New USAToday article

[JPINFV]

by cookbook you mean protocols? They are there for a reason, just like you as and RN dont make decisions without a doctors orders, or your standing protocols, If we didnt have a set guideline to follow we would have people running around doing whatever they wanted to.[like doctors?] Lets face you and rid are the exception to the rule not the norm. We cant assume all paramedics and emt's have competent and educated clinical judgement.

Lets face it, protocols have to start at some level, and above that level, the providers do what ever they want to (just checked by insurance and hospital privileges). Granted, 4 years of general, post-secondary education, followed by 4 years of applied education, followed by 3-4 years (assuming straight EM, not FP or a combined program) of on the job training is a lot more education then even the degreed medics have. Let's not compare this to the training basics get.

Not every patient follows the protocols. Should there be mandatory contact for the rare procedures (child birth, any thing involving needles but not veins, etc)? Sure. Should there be a base hospital available for those weird presentations? Sure. That said, a paramedic should be able to treat patients as they present, which may not be completely in line with protocols. Unfortunately, the amount of education required to do this is not achieved by the vast majority of basic schools.

[whit72]

I am not comparing the two medics have their role and emt have theirs. What I am saying is you cant assume everyone knows what is going on thats why there are protocols. Thats all its not difficult

[JPINFV]

I am not comparing the two medics have their role and emt have theirs. What I am saying is you cant assume everyone knows what is going on thats why there are protocols. Thats all its not difficult

As if doctors always know what is going on, yet they don't....

Oh, never mind.

[whit72]

Did I say they did. What it needs to become is a team not a bunch of ego-maniacs running around thinking they are smarter then everyone else. Doctors , medic emt nurses police and fire. You are all there for the good of the community we should start acting like it.

[JPINFV]

Did I say they did. What it needs to become is a team not a bunch of ego-maniacs running around thinking they are smarter then everyone else. Doctors , medic emt nurses police and fire. You are all there for the good of the community we should start acting like it.

1. Not everyone has the same intelligence. Unlike in grade school, not everyone in the real world is smart. It's not about egos, it's about education and ability.

2. Blindly following protocols (which was what I was trying to counter with using doctors as an example) is bad. Not every patient will happily follow how the local protocols are written. Innovation is good. Understanding what you are looking at and how to treat it (be it strictly following protocols or not) is good. Throwing up your hands and giving up because the patient isn't presenting how the protocols says the patient should is bad.

3. Very few people are in it only for the good of the community, if even for that.

[Ridryder 911]

1) You are absolutely right, and that is why formal education should be required for all levels. At least with this way we would be at the same minimal reading/math/ comprehension level. Along with this the 1 junior high reading level textbook could be totally eliminated, and detailed in-depth studies of systems, specialties could be explored.

2) There is not enough paper to write a protocol for every event, as well as having a medic memorize them. That is why protocols should be written as "suggested guidelines" so that they can be adapted to, not followed as a cookbook. There is an art of writing good protocols, again, leaving the discretion up to the medic. That is why medical director participation is so crucial. If one cannot be trusted with patient care, without specific treatments, procedures, written down, they not need to be there. There are plenty that can provide good care that could replace them. Allowing incompetency, stupidity, should never occur. Patients deserve more than that. Each service should have an active education department, that regularly tests protocols, CEU's and grade level and participation should be part of that employee evaluation for merit raises and ability to keep ones employment. An active TQI department to monitor skill and knowledge level. Unsatisfied skill levels or misdiagnosis comparisons should be closely monitored. If there is apparent poor skills, then either perform skill reviews by class, clinical performance settings, should be offered to that employee, if this does not correct the problem then discharge of the employee.

3) I have to admit it, I am not in it for the community. Nor, do I know of very few professional Paramedics that are. They are in it for a profession, that provides health care for the community, and by being competent, well abreast of the medical standards, keeping continuation of medical knowledge and skills, I am providing a much needed service for that medical community. One does not have to be community orientated, to provide good professional care to each of their patient(s).

R/r 911

[Ace844]

Why would you think that. half the population is retarded they have to work somewhere why would EMs be any different.

"whit,"

As far as calling codes and wroking them or not. Do a search as this has been discussed ad nauseaum here. The info is here you just need to 'work' to get it. This is more than likely why 'Rid," sisn't feel the need to elaborate much more on that. Next, your protocols for 'calling arrests' are posted on here as well. Again, anyone can find them do a search. Based on your overall posts that I have read thus far it sounds like you may need to participate in some 'higher' con-ed to get up on the 'Standards of Care.'

A protocol is not an END ALL BE ALL. It is a guideline. ALWAYS has been and always WILL BE. If you believe your protocols are your '10 Commandments etched in Stone' than I doubt you are as educated or as able a clinician as you purport.

Out here,

ACE844

[Dustdevil]

by cookbook you mean protocols?

Depends upon the protocols. If they are the typical flow-chart, "if A happens, do B" paint-by-the-numbers protocols that do not allow for the medic to forumlate a plan of treatment that is best suited to the patient's condition, then yes, those are cookbooks.

They are there for a reason, just like you as and RN dont make decisions without a doctors orders, or your standing protocols...

You don't get out much, do you? You should. That is exactly how it works in many locations, as well it should.

If we didnt have a set guideline to follow we would have people running around doing whatever they wanted to.

Yeah. And...? You honestly don't think this would be better??

Lets face you and rid are the exception to the rule not the norm. We cant assume all paramedics and emt's have competent and educated clinical judgement.

That is exactly our point! It SHOULD be the norm! We SHOULD be able to assume that everybody who calls themselves a paramedic has the education, training, experience and aptitude necessary to diagnose a patient's condition and prescribe a plan of treatment appropriate for them. That is why educational standards are going to have to increase significantly -- measured in years, not hours -- before this joke of a passtime becomes a true profession.

I take no pride in being an exception. In fact, I am ashamed that it takes so little to be exceptional in this field.

[whit72]

I dont get to deviate from mine. Thats all im saying, I dont always agree with it. But that is how it goes in my area.

[TechMedic05]

...Just because you don't get to deviate means everyone else in the world should need to work to your protocols? Granted, may be a higher or lower level depending on circumstances.