Whose protcols have the last say?

[Guest]

I know that your REMSCO's protocols override the state protcolos, but can an agencies medical director overrule the REMSCO's protocols, or does your REMSCO have the final say?

Edited November 15, 2005 by JaredHG

[ny10570 745]

Med control can overide protocols, but at a risk. Most if not all of the responsibility now falls on med control, but there is still a level of liability out there for operating outside your protocols.

[MGMedic 0]

Pretty much. You are working under that medical control's license, so whatever's done outside protocols has increased liabilty from the doctor and the provider (you). I know in NYC if telemetry suggest something outside the protocols (discretionary), you are encouraged to question the doctor if you are comfortable with said order.

[WAS967 97]

I've had QA/QI reviews of calls I have done go so far as to say that the WCREMSCO protocls DO NOT allow you to do anything beyond what the medical control options state. Meaning if it is not a standing order or a M/C option, then it can't be done. EVEN IF the M/C doctor says you can. Which I think is BS. It's a VERY literal translation of the protocols and if you look at them it can definatly be interpretted that way. This is a perfect example of something in the protocols that may need to be modified next revision.

BTW...for those interested....the call was a Labetalol usage. Patient with 180/110 B/P. Called for orders, got initial push of 20mg Labetalol per M/C doctor. I got gigged because 1) according to protocol "hypertensive crisis" is defined as diastolic of over 120 (mayo clinic and other say 110) and 2) according to M/C options, starting dose of Labetolol is 10mg (both drug insert and PDR state 20mg).

[Guest NYTruckie]

I've had QA/QI reviews of calls I have done go so far as to say that the WCREMSCO protocls DO NOT allow you to do anything beyond what the medical control options state. Meaning if it is not a standing order or a M/C option, then it can't be done. EVEN IF the M/C doctor says you can. Which I think is BS. It's a VERY literal translation of the protocols and if you look at them it can definatly be interpretted that way. This is a perfect example of something in the protocols that may need to be modified next revision.

BTW...for those interested....the call was a Labetalol usage. Patient with 180/110 B/P. Called for orders, got initial push of 20mg Labetalol per M/C doctor. I got gigged because 1) according to protocol "hypertensive crisis" is defined as diastolic of over 120 (mayo clinic and other say 110) and 2) according to M/C options, starting dose of Labetolol is 10mg (both drug insert and PDR state 20mg).

←

WCREMSCO protocls hypertensive crisis diastolic over 130 in both arms associated with such symptoms as nausea,vomiting, headache, or visual symptoms in the absence of localizing neurologic signs:

1 Rutine medical care

2 begin transport and contact medical control if localizing neurological signs are present.

[Remember585 815]

The DOH Laws are the supreme. Like previously said, if Medical Control gives a different order - go with it. Same thing goes for those of us on the Basic level. If a Medic tells me to do something I am not sure of, and I DOCUMENT IT, then I would think that Medic would have to explain thier actions - right? And I would think that me, the EMT-B, would be obsolved of a wrong-doing sanctioned by ALS.

Good Samaritan Laws should cover you too - so long as you stay in your scope of practice / certification.

[WAS967 97]

Like previously said, if Medical Control gives a different order - go with it. Same thing goes for those of us on the Basic level. If a Medic tells me to do something I am not sure of, and I DOCUMENT IT, then I would think that Medic would have to explain thier actions - right?

I would have to disagree here.

If we are given an order by Medical Control, common sense dictates that we should question it. But unfortunatly, WC protocols don't seem to be built on common sense but more on a "do what I say" mentality, where as if you are given an order, EVEN IF YOU DISAGREE WITH IT, you must follow. Previous protocols (and other regions) state that if you recieve an order that you do not agree with or feel can be detrimental to the patient you can opt to not follow and talk to the doctor at the hospital. Not so here. One of several things in the protocols that I don't like. Of course if said order falls outside your scope of practice (doctor says to perform C-Section, Amputation, what have you) then of course you can't follow that.

As far as EMT-B's doing something outside of protocol: when the medic tells you to, thats iffy. Even medics are bound by BLS protocol (states so right in our ALS protocols). Yeah, not everything falls under protocol, and you have to use common sense and "street smarts" to get by sometimes. But if the medic ever tells you to do something, and you don't think that is right, you have an OBLIGATION to call them on it. Question the order. Just like we should in the above with medical control. And definatly document anything that fall outside of the norm. It's your best defense should anything arise from it.

Edited November 30, 2005 by WAS967

[roeems87 0]

Anytime you think you don't agree with an order or direction, ask about it. There is probably a reason you gut (or preferably your brain) is telling you it's not right--either you've never done it before or you shouldn't be doing it in the first place. Repeat the order back to the person giving it (just in case you were mistaken in hearing it), let them confirm. If you still have question, then tell them your concern. "Doc, I'm sorry, that's really not within my protocols, are you still asking me to (do this)?" If they say yes, then I think the ultimate rule is that you are following the direction of a higher medical authority. It's just confusing when it's something you are theoretically not capable (i.e. not trained, even if you know how) of doing...

[Guest]

THIS SHOULD ANSWER YOUR QUESTION,IT IS PAGE 5 OF THE WESTCHESTER ALS PROTOCOLS:

"Protocols are treatment algorithms that should be used in conjunction with GOOD CLINICAL JUDGMENT. Protocols should be considered as the 'models' by which all patients should be treated. Protocols are guidelines for non-physicians to administer emergency care in specific situations. Since patients do not always fit into a rigid formula approach, situations may occur which do not fit these protocols. For patients who do NOT fit into a rigid formula approach, or where there is no existing protocol and a clear need for Advanced LIfe Support exists, the paramedic shall initiate appropriate therapy and contact Medical Control in order to differentiate the most emergent clinical problem and define the most suitable therapy. At that time, the Medical Control physician shall order the most appropriate treatment within the paramedic's scope of practice as defined by their level of training, certification, and regional protocols."