Protocols - From here to there.

[Jason]

Earlier today I was in Chat and we were discussing the differences in protocols and how EMS is done from place to place. This Site has such a wide variety of subscribers, from all over the US to all sorts of places around the world - I thought we could share protocols to see what others are doing and where. A somewhat similar post about state protocols is on this site, but it's hard finding state protocols when regions within the state change what we are allowed and not allowed to do. I find it interesting what providers are allowed or expected to do, who are no where near me.
So ... From VA, from the ODEMSA region :

http://www.odemsa.vaems.org/index.php?option=com_content&view=article&id=5&Itemid=50

Now within the ODEMSA region, OMDs from agency to agency are allowed to make a certain amount of changes if they wish. My agency's protocols are very similar, with only slight differences.
I look forward to seeing what the rest of the US (west coast maybe) and world do.

 

[DesertMedic66]

Riverside county, southern CA: http://remsa.us/policy/

San Bernardino, inyo, and mono counties southern CA: http://www.sbcounty.gov/icema/main/ems_policy_manual.aspx

 

[emt_irl]

Here in Ireland we have national guidelines for each level of practitioner.

Here are the Clinical Practice Guidelines for EMT:
http://www.phecit.ie/Images/PHECC/C...0141031 Emergency Medical Technician CPGs.pdf

Paramedic:
http://www.phecit.ie/Images/PHECC/Clinical Practice Guidelines/2014 CPG/20141031 Paramedic CPGs.pdf


Advance Paramedic:
http://www.phecit.ie/Images/PHECC/C...14 CPG/20141031 Advanced Paramedic CPGs-1.pdf

if you scroll to the end of each pdf, there is a much more condensed chart of what skills each level can provide

 

[NomadicMedic]

In most places, paramedics have a pretty standardized scope. The exception is RSI and other advanced procedures. For example, I'm in Georgia and in this state there's NO RSI, but across the state line in SC it's standing orders for medics who've been cleared.

EMTs have a far more varied scope. For example, in Seattle, there's no glucometers and no NPAs for basics, but daw and shoot epi for anaphylaxis is okay.

 

[Jason]

emt_irl -
What is the training difference in Paramedic and Advanced Paramedic in Ireland?
Thank you.

 

[Jason]

In most places, paramedics have a pretty standardized scope. The exception is RSI and other advanced procedures. For example, I'm in Georgia and in this state there's NO RSI, but across the state line in SC it's standing orders for medics who've been cleared.

EMTs have a far more varied scope. For example, in Seattle, there's no glucometers and no NPAs for basics, but daw and shoot epi for anaphylaxis is okay.

In VA, there is a lot of similarities - however there are a few areas that differ greatly.
More and more areas / regions want their paramedics to be NR not just state. Some agencies make state only medics function and pay at Intermediate level. Some areas restrict the freedom of the medic provider to making them call in for a lot of things. It's in their scope of training, but can't do the skill or med without a call by call permission. It's odd.

 

[medicasaurus]

BC Ambulance treatment guidelines in British Columbia, Canada.
New addition of TXA as of this month.
http://bctg.bcas.ca

 

[Tigger]

I work full time for a pretty rural place and part time in a good sized city with the same hospital providing medical control. Our protocols are fairly close to one another, with the difference being in what must be called in for, max doses (for instance we have no max pain medication dosage), and a few extra waivered medications and skills (IV nitro and the use of an infusion pump for non-IFT calls).

Our protocols are too large to attach, if you're that interested I'll happily PM them to you.

 

[emt_irl]

emt_irl -
What is the training difference in Paramedic and Advanced Paramedic in Ireland?
Thank you.

It's hard to explain to someone outside of Ireland but here it goes:

Our advance paramedic is called a paramedic elsewhere in the world(no idea why we felt the need to make a new name for it) and our paramedic lies somewhere in between. You could class our paramedic's as ILS and our advance paramedic as ALS

 

[TransportJockey]

Here in Texas, protocols and scope of practice can change from county to county. And the level of those protocols can vary from the normal to extremely advanced

 

[Clare]

We have one national set of Clinical Procedures and Guidelines (CPGs) for New Zealand.

They are called so because they contain both procedures where you must do certain things (for example cardioversion or pacing in a certain order, or refer patients to hospitals if certain conditions are met) and they also contain guidelines where you should do things but you don't have to because clinical judgement is required.

There is the "pocket" version which is a slimmed down version containing the "nuts and bolts" and a "comprehensive" version which is a huge thick book of about 300 pages containing much more guidance and a lot more stuff. I refer to it on at least a weekly basis and I can't even remember a lot of stuff in the comprehensive version, if you see somebody walking lop sided you know they've been carrying around the comprehensive CPGs.

A link to the pocket version is here http://www.resuscitationskills.com/...iles/St John 2013-2015 CPG Pocket Version.pdf

If you read those they're still in use exactly as printed however the levels of "Primary Care" and "BLS Paramedic" no longer exist.

We are due for a new version of the CPGs about this time next year.