Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Do My Posts Authorize Protocol Violations


At EMS Office Hours is a podcast titled, A Few Realities Of EMS – It’s Not Puppies Dogs & Ice Cream Cones.

A couple of points are made. I am very critical of bad protocols, bad medicine, and just all sorts of things that I would change about EMS. Jim is right that I do not have the authority to change your protocols. It shouldn’t take a podcast for you to understand that.

In the sidebar of my blog, since I first started blogging with a blogspot address, has been a disclaimer. It is hidden over there under Sidebar Navigation (click on that and scroll up a touch to see the title – Sidebar Navigation). If you click on the link Disclaimers, you will be taken to a section, where I explain a lot of limitations on what I write.

I am not dispensing medical advice. If you get your medical advice off of a blog, instead of consulting a physician (such as your medical director), you probably should not be treating anyone, not even yourself. I could include your dog, but that would suggest that veterinarians do not provide excellent care. The veterinarians I know take pride in the care they deliver and deliver excellent care, more so than many people I know in EMS.

I do point you to research to support what I write, but you still need to make sure that you have the authorization of your medical director before changing any of your treatments. If your medical director does not agree, you can point to the research I write about. Most doctors do understand research, they just have trouble keeping up with the amount of research that is produced.

What I write does not change your protocols. If you do not like a protocol, take it up with the medical director. I have several inadequate protocols, too. I call medical command and attempt to persuade the physician that what I am requesting is in the best interest of the patient. It is rare that I am turned down, but the dose is often inadequate. I call back before I need more, so the patient does not have to put up with the On Line Medical Command delay in treatment. Health care providers should be anticipating where the care of the patient is headed – both for good and for bad.


I addressed these concerns long before I began writing about them on this blog.

There is a lot write about regarding the ethics of following bad protocols. This topic needs to be thoroughly covered, including these –

Does the use of restrictive protocols by a medical director (protocols that prevent appropriate care of their patients) constitute a form of patient abandonment?

How unethical is it to disobey unethical orders?

All protocols should include a statement that a medic should not follow the protocol if the medic believes that the treatment will harm the patient. I am still surprised that some protocols are written without this statement. This is irresponsible incompetent behavior by the author of the protocols.

Imagine being in court. Explaining giving a treatment to a patient that appears to have caused the death of the patient. Stating that the protocol must be followed, even when we expect the treatment to harm the patient.

Should we expect anything good to come from this?

Does this establish reckless disregard and gross negligence?

Would this create grounds for criminal charges, rather than just a civil malpractice case?

But these will be in other posts.



  1. I agree with what you have to say and it provoked some thoughts of my own about education and training:



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