Morning Bieber,
Well, I must say that you are very ambitious. One thing you'll have to remember is that Rome wasn't built in a day. If I were you then I would pick out 2 or 3 of these subjects on focus on changing those first. My choice would be c-spine clearance, standing orders for pain management and a reappraisal of dosages in the pediatric patient. You have plenty of other relevant "burning isuues" but these would be my priority. Yours may differ, I don't know.
I'll give you my take on the rest:
MOI in trauma is a good indicator of the types of injury one might expect. Don't forget that if someone does not intially present with symptoms then it's not to say there's nothing going on. There are many cases of particularly splenic and liver injuries with late on-set presentation.
Elimination on restrictions on EKG/IV application. What do you mean?
EKG/BP/Spo2 montoring of patients that have received narcotics or sedatives is good, safe practice. Why would you want to change it? The subtle signs that monitoring shows may alert you far more quickly to a impending problem.
Eliminating transporting Code Blue patients: Here I tend to agree, to a point. We all know the importance of BLS and that massage in a moving truck is pretty ineffectual. However, there is a progression towards automated compression with a Lucas or Zoll. This changes the rules somewhat as there is a growing body of evidence that suggests PCI (angioplasty) in cardiac arrest may have some effect. Also, we are currently trialling a new protocol which indicates transport in potential organ donors.
Cardioversion as a standing order: Agreed! Clinically unstable patients that do not respond to pharmacological agents need treating stat (God, did I just say, STAT? Shoot me..). I would however advise an adjunct protocol for the administration of a benzodiazepine. Cardioversion without Versed on board..Oww!!
Pain management: agreed! Multi-system trauma should not be excluded. If anything, they have more right to be medicated. Pain is a disabilatting factor that leads to higher mortality. Pijn management protocols should be linked to the individual pain score. My personal favorite is a combination of ketamine, midazolam and fentanyl..
NSAIDS? Mmmm.. I have limited experience of these drugs in EMS. The only real benefit I saw was with diclofenac in renal colic patients. Wouldn't be my first choice. Also, there really are not many patients by which opiates are contra-indicated.
O2 therapy only to those who need it: I agree wholeheartedly! By now we all know about the effect of 02 generated free radicals in the MI patient, don't we?
A protocol for febrile patients is actually quite easy: cool em' down and give IV/rectal paracetamol titrated to weight/age.
Treat and release options: One of the problems in US EMS is that most of the ground rules are based on the lowest common denominator. Whilst you come across as being a very engaged practitioner that is hungry for new knowledge, that can't be said of everyone. Can a part-time medic with a certificate from a paramedic mill school be trusted to make that decision? EMS needs to pull up it's boot straps nd make a degree mandatory before we take that route. (Or be a nurse-led profession, but I wouldn't want to offend anyone here..)
Here is the link to a presentation I gave in Pennsylvania last year, there is a relevant section on pain mangement in the middle. You have my blessing to reproduce, should you wish...
https://docs.google.com/present/edit?id=0Adxb-ZUzuZENZGdkendqcG5fMThkenJnZDZkMg&hl=en
Good luck with your crusade!
Carl
Edited to include link