Universal protocal's ?

[Doczilla]

The short answer is, no, I don't think that everyone should be playing with the same deck of cards, for the following reasons:

1) Differential levels of medical director involvement. Some medical directors are cut out for close EMS oversight, others not. In addition, close oversight can be damn near a full time job. If the MD has several squads, this can be prohibitive.

2) Different levels of quality assurance between services. Some do this really well, some not.

3) Different levels of experience between services. Some run the complex critical patient call all the time, others get it only rarely. Some medics get the chance to intubate weekly, others only once a year.

4) Different cultures among the services. Some embrace aggressive protocols and the training that it takes to sustain them, others see it as an impingement on their time and unnecessary when they can just "take someone to the hospital".

I don't think it makes one whit of difference to know if another service has permission to do something prior to your arrival. It doesn't mean that it got done, and doesn't mean that it was done right, and doesn't mean that it worked, so you've still got to bring all of your equipment.

'zilla

[Dustdevil]

ya know your malicious remarks are not constructive i merely asked a question did not ask to be bashed. I am a professional EMT with 10 years experience the last of which as training officer, I work with some really great people paramedics and basics, if you don't have something constructive to add please refrain from replying to my posts.

Well, we just learned a lot about the quality of your personal practice, as well as your service. Thanks for that clarification.

Sounds like you have a LOT bigger problems to worry about than what neighbouring services protocols are.

[Eydawn]

Which national park? Sounds like a cluster.

You don't need to tweak everyone's protocols, you just need to provide the best care you can to patients who are being transported by your service. That includes being the best medical provider you can be.

Are there "turf" issues? People starting interventions that your service can't continue and you having to take on out of service providers to transport patients? What's the real problem here- be specific with why it seems like an issue.

Wendy

CO EMT-B

[Scaramedic]

You know your malicious remarks were not constructive. I merely asked a question, I did not ask to be bashed. I am a professional EMT with 10 years experience, the last of which was as a training officer. I work with some really great people, both Paramedics and Basics If you don't have something constructive to add please refrain from replying to my posts.

That's better. :wink:

[NREMT-Basic]

If you were professional, you would know how to spell P-R-O-T-C-O-L-S.

Ummm....so would you. P-R-O-T-O-C-O-L-S!!! :roll:

[NREMT-Basic]

Well let me explain a little better, We cover a national park and "park medics" (EMT-I 85) that are allowed to go out of NREMT scope for there level because they are on federal land, ie; an intermediate giving MS and requesting a BLS ambulance. Or never knowing which service can provide what care prior to our arrival. I think it would be beneficial to pt care if everybody was playing with the same deck of cards. don't you?

Just FYI, the National Registry doesn't set protocols. It never has. It doesn't have that much authority. I do agree with you about Dust not saying anything if he doesnt have anything constructive to say, but then we would never hear from him. :shock:

[TOPDOGEMT]

Well a note about this issue. The state has released protocols for 2008 from EMT-f to CC EMT-P suprisingly they are very well written and cover most situations. The real test will be how many agencys adopt them. Back to my original question though. How many of you work in a district/county/city/state with multiple agencys that operate under the same protocols and if so how well does it work? there are understandably differences in areas, training levels etc. but in my opinion an EMT-B on the west side of the city should be doing the same thing as an EMT-B on the east side. Call me crazy. I AM NOT TURNING THIS INTO A MEDIC VS EMT ISSUE!!!!!!! it is simply an operations question.

[Dustdevil]

I AM NOT TURNING THIS INTO A MEDIC VS EMT ISSUE!!!!!!! it is simply an operations question.

Nobody else was either. I don't get where you are coming from. You asked the exact same question in the original post, and you got a pretty well unianimous reply that we thought it was a pointless, non-issue that you were wasting time even concerning yourself with. BLS is nothing but first aid to begin with. Why would the state micromanage that? I just don't see what your concern is. Somebody else pointed out that it seems that you are just being jealous of other agencies ability to do more than yours can. Whether that is or is not true, it does appear to be what this may be all about.

How many more people do you need to disagree with you before you accept it? If you aren't really interested in our opinions, why did you bother to ask?

[NREMT-Basic]

Probably because he hoped he might get more than the off the cuff bash the EMT-B, run of the mill answer which prevails on this site, particularly from certain members.

[JPINFV]

How many of you work in a district/county/city/state with multiple agencys that operate under the same protocols and if so how well does it work?

I work in such a system (County wide protocols) and it works great, if you don't expect much involvement at the EMT-B level from the medical director. The only actual written protocol for basics is when to call medics which no one follows ("moderate medical" and above require paramedic escort. Moderate is defined as a patient who "needs definitive care, whose vital signs deviate from normal, or symptoms/complaints of medium severity." That describes most nursing home patients and it would simply cause a mess if all of the basics followed it to a T by calling 911 for every patient that was being transported to an emergency room. 911 is paramedic first response though).

Of course, this means that there is no medical director chart review at the basic level either. That is left up, for better or worse, to the individual ambulance companies. Unfortunately, outside of a PUM style system where all ambulance personal are within the same system, you will either have a regional protocol with more providers than one medical director can reasonably monitor, or you will have different services utilizing different protocols and with different procedures.