Things in your protocols/CPGs/scope that your hospitals don't like

thegreypilgrim

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I hinted at this in another thread, but wanted to see to what extent this exists in other systems.

In my system, there appears to be some considerable discord between what the receiving hospitals here expect or want out of EMS versus what the EMSA and medical direction does. The main one like I've said before is the spinal clearance protocol. Obviously there are exceptions but overwhelmingly hospital staff does not like EMS clearing c-spine. They prefer everyone with any kind of "injury problem" to be placed in spinal immobilization in the field and then immediately cleared in the ED. In other words, they seem to believe that spinal clearance is an ED procedure not a prehospital one.

That appears to be pretty universal for the region. I've worked in 3 different systems down here and experienced the same hostility to it in each one, and have heard similar accounts from people working in other nearby systems.

Another one they don't seem to like is our rate control of A-Fib with RVR protocol. I suppose this is more understandable since we use verapamil and they all seem to use diltiazem for first-line. So I get that one.

Finally, they don't like "notification only" type radio reports. Even though by EMSA policy base contact is only required in very limited circumstances, in practice we have to do it on every call. Because the hospitals get all in a tissy if you just notify. They say it "builds relationships" and I suppose it might, but it gets old real fast.

So, does anybody have anything similar going on in their system?
 
The part that says to transport to their hospital.
 
We have lasix in our protocols and drug box but the hospitals will never allow us to give it.

If that's what you are asking.

They don't like us doing cpap or cardioversion either.
 
Los Angeles hospitals have a strange love affair with asking us why our patients aren't on oxygen, no matter the need.
 
We have lasix in our protocols and drug box but the hospitals will never allow us to give it.

If that's what you are asking.

They don't like us doing cpap or cardioversion either.

do you need olmc orders for these?
 
Lasix yes.

The other two are standing. As long as specific criteria have been met.

They aren't necessarily mad. But they aren't too happy.
 
We have certain docs that don't like to grant what we call a "BLS release". That's when a paramedic has made patient contact, but determined that it's not an ALS call. We have to call a doc to confer about the reasoning that we want to send the patient in BLS. With some docs, it's useless. It doesn't matter if tthe patient has no issues, the doc still insists that a medic "ride it in". They fell that if we're there, we need to ride in.
 
I've also heard from other medics that the docs don't like giving orders for Atenolol for hypertensive crisis patients, but I've had no issues when I've called for it. I guess YMMV when it comes to OLMC orders. ;)
 
Here the local cardio center really hates when EMS transmits a 12-lead, cardio reviews it, and says the patient doesn't need an academic cardio center and the EMS unit shows up anyway.
 
Giving D50 for AMS with a BGL of 119 :wacko:

It's diagnostic...duh!

In all seriousness that is absolutely ridiculous and I hope someone got a firm talking too. Textbook medication error.

The only thing I've ever caught flack for was not c-spining two patients from a multi-rollover MVA. They both were capable and competent and refused on scene. "just try to sell it a little more next time."
 
It's diagnostic...duh!

In all seriousness that is absolutely ridiculous and I hope someone got a firm talking too. Textbook medication error.

Someone would more than likely get a firm talking to if they didn't give it.

NYC REMAC AMS protocol states:

"If the glucometer reading is above 120 mg/dl, Dextrose and Glucagon should be withheld"

http://www.nycremsco.org/images/articlesserver/ALS_Protocols_July 2012_v07012012.pdf

Which basically means if it is <120, it should be administered.

I agree though, it is ridiculous.
 
Someone would more than likely get a firm talking to if they didn't give it.

NYC REMAC AMS protocol states:

"If the glucometer reading is above 120 mg/dl, Dextrose and Glucagon should be withheld"

http://www.nycremsco.org/images/articlesserver/ALS_Protocols_July 2012_v07012012.pdf

Which basically means if it is <120, it should be administered.

I agree though, it is ridiculous.

Classic logical error scott! It should be withheld if it's >120, but that doesn't mean that it sholdn't be withheld if it's 120 or less. Try this:

"I forbid you from going to play outside after 11 PM tonight."

Does that mean that my (hypothetical) kid HAS to go outside to play right now if it's only 8 pm?
 
We have a lot of CYA stuff in our protocols that results in long scene times. Because we are usually about only 5 minutes from the hospital in the city, sometimes to do a full 12 lead, check glucose, vitals, etc. you wouldn't be finished with the half of it before you get to the hospital. So we sit out on scene or in our rig just outside of someone's home and play for 20 minutes before we get going. Alternately, some crews get going to shorten their o/s time, but then sit in the hospital parking lot finishing their CYA stuff. I know why it's there as a matter of liability, but it get annoying sometimes. I had a dialysis patient who was ordered to call 911 by his physician whose vital signs were very stable and he was asymptomatic. We were about 5 blocks from the hospital, so as a proponent of getting people to definitive care, I just had the driver start going and did everything enroute. I know in the monthly CQI i'm going to get dinged for no BGL check, due to his hx, but when I was finishing vitals in the parking lot of the hospital I'm not going to sit there for another 2 minutes to get a BGL when it's something the hospital can get.

On second thought, I might be ok on the lack of a BGL check since it's further down the protocol than vitals so the fact that I never got to it might not be a negative technically. But I know for medics that start IVs, they have to do certain assessments first, or at least are listed above the IV start on the protocol so they will get dinged if they don't get everything done before arrival. Of course they could just skip the IV in those cases, but I'm guessing that'd just be one other thing the hospitals don't like! :)
 
I'd like to change the fact that we have protocols.

I would like to see protocols replaced with further education and knowledgeable providers with decisional capacity.
 
We have lasix in our protocols and drug box but the hospitals will never allow us to give it.

That's funny, we have the opposite problem. We have furosemide in our protocols and the hospitals love it while we do all we can to avoid giving it in most patients.
 
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