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

- Rogue Medic

Bad Patient Care – Literalists


There are many ways that we harm patients.

One way is by claiming that we need to literally interpret some rule, such as a protocol.

Once we start to try to do this, we come across contradictions.

What is most important in patient care?

Doing what is best for the patient?

What is most important in literal interpretation of anything?

Protecting the literal interpretation.

But it is literally what is written, it is not open to interpretation.

All writing is open to interpretation. We can try to simplify it as much as possible. We can try to make it as clear as possible. Someone will read the writing as meaning something else. Some of those people will have valid points about what the writing means.

For EMS protocols, are all penetrating injury patients the same?

Of course not, so we try to be specific.

Are all penetrating injuries to the neck the same?

Of course not. When I shave, I occasionally penetrate the skin of my neck with the razor, thus lightly slashing my neck.

Should that be treated the same as the slashed neck of someone who is slashed with a knife in an attempt to kill the person?

Of course not.

You may claim that I am being ridiculous.

That is the point. Literal interpretation is ridiculous.

That is why protocols should be written as guidelines that are flexible enough to deal with the real world.

Assessment is the way we determine the difference between a penetrating injury to the neck that needs a trauma center and the minor injury that does not.

Competent assessment does not work with attempts at literal interpretation.

Literal interpretation is an excuse to lower standards so that the least intelligent people can participate.

We need to raise our standards.

If raising our standards mean that some people cannot play with the lives of others, that is a real shame. 😳

How little do we care about our patients that we are more worried about offending dangerous instructors and dangerous medics, rather than worried about protecting patients from the results of dangerous instructors and protecting patients from dangerous medics?



  1. What about when you have protocols that actually state they are to be used as guidelines but you have those medical directors insisting they must be followed as if it were a law not to be broken?