Duty to act?

[uglyEMT]

I would have all the time in the world (not literally) to remove that patient safely without the chance of causing more possible injury to him. This can only be done by being properly instructed about the skill of safely stabilizing a patient and safely removing him or her from a car. Chance is your regular Joe off the street isn't going to know how to perform it or know the dangers.

First I want to say that if the patient is stable as you stated your best course of action would be to asses the patient, stabalize the C-Spine if necessary and wait till a crew shows up. Unless you have all the proper equipment with you then you can not properly move the patient.(looks like ERDoc replied while I typed, yes we are learning that its not all necessary but please follow your local protocols just to CYA, no need for a law suit because you became Randy Rescue) As you say you are new to the field. Alot of that new knowlege has to be tamed. Yes its going to suck sitting in the backseat holding the person still waiting for the crew to show up because you want to do all that fancy stuff you learned in front of everyone. But I would rather roll up on you doing just that and tell you great job knowing what to properly do then seeing a person lying supine on the ground outside of the car (unless of course thats how you found said individual or circumstances required immediate removal)

Back to the OP. After doing a quick check, No VA does not have a duty to act law on the books. Local protocol then would dictate what you should and shouldn't do. Ethics and morals then come into play as well. If that was you on the side of the road would you like to see a rig roll by and look but not stop? Think back to the story that made the rounds a few years back of the Dr whos son borrowed his car drove passed an accident (which he rightly should have done) but someone there spoted the MD plates and called the local news to complain. It wasnt until the details came out that the son was driving and not him that it died down. But for a while the Dr's name was dragged through the mud. That was just a personal vehicle with MD plates imagine what an entire rig would do?

Edited December 3, 2013 by uglyEMT

[ChanceAndCircumstance]

I practice by the standards I was taught. Everything I was taught in my training was needed to pass the written and practical exams. It wasn't really my place as the student to say that's wrong, oh you can't do this, or that's outdated, especially at times I wanted to say stop with your field experience stories. Most of the class was irrelevant stories to the current topic that the instructors would always talk about. Anything I said to the instructors would mean squat because of their experience and place in that class.

I am currently out of Maryland. I lived in the deep eastern shore by St. Michael's where I worked as a volunteer firefighter/emt, and then I moved up state and was able to land a gig as a part time firefighter/emt near Annapolis. I have been loving it ever since. My initial plan is to volunteer as a firefighter or emt and keep my certs up wherever life takes me.

If I can ask where the studies are when you said "The whole idea of rapid extrication/KEDs/longboards is being questioned and most studies are showing more harm than good.". It had me thinking because when I was in training to become an EMT one of the instructors said their biggest pet peeves is when they take a patient into the ED after falling down a flight of stairs,or involved with a MVA and the attending tells them to rip all the stabilization off the patient and it putting the patient in danger. Now I am going to go with what the ED attending is saying over what my EMT instructor is saying, unless he or she is a practicing physician. So cutting to the chase, why do EMS providers even bother with stabilizing patients if it may be causing more harm or have to take it all off anyways once the patient gets to the hospital?

For the moment being I am going to follow what I have been told to do, until things change.

[island emt]

following maryland state protocols is a smart thing to do as a basic just starting out..

However don't become a protocol monkey that loses the ability to think and use the mass between your ears to evaluate and make proper decisions on providing quality prehospital care.

Golden hour went out the window years ago along with many other myths as current science based studies have shown us better ways.

[paramedicmike]

I practice by the standards I was taught. Everything I was taught in my training was needed to pass the written and practical exams. It wasn't really my place as the student to say that's wrong, oh you can't do this, or that's outdated, especially at times I wanted to say stop with your field experience stories. Most of the class was irrelevant stories to the current topic that the instructors would always talk about. Anything I said to the instructors would mean squat because of their experience and place in that class.

I am currently out of Maryland. I lived in the deep eastern shore by St. Michael's where I worked as a volunteer firefighter/emt, and then I moved up state and was able to land a gig as a part time firefighter/emt near Annapolis. I have been loving it ever since. My initial plan is to volunteer as a firefighter or emt and keep my certs up wherever life takes me.

If I can ask where the studies are when you said "The whole idea of rapid extrication/KEDs/longboards is being questioned and most studies are showing more harm than good.". It had me thinking because when I was in training to become an EMT one of the instructors said their biggest pet peeves is when they take a patient into the ED after falling down a flight of stairs,or involved with a MVA and the attending tells them to rip all the stabilization off the patient and it putting the patient in danger. Now I am going to go with what the ED attending is saying over what my EMT instructor is saying, unless he or she is a practicing physician. So cutting to the chase, why do EMS providers even bother with stabilizing patients if it may be causing more harm or have to take it all off anyways once the patient gets to the hospital?

For the moment being I am going to follow what I have been told to do, until things change.

Here's a recent article published by Bryan Bledsoe regarding the use of LSBs in EMS. At the end of the article is a good list of sources for further research.

Maryland EMS is a unique beast. The Maryland Way used to be, at one time, the way to do things. Unfortunately, many EMS providers in the state still live in that same mindset simply because "...that's the way we've always done it...".

Be smart. Do your research. Respectfully challenge what you can when you have the evidence to back it up. Be smart about what you're doing.

As was already mentioned, don't let yourself be a protocol monkey. That's a common mindset in Maryland. It's tough to be an independent thinker.

[ERDoc]

I agree with the above. No one is telling you to go outside of your protocols. In fact, we are telling you the exact opposite. You have to work inside your protocols. But understand the limits/errors with those protocols. Always question them but not in front of your pts. If you want to become a better provider, become friends with pubmed.

EDIT: Also understand that a large proportion of EMS providers do not understand how research works and changes things, this is especially true in the volley systems.

Edited December 3, 2013 by ERDoc

[scubanurse]

Maryland EMS is so quirky sometimes it annoyed me. Basics couldn't do a simple BGL check in the field and the order was to just give oral glucose to all altered LOC for unknown causes.

Mike, the doc, and island are right, challenge those who make the protocols with evidence. Ask Dr. Alcorta and Dr. Bass why the protocols are the way they are.

They have taken out spinal immobilization for isolated penetrating trauma, where when I practiced, it was in the protocol to backboard penetrating injuries, so changes do occur.

[ERDoc]

Ask Dr. Alcorta and Dr. Bass why the protocols are the way they are.

Because they have to accomodate the lowest common denominator.

[scubanurse]

But asking can spark discussion and debate. In my experience, both docs are very open to providers calling or e-mailing them with questions and discussing issues or new research.

[ERDoc]

But asking can spark discussion and debate. In my experience, both docs are very open to providers calling or e-mailing them with questions and discussing issues or new research.

Absolutely, and I'm sorry if I gave the impression otherwise. It is a matter of asking the right people at the right time.

[scubanurse]

You didn't give the impression otherwise, just wanted to make sure I was clear. I tend to space when posting and half the time I'm sure I sound like a special cup of apple sauce.