Referring to standing orders/protocols on a call?

[akroeze]

I hope you aren't suggesting that you perform a procedure on a patient when it is not necessary?

[FireGuard69]

No, of course not. I intubate ANYone who says they are SOB. Chest pain from coughing so much from the Red Tide? Thats ASA, ntg, and morphine! Neck a little sore from the minor fender bender? Well shoot, thats a Trauma Alert, RSI, and a helo flight to HRMC, nah, ya know what, make the ORMC, since they are a Level I Trauma Center. :roll:

[EMS49393]

Looking up how to do something is sometimes necessary in EMS. But looking up what to do in the first place should just very, very rarely ever be necessary for a properly educated practitioner. Especially as limited as EMS interventions are in the first place.

I said very nearly the same thing in a chat a few weeks ago and I was labeled "arrogant." Not everyone that is educated is arrogant, and not everyone that is arrogant is educated. I often find it's the undereducated practioner that ends up calling the confident practioner arrogant.

I'm perform thorough assessments. I know what drugs I carry (the list is short at my current employer) and I know when they are indicated in my protocols, and when that indication is followed by a "consult medical control." I rarely reference my protocols. I do however reference my trusty broselow tape every time I have a pediatric patient requiring pharmaceutical intervention.

I'm not arrogant. I'm educated. I worked hard to learn above and beyond what I was responsible to know. I also had one amazing paramedic instructor that refused to take "the protocol said so" as an answer for performing an intervention or administering a medication. He wanted to know why we thought it was the right choice. He would kill our patient swiftly with one incorrect answer. He was good, and I owe him my career.

I guess I have to wait until I'm crusty like Dust before I can be taken as educated instead of arrogant.

[akroeze]

almost every pt of mine gets IV

Hmmmmm..... sounds like that is a yes.

[bigj1130]

I think we have the protocol books for a reason, Reference. If you need to confirm something use the book. I think for dosage stuff your pocket guides are invaluable, especially if you are doing weight based pedi stuff or drugs that you don't just use on a regular basis. I agree with Dust that if you are looking your standing orders to see what happens next on a regular basis, you should probably be a garbage man. just my 2 cents

[FireGuard69]

Hmmmmm..... sounds like that is a yes.

Jump to conclusions much?

Why not ask me, "well, are they ALS pts?" or, "why do you do that?", or "is that part of the standing orders you give?"

C/P, hypo/hyper tension and glycemia get them, as well as "real" trauma pts. No questions asked.

Most of my Medic preceptors, as well as myself, have worked in the local EDs as techs, either ED Tech I (EMTs with phlebo, and EKG) or ED Tech II (Medics). So we KNOW what kind of pt will be getting IVs in the ED.

Why let the ED do it, when I could be getting the practice?

[EMDP2081]

here is my stance on the issue at hand. I am not an amazing paramedic. I've been doing this EMS stuff full time for 5 years, 3 years as a paramedic and i know i am still a very new paramedic. I do know what i am doing and I am proficient at what i do but I will be the first person to admit that i don't know everything in the world and that i have made mistakes.

An education will teach you the be a paramedic, but a thorough education that goes above and beyond the standard curriculum theoretically makes you a professional who is able to understand the pathophysiology of patients in the out-of-hospital setting. you will not only understand what a medication does, but you should also know why it works the way it does. You should not only know why you should and how to obtain a 12 lead, but you should know in the first 5 seconds after a 12-lead is run if it is a STEMI or not and what you can best do to treat that patient.

Patient advocacy is every providers responsibility and a personal charge. If you are comfortable with yourself as Dust is and know you protocols inside and out and have a thorough understanding of how the human body works, more power to you, but it should be a personal choice. I am not that kind of a provider. While reading this entire thread i did some thinking. I think i probably reference my SOG's every couple of months or so, but never in a life and death situation and it is only a double check of something I might be a bit foggy on. I know when to give what class of med, i know when BLS is a better option for a patient, i understand why i do the things i do. there is a method to the madness.

Patient care is a dynamic thing that cannot be treated with a protocol. cookie cutter medicine is irresponsible and has no place in EMS.