 minutes.

Our medical director gets many cudos. He will allow you to shadow him any time in the ER that you want to. He teaches CE classes, especially if he has changed a protocol. I haven't seen it personally, but they say that he even rides from time to time to see how things are going (and acts as a gopher at that, which means he knows about things on the truck). If you do something that can be improved on, he will not only tell you what to do to improve, he will show you how to do it and explain why to do things differently. He is approachable on professional level as well as on personal problems. He will know your name within weeks of hire (and that is for all the paid crews, city and county, volunteer crews, and ambulance service. That's about 400 +/- individuals that he may onlysee once in a 6 month place). I feel very lucky to have him as a medical director.

[Richard B the EMT]

From 1973, when it was founded, to when it folded (due to lack of money and members- the infamous M&Ms) in 1996, the guy who founded my Peninsula Volunteer Ambulance Corps never elevated his medical training beyond that needed by corps requirements, that of American Red Cross Advanced First Aid, and ARC or equivalent CPR. He dispatched, which didn't require any first aid training, and he drove, which did require that minimum, by the SOP we had in effect back then.

[EMS49393]

Although I don't mind the idea of driving a little farther for a better working enviroment, I'm sad to say that most of the state has it worse then we do. Leaving the working enviroment would require a larger move then I'm able to do in the next few months. That move is planned next year.

In this case, if you can't beat them, leave them. I am not about to waste thousands of hours and dollars of education by joining them. While I'm saddened for the public, I agree that in some cases, the public get what they deserve, and in many cases what they will pay for.