Ambulance Crash, buckle up guys.

[gdickens]

I don't know whose protocols were copied to the forum, but they weren't mine.

I would never discuss the specifics of our protocols in a world wide forum of this nature. While some will probably argue that we should have an international standard of care, that simply isn't the reality under which we live. Protocols are prepared and/or approved by the local Medical Director based on the skills and competencies of his/her staff, the availability of equipment and resources, the logistics of their service area, the availability of other medical resources in the community, the level of trust they have in their staff, and their personal disposition toward the professional liability associated with all the above.

Once the Medical Director publishes the protocols and entrusts us to implement them, he/she turns us into Physician Extenders. This means that any and all liability associated with assessment of the patient, appropriateness of the orders, and the execution of the orders comes directly back to the physician's license. This is very different from the physician's liability associated with the actions of a nurse. In situations where nurses are involved, the nurse's personal license "carries the water" when it comes to the appropriateness of the assessment and the actual execution of the orders... leaving the physician responsible only for the appropriateness of the orders given as relates to the information he/she was given regarding the patient's condition.

Some Medical Directors take on their role because they are the only physician in the area. These physicians are often General Practitioners who have absolutely no idea what emergency medicine is about, and they often take the stance of "better safe than sorry" because they are scared of their (perceived) liability associated with the practice of modern pre-hospital medicine. Given this climate in the EMS industry, I find it appalling when one medic questions the actions of another's implementation of protocols when they have never actually seen the protocols and have no idea what the Medical Director's intentions were when he/she published them. I am not saying that there is no situation where the idiots can be put in their place. I'm just saying that it should be done close to home where we can make a realistic assessment of the situation based on first hand knowledge of the patient's condition, the protocols, and the Medical Director's disposition.

Where I come from, the guys who take advantage of ambiguous protocols and interpret "consider" to mean "I won't get in trouble if I do it, so let's go out there and have some fun" are called WOO WOOs. Those who operate under very specific protocols and/or who are afraid to look beyond the criteria that meets the first algorithm they come to are called Protocol Monkeys because they go out there and operate like a robot. My Medical Director likes to wash the Woo Woos out of the system as quickly as possible and marks their file "WWDNH" (Woo Woo, Do Not Hire). He likes to work with the Protocol Monkeys to build their confidence and assessment skills to the point where they understand the concept that "Medicine is an Art Enhanced by Science".

It took me 20 years to come to peace with the fact that each agency has it's own set of protocols, and those protocols directly reflect the personality, practice style, and aversion to risk of the Medical Director. Maybe in another 20 years I will be able to come to peace with the fact that terminology (especially the slang) differs as widely. However, I don't think I will ever come to peace with the fact that so many of us (myself included at the top of the list) are so opinionated and quick to insult the intelligence and/or education levels of those who see the world through a different prism.

The above are just my opinions, and YES, I do understand that opinions are like ###holes... everyone has one and noone is interested in mine.

[Dustdevil]

The above are just my opinions, and YES, I do understand that opinions are like ###holes... everyone has one and noone is interested in mine.

For what it's worth, I completely agree with yours.

[Asysin2leads]

I'd have to disagree with the paramedic's decision to fly these two as well. Everyone has to remember, a helicopter landing at a field location, loading, taking off, and landing at a facility puts a lot of highly trained people and expensive equipment at risk for disaster. I also disagree with the concept of flying someone to a trauma center simply because they are "one of our own." Going the extra mile for an MOS is one thing, but using a helicopter to transport should be based solely on need. Also, to sound like a complete dick, given the scenario where the 911 ambulance is 15 minutes out and the private is 6 minutes out, at the BLS level, what exact intervention will be provided that will make a world of difference for the patient?