Stuff that's not in protocol

[NPO]

So an EMT asked me the other day if a procedure was allowed under state protocols, and I really didn't know what to say.

Well, no. Not specifically. But a lot of stuff isn't specifically allowed, but is still done or allowed.
I've never had a protocol on the heimlich maneuver, but I can't imagine it's "not allowed."

Specifically she asked about wound packing. Is this just considered basic care? Or is a specific protocol needed for this?

 

[mgr22]

First, protocols vary by system. Second, you probably do have a BLS protocol for removal of a FBO and another for hemorrhage control. Check your state EMS website.

 

[RocketMedic]

I reckon the specific method of hemorrhage control isn't in our protocols; that's the point of all that fancy training.

 

[VFlutter]

Most protocols have a disclaimer written in stating that they do not cover every situation and that in absence of a specific protocol to use clinical judgment, established practices, or contact medical control.

 

[DrParasite]

I reckon the specific method of hemorrhage control isn't in our protocols; that's the point of all that fancy training.

several few years ago, tourniquets weren't in our EMS protocol, as our medical director didn't approve of their use. I know of a medic who used one on an amputation, and he was called into the office to explain his actions (he was a former military medic, so that was what they did). Thankfully the MD has since updated his stance on them.

And as for if it is in the state protocols? https://www.ncems.org/protocols/TB 4 Extremity Trauma Protocol Final 2017 Editable.pdf

As for heimlich? https://www.ncems.org/protocols/AR 1 Adult Airway Protocol Final 2017 Editable.pdf

If you want to find the actual procedure, as referenced in the state guidelines: https://www.ncems.org/procedures/allprocedures.pdf with AP13 being FBAO, WTP-5 is for hemostatic agents, and WTP-7 is for tourniquets.

 

[EpiEMS]

Specifically she asked about wound packing. Is this just considered basic care? Or is a specific protocol needed for this?

This is an interesting one. On one hand, it may not be explicitly in your scope. On the other, it made its way into the (non-authoritative) National EMS Scope of Practice Model recently (see pg. 5), and it's been recommended practice all over the place (TCCC, for example, and ACS CoT) for a some time now.

I think the answer is that unless it is expressly forbidden by your protocol/medical director, you *ought* to be doing it.

several few years ago, tourniquets weren't in our EMS protocol, as our medical director didn't approve of their use. I know of a medic who used one on an amputation, and he was called into the office to explain his actions (he was a former military medic, so that was what they did).

Oof...

 

[VentMonkey]

I think it can all be summed up best as a mixture of common sense, protocol and clincial applicability, and best practices.

...mostly common sense; something that has sort of lost its way within the workforce and in general over the years. Eesh.

 

[CALEMT]

mostly common sense; something that has sort of lost its way within the workforce and in general over the years. Eesh.

I blame it on schools producing cookie-cutter EMT's and paramedic's instead of teaching clinical/ critical thinking.

 

[NPO]

I blame it on schools producing cookie-cutter EMT's and paramedic's instead of teaching clinical/ critical thinking.

I blame it on scaring EMTs and Medics that if you put a toe out of line you'll instantly have your license revoked.

 

[mgr22]

I blame it on scaring EMTs and Medics that if you put a toe out of line you'll instantly have your license revoked.

NPO, I haven't found that to be the case. Is license revocation totally automatic for protocol deviations where you work?

 

[StCEMT]

I blame it on scaring EMTs and Medics that if you put a toe out of line you'll instantly have your license revoked.

Despite some of my complaints, this is one thing I appreciate about where I work. If I have to step over my line in a reasonable, appropriate, and indicated manner for the best interests of the patient, it is encouraged that I do so.

 

[NPO]

NPO, I haven't found that to be the case. Is license revocation totally automatic for protocol deviations where you work?

Not in the slightest. And nor was it at my previous employer. But in school it's often taught to be the case. Every medical director I've ever had was pretty firm in the mindset of "do what you need to do if it's backed by sound clinical judgment."

 

[VentMonkey]

I blame it on schools producing cookie-cutter EMT's and paramedic's instead of teaching clinical/ critical thinking.

This goes WAAAAAAY beyond just EMT and paramedic school.

I blame it on scaring EMTs and Medics that if you put a toe out of line you'll instantly have your license revoked.

Anyone who's been "scared" into seeing to it other's threats outweigh their own God-given common sense has bigger issues, IMO.

I can blame it on the sun, the moon, the stars, etc. etc. etc., but what good is it doing me? Ultimately without accountability we're all perpetually stuck questioning things without actively seeking out the answers for ourselves, right?

 

[NPO]

Anyone who's been "scared" into seeing to it other's threats outweigh their own God-given common sense has bigger issues, IMO./QUOTE]

This is my school of thought. I've pushed the limits of the protocols before then asked the medical director later, and they've always backed my decision.

 

[luke_31]

Not in the slightest. And nor was it at my previous employer. But in school it's often taught to be the case. Every medical director I've ever had was pretty firm in the mindset of "do what you need to do if it's backed by sound clinical judgment."

I can agree with this statement. Our medical director is all about doing what will work best for the patient and if it's not in protocol call the ER and talk with one of the MDs to get permission to do something outside protocol. Most of the time they let us do what we need to and it's already in protocol for us to do any procedure that we are trained on, that we have equipment for, and a doctor orders it. Not to mention we can give any drug in the pharmacy with a doctor's order.

 

[chriscemt]

I blame it on scaring EMTs and Medics that if you put a toe out of line you'll instantly have your license revoked.

I've repeatedly told my supervisors that I'm not afraid to make mistakes, and several times I've had to rationalize deviating from protocols/standard practices. First time it happened, I won my case, and it was possibly the most liberating experience of my life, save for proposing to my wife.

 

[VinceVega91]

I believe wound packing is technically considered bandaging care which is allowed by us and is found in most protocol systems. For most major traumas and bleeds, wound packing is often encouraged. Unless a protocol specifically says not to do this, just do what's in the best interest of the patient.

 

[DesertMedic66]

I believe wound packing is technically considered bandaging care which is allowed by us and is found in most protocol systems. For most major traumas and bleeds, wound packing is often encouraged. Unless a protocol specifically says not to do this, just do what's in the best interest of the patient.

At the same time doing things that are not listed by your protocols may get you fired and your license revoked.

“I believe surgical cric is technically considered establishing a patent airway and establishing a patent airway is allowed by us and found in most protocol systems. There is no mention about surgical cric in our protocols that says we can’t do it so I’m going to do it because the patient needs it”. My protocols also say nothing at all about chest tubes, c-sections, umbilical IVs, central lines.