Local Protocals... Do You Ever Break Them?

[tunnelrat83]

that is kinda what happens w/ me... I will set up the IV stuff... get the drugs out... stuff like that... and very basic EKG reading...

[bumper]

I usually try and stay true to our protocols but sometimes they are too restrictive when dealing with certain scenarios. I usually call in to the doc on duty and ask them. A lot of our docs know we are in rural areas that can take up to an hour to get to and then back to the facility. IF and only IF they instruct me I will do something but not ever on my own.

Did you guys hear about the two medics in FL (I think) that arrived on an MVA and the Fire Dept was performing CPR on a full term OB and they decided to perform a C-Section on scene.....YIKES

They saved the mother but the newborn died.

[medic05~ Bouncer]

While I was in Texas my partner was a medic and he taught me how to read basic EKG's. While I was going thru medic school, I assisted in getting IV's and drugs ready for him. The Doc's signed off for me but never really stepped outside of my protocols just bent one or two.

[emtmoira]

I don't really break them persay but I've been known to have someone on my crew who is not and EMT-I (which are the ones around here who can do glucometer) but is a diabetic or a significant other of a diabetic do a finger stick on someone if I have like 10 other things to do. I don't really break protocols exactly just a little bit sometimes maybe perhaps.

[shorthairedpunk]

Ive come across a protocol or two I may have pushed my luck on, but only within reason. As long as good judgement is used, then breaking a protocol isnt a bad thing. If I were genuinely tied up with another aspect of patient care and my basic was capable, I would let them start a line for me, itsa monkey skill. I probably would not let them push a med they arent trained to push, just because that puts a huge liability on them and the risk for mistake is higher.

Its all about judgement, morons who dont use judgement are the reason protocols tend to be restrictive.

[THE_DITCH_DOCTOR]

***COMMENT ABOUT SHORTHAIR REMOVED BY ME IN THE INTEREST OF PROMOTING PEACE AND MAINTAINING THE CEASEFIRE***

[emtmoira]

If my basic was a RN or a doc that had IV skills in another setting MAYBE I'd let them but letting just a basic start an IV which mind you is an INVASIVE PROCEDURE WITH A HUGE INFECTION RISK IF NOT DONE PROPERLY that's just moronic. I'd rather have them push the prepackaged drugs that stick a needle in someone. That's not breaking protocols that's risking patient's safety!

[shorthairedpunk]

In my system, not in Illinois as a whole, hell most basics in Illinolis cant intubate, let alone first responders. Our system is advanced, which is one of the benefits of being largely rural, you get to do more. The ALS system just south of us, for the most part does what our Is do. We were the pilot system for first responder AED, the pilot system for BLS monitoring capabilities, we will be pushing for BLS glucagon, we are in the process of getting the B's the option of performing 12 leads to better make transport and intercept decisions. and like I said, dont quote me on the FR intubations.

IVs have a minimal infection isk, the issue with pushing meds isnt pushing the med itself, its the risk for grabbing the wrong box, or giving the wrong dosage, etc, med errors happen on a regular basis across the country by people who are trained, so its more likely to happen to someone not familiar with a medication, nor its packaging.

[Summit]

We were the pilot system for first responder AED

Novell... broundbreaking...

:roll:

we will be pushing for BLS glucagon

Cool.

we are in the process of getting the B's the option of performing 12 leads to better make transport and intercept decisions.

I assume you mean they will be trained how to hook up the 12 lead and run the strip so its ready for the I/P, not that the B will be interpreting 12 lead?

IVs have a minimal infection isk

Yes, they do. However, the infection risk is easily mitigated with 5 minutes of training.

From what I understand, our first responders will be intubating soon as well, and I believe they have already gotten combitube protocols, but dont quote me on that.

Too late :wink:

[Ridryder 911]

shorthairedpunk wrote:

We were the pilot system for first responder AED

Maybe for your state, but nationally... sorry!

Prehospital trials began in Brighton, England, in 1980 using the Heart Aid. The device weighed 28 pounds and used an oral/epigastric and a precordial electrode to record ECG tracings and deliver electrical shocks. It was also capable of transcutaneously pacing the heart. In 1982, the US Food and Drug Administration (FDA) gave approval for EMT-defibrillation (EMT-D) clinical trials. Early US investigations of manual EMT-D were carried out in Washington, Iowa, Minnesota, and Tennessee.

Cummins RO, White RD, Pepe PE: Ventricular fibrillation, automatic external defibrillators, and the United States Food and Drug Administration: confrontation without comprehension. Ann Emerg Med 1995 Nov; 26(5): 621-31; discussion

Sorry, for those who were around & actually helped perform those studies.

Respectfully,

Ridryder 911