Most Progressive Protocols 2017

[michael150]

@michael150 I see you're from Omaha, and can't help but wonder if you're a Creighton paramedic student. If so, when I was in Omaha last year it seemed to be a heavily fire-based EMS city.

I talked with one of their former students who said Omaha Fire still utilizes MS for pain management with no other option. In short, the impression left regarding the city's EMS system was hardly a progressive one.

With all of that said, kudos to you for wanting to push for higher educational standards. Just know that as everyone else has mentioned, progressive is definitely subjective. Having chosen a field that is chocked full of "strong-minded" individuals you definitely have your work cut out for you, so good luck.

As far as RSI goes, not to thread derail too much, but it really is best left in the hands of those that possess the crux of airway management, from alpha to omega.

I actually go to the community college for paramedic. As much as I wish I had the money to go to Creighton, it's 2x the cost of tuition where I go. In addition, I'm going to be getting my associates and not just the certificate. Moving on to your comments about OFD. It is completely fire based as the two private companies only run IFTs and no 911 whatsoever. They now have Fentanyl for analgesia but those are the only two. They also now have Ketamine to be used for combative patients and they have to provide a RASS score first. We have the saying in class that Omaha EMS is 10-15 years behind everyone else protocol wise.

It is a very non-progressive city when it comes to EMS and it still blows my mind the amount of hospitals they have here. Coming from Las Vegas, we don't even have 2 trauma centers (just UMC whereas Omaha has UNMC and now Bergan Mercy). I definitely have my work cut out for me and I can see the difficulty and amount of time it's going to take to get there. What I want to use this essay for in school is to start building a platform for the future!



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[michael150]

Well in speakong with field RSI (which i am a fan of) alot of patients need to be rescusitated first.

Say for instance the trauma patient with a shock index of 0.9 or greater. Sure they may need an airway but what is worse for THIS particular patient. The questionable airway or post intubation hypotension ? Sometimes forgoimg the procedure so patients can be adequetly rescusitated BEFORE RSI can make a significant difference in the patient. So passing the buck to an ER or flight crew isnt necessarily a bad thing.

I don't seem to be understanding. I apologize.


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[VentMonkey]

I don't seem to be understanding. I apologize.

With due respect, he's referring to things typically not taught in the standard DOT paramedic curriculum. It goes back to my point about the crux of airway management.

Also, I thought Creighton was a Level 1 trauma center out there? I can see it being a bit steep. I did their critical care course, and it wasn't cheap, but definitely well worth it.

 

[michael150]

With due respect, he's referring to things typically not taught in the standard DOT paramedic curriculum. It goes back to my point about the crux of airway management.

Also, I thought Creighton was a Level 1 trauma center out there? I can see it being a bit steep. I did their critical care course, and it wasn't cheap, but definitely well worth it.

I need to do some research into that. We didn't learn anything about post-intubation hypotension, just the possibility of vagaling out our patients. Creighton University Medical Center was closed as of the beginning of June I believe. Bergan Mercy was completely remodeled and now serves as the CHI L1 and Nebraska Medicine as the other!


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[Carlos Danger]

Hey all. I am going to be doing a final essay in paramedic school and I just wanted to post on this forum to see what everyone thought. I am interested in progressive protocols and perhaps sometime in my career, be involved or start a movement for a nationwide set of protocols and more training for EMS. So, what EMS system, to you guys, have the most progressive protocols? Can you also post a link to your protocols?

Any help would be most appreciated and thanks in advance!

I appreciate your enthusiasm and desire to help change EMS for the better. A common theme of the discussion on this forum is dissatisfaction with the educational standards of EMS in the US. We pretty much all agree that EMS education in general should be more rigorous.

If you really want to start working towards this, I would start by thinking about what you mean by "progressive". It might be tempting to use that term to describe protocols that are more comprehensive than most, or that include more "advanced" interventions than is typical, but I don't think having protocols for chest tubes and field amputations (merely as examples) necessarily makes an agency progressive. It could actually make them regressive, depending on certain factors, including the simple fact that there are good reasons why you rarely see those things done in the field. Just something to think about.

 

[Carlos Danger]

I need to do some research into that. We didn't learn anything about post-intubation hypotension, just the possibility of vagaling out our patients. Creighton University Medical Center was closed as of the beginning of June I believe. Bergan Mercy was completely remodeled and now serves as the CHI L1 and Nebraska Medicine as the other!

This would be a good topic to discuss in a separate thread.

 

[michael150]

I appreciate your enthusiasm and desire to help change EMS for the better. A common theme of the discussion on this forum is dissatisfaction with the educational standards of EMS in the US. We pretty much all agree that EMS education in general should be more rigorous.

If you really want to start working towards this, I would start by thinking about what you mean by "progressive". It might be tempting to use that term to describe protocols that are more comprehensive than most, or that include more "advanced" interventions than is typical, but I don't think having protocols for chest tubes and field amputations (merely as examples) necessarily makes an agency progressive. It could actually make them regressive, depending on certain factors, including the simple fact that there are good reasons why you rarely see those things done in the field. Just something to think about.

I appreciate that! From the reading I've been doing on the forum, I am starting to see the general consensus that education needs to be more rigorous and more in depth. That's fantastic because we as providers are the ones that determine the fate and track that EMS takes.

I also see what all of you mean by deciding what I mean by "progressive". To me, it was always being able to work with a certain autonomy with the skills I was taught to do. It's critical thinking to figure out the issue and fixing it to the best of my ability. No, field amputations would probably not be included in what I would describe as the perfect protocol list; however, if it was, critical thinking would need to take place on the ALS level to determine necessity or not.


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[VentMonkey]

Creighton University Medical Center was closed as of the beginning of June I believe.

That's too bad, I enjoyed my clinical time there.

 

[johnrsemt]

Why do we need to carry more meds for a procedure that we do 1% of the time?

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So for that theory; we have only had 3 cardiac arrests here in 9 years (only 1 workable) so why carry ACLS meds?

 

[johnrsemt]

There needs to be a Nationwide BLS protocol; and basic ALS protocol: then you can add or subtract as needed: Add Altitude and avalanche protocols or subtract them.
Worked a place in July (different state) that had an 84 page BLS protocol. Everywhere else I worked figured that you learned BLS in school and didn't need a written protocol to do that.

 

[GMCmedic]

So for that theory; we have only had 3 cardiac arrests here in 9 years (only 1 workable) so why carry ACLS meds?

Because nobody has been brave enough to start working codes without them in a prehospital setting, but that's apples and oranges. I didn't say we shouldnt carry any meds, we just don't need to carry multiple options.

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[GMCmedic]

As far as National protocols.....well, States Rights. Ill leave it at that.

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[Carlos Danger]

So for that theory; we have only had 3 cardiac arrests here in 9 years (only 1 workable) so why carry ACLS meds?

Honestly, I would say good question. It seems like any setting that only handles one workable arrest per decade could easily get by with BLS services.

 

[EpiEMS]

So for that theory; we have only had 3 cardiac arrests here in 9 years (only 1 workable) so why carry ACLS meds?

Well, first, there's little evidence that those meds actually make a difference (to important metrics like neurologically intact survival).

Everywhere else I worked figured that you learned BLS in school and didn't need a written protocol to do that.

Defining BLS is part of the problem. Is glucometry BLS? CPAP? How about EpiPens? I'd say all three are BLS measures, but ought to have a protocol, no?

 

[Summit]

There needs to be a Nationwide BLS protocol; and basic ALS protocol: then you can add or subtract as needed: Add Altitude and avalanche protocols or subtract them.

The end product of this is exactly what we have now.

 

[Pond Life]

Perhaps progressive should encompass the freedom to act autonomously across the whole of the paramedic scope of practice. Or maybe it could mean that the paramedics develop their own areas of practice. Perhaps even allow the paramedic to make the decision not to transport to ED in all but the most serious of cases.

 

[Gurby]

@michael150 : make sure you figure out what a "progressive protocol" really means.
Is it the longest list possible of no-call-in protocols and whizbang skills like central lines and pericardialcentesis?
Is it appropriate evidenced based guidelines and independence matched to the provider skillset, patient population, and practice environment location?
Is "most progressive" for one agency really the "most progressive" for everyone?

 

[RocketMedic]

We (and ESD-48) transfuse blood into people on the regular here in North Harris County (Houston).

 

[EpiEMS]

We (and ESD-48) transfuse blood into people on the regular here in North Harris County (Houston).

Is that part of a research project, or regular ol' protocol?

 

[RocketMedic]

Regular protocols. But we're always researching too.