So many of us in EMS complain about “cookie-cutter” protocols. You know, the ones that mandate blindly following a flowchart instead of allowing you to use your clinical judgment and knowledge.
Why do we have cookie-cutter protocols and why are these policies rigidly enforced? Quite simply, your medical director and EMS service often write these protocols for the lowest common denominator. In other words, there’s a moron (or morons) who likely caused your medical director to write one of those clinical advisory memos. Or maybe the operations manager sent out an email about some bone-headed move that you didn’t even think was humanly possible.
When you see protocols mandating what equipment you have to bring into each call, it’s because “Whatshisname” didn’t take a cardiac monitor into a chest pain call. When you see that all patients have to be transported on a stretcher, it’s because “Whatshisname” walked a syncopal patient out to the ambulance. When you have to call a field supervisor before you can leave a refusal, it’s because “Whatshisname” told someone that their heart attack was indigestion. Each of these policies take away the clinical judgment of the average EMT or paramedic because someone proved that somehow, in some way, there’s a below average EMT or paramedic who isn’t worthy of complete trust.
“Whatshisname” harms each of us in EMS. Most patients (and thankfully, it truly is MOST of our patients) rarely call for an ambulance for a medical emergency. When we show up, we owe it to the public to make sure “Whatshisname” isn’t treating the public. Sadly, because so many of us in EMS tolerate “Whatshisname,” our management and medical direction have to mitigate for him/her by drafting policies and protocols that take away our ability to utilize our brains or common sense.
The solution is simple — we need to police our own profession. When you hear about a “Whatshisname,” speak up. Don’t saddle someone else with “Whatshisname” for a partner. Your patients and ultimately, our profession, will thank you for it. Until then, every patient goes on the stretcher, offer transport to every patient, get two sets of vital signs on every patient, and give the “unconscious, coma, or death” speech to every patient who wants to refuse transport. Why? Because “Whatshisname” is still out there.
TOTWTYTR suggests as one of his (many) rules of EMS “Never get a rule named after you.” I suppose this is true of protocols as well.
EMS is unique among other healthcare professions in the sense we tend to appreciate much more autonomy in terms of supervision of patient assessment, skills performed, and medications prepared and administered. The physician Medical Director must become familiar with his providers knowledge, skills, and abilities before granting a clearance to practice at the providers level of certification or licensure. This “clearance” ideally acts as the final check/balance of the disparity in EMS training. While this investment in the providers may not prevent a “whatshisname” from infiltrating a system, I see it as a necessary component of every EMS system. Of all the EMS systems I’ve worked for, only one has had a full-time Medical Director who has taken this important investment in his providers, and it shows in the field. More EMS systems need to ensure they have a full-time Medical Director so the providers have a dedicated physician resource, teacher, confidant, and supporter. This will allow EMS providers to exercise their unique autonomy in a way that is more respected among the healthcare disciplines.
Great observation and advice. I think that the solution starts with more rigorous initial education, at all provider levels, so that “Whatshisname” gets weeded out long before they end up on an ambulance.