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

- Rogue Medic

Comment on ALS is Oxygen, IV, Monitor, and Transport – Part II

Continued from Part I.


Image credit.

I agree with a lot of what I read here. However, why is anyone going to give a medic with 18 months of technical school freedoms that ED docs with 8 years of medical education can’t always handle?

Because well trained medics have demonstrated that they do make good patient care decisions in the several limited areas that medics treat aggressively.

What medics do is very limited, but still cannot fit into any group of protocols, no matter how detailed.

We need to hold medics to high standards, not pretend that restrictive protocols make incompetent medics safe.

According to Joe Paczkowski (EMT-Medical Student), one of the 4 Phrases That Should Never Be Said on an Ambulance is –

We’re not doctors.

. . .

Is it any wonder that there are so many problems in EMS when EMS is one of the few, if any, fields that actively teaches their students to not think about what they’re doing past the cookbook? After all, why question any of the care you’re providing if you’re “not a doctor?”

He is going to medical school, but he does not seem to think that those who do not go to medical school should not think.

Unless you work for a service that practices “different rules for different medics”, you’re going to have to stay within protocol – not necessarily throw the protocols at every patient, but at least remain within them, or know enough to convince a reasonable doctor to agree with you.

Which is exactly what I am stating. In my response to MOE Medic, I explained a practical way to deal with protocol deviations. Why should we let paramedics make decisions about whether protocol deviations are appropriate?

I am all for taking it to the medical director. I used to make these calls about once a week to explain each deviation I made from our protocols.

I had doctors in the local emergency departments who were willing to listen.

I had even more doctors in the university hospital emergency departments willing to listen.

I also had medical directors willing to listen.

What they cared about was whether I was taking care of the patient appropriately, not whether I was taking care of the protocol appropriately.

The doctors are not usually the ones opposed to having paramedics think. This objection seems to come from the paramedics.

As in, Stop making the rest of us look bad!

I’m willing to give up some freedoms that I might be able to handle so they won’t be abused by a lazier or less proficient medic, and call med control. It’s all about doing the greatest amount of good for the largest amount of people, not stroking our ego by allowing us to declare C/P non-cardiac or do sutures.

We need to remediate, or teminate, the lazier or less proficient medics.

We do not need to dumb down the system to whatever level deceives people into believing that they are protecting patients from the lazier or less proficient medics.

Punishing patients in order to avoid remediating, or terminating, the lazier or less proficient medics is dangerous management.

Punishing patients in order to avoid remediating, or terminating, the lazier or less proficient medics is probably one of the reasons so many competent medics leave EMS.

 

There is no protocol that can make a lazy and/or incompetent medic safe.

 

There is no drug that is safe in the hands of a lazy and/or incompetent medic.

 

Making the protocols safe for the incompetent is the wrong approach.

1. It is guaranteed to fail.

2. What kind of Luddites are we that we oppose progress and oppose thinking?

Am I happy about that – no, but I didn’t go to medical school or do an internship either.

If you want to be a doctor, you should go to medical school and you should think.

If you want to be a paramedic, you should go to paramedic school and you should think.

 

Thinking is within the paramedic scope of practice.

 

Thinking is an essential part of the paramedic scope of practice.

 

This is not about what makes medics happy.

This is about what is best for patients.

To be continued later in Part III.

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Comments

  1. “Punishing patients in order to avoid remediating, or terminating, the lazier or less proficient medics is probably one of the reasons so many competent medics leave EMS.”

    Couldn’t agree more. I’ve enjoyed reading your response – very thought provoking.

    I have to admit that the “We’re not doctors” phrase has passed my lips while dealing with some patients refusing care – a phrase that will most assuredly never be heard on my ambulance again.

    • Prmedc,

      “Punishing patients in order to avoid remediating, or terminating, the lazier or less proficient medics is probably one of the reasons so many competent medics leave EMS.”

      Couldn’t agree more. I’ve enjoyed reading your response – very thought provoking.

      Thank you.

      Much of what we are told that we may not do is within the paramedic scope of practice, which will vary from state to state. If I am doing one of the few things that a paramedic is trained to do, should I have to become a doctor to do it as a variation from protocol?

      I am not opposed to review of all of these deviations and the need to justify any deviation, but I am opposed to automatic prohibitions on deviation. That can be one way to help separate the medics who need remediation/termination from those who know what they are doing.

      I have to admit that the “We’re not doctors” phrase has passed my lips while dealing with some patients refusing care – a phrase that will most assuredly never be heard on my ambulance again.

      Joe Paczkowski of EMT-Medical Student is the one who deserves credit for that part.

      .

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