gdickens

Truck. The deeper you get into East Texas, the closer the pronunciation of the technical term gets to "ama-LANCE". gd

I don't know whose protocols were copied to the forum, but they weren't mine. I would never discuss the specifics of our protocols in a world wide forum of this nature. While some will probably argue that we should have an international standard of care, that simply isn't the reality under which we live. Protocols are prepared and/or approved by the local Medical Director based on the skills and competencies of his/her staff, the availability of equipment and resources, the logistics of their service area, the availability of other medical resources in the community, the level of trust they have in their staff, and their personal disposition toward the professional liability associated with all the above. Once the Medical Director publishes the protocols and entrusts us to implement them, he/she turns us into Physician Extenders. This means that any and all liability associated with assessment of the patient, appropriateness of the orders, and the execution of the orders comes directly back to the physician's license. This is very different from the physician's liability associated with the actions of a nurse. In situations where nurses are involved, the nurse's personal license "carries the water" when it comes to the appropriateness of the assessment and the actual execution of the orders... leaving the physician responsible only for the appropriateness of the orders given as relates to the information he/she was given regarding the patient's condition. Some Medical Directors take on their role because they are the only physician in the area. These physicians are often General Practitioners who have absolutely no idea what emergency medicine is about, and they often take the stance of "better safe than sorry" because they are scared of their (perceived) liability associated with the practice of modern pre-hospital medicine. Given this climate in the EMS industry, I find it appalling when one medic questions the actions of another's implementation of protocols when they have never actually seen the protocols and have no idea what the Medical Director's intentions were when he/she published them. I am not saying that there is no situation where the idiots can be put in their place. I'm just saying that it should be done close to home where we can make a realistic assessment of the situation based on first hand knowledge of the patient's condition, the protocols, and the Medical Director's disposition. Where I come from, the guys who take advantage of ambiguous protocols and interpret "consider" to mean "I won't get in trouble if I do it, so let's go out there and have some fun" are called WOO WOOs. Those who operate under very specific protocols and/or who are afraid to look beyond the criteria that meets the first algorithm they come to are called Protocol Monkeys because they go out there and operate like a robot. My Medical Director likes to wash the Woo Woos out of the system as quickly as possible and marks their file "WWDNH" (Woo Woo, Do Not Hire). He likes to work with the Protocol Monkeys to build their confidence and assessment skills to the point where they understand the concept that "Medicine is an Art Enhanced by Science". It took me 20 years to come to peace with the fact that each agency has it's own set of protocols, and those protocols directly reflect the personality, practice style, and aversion to risk of the Medical Director. Maybe in another 20 years I will be able to come to peace with the fact that terminology (especially the slang) differs as widely. However, I don't think I will ever come to peace with the fact that so many of us (myself included at the top of the list) are so opinionated and quick to insult the intelligence and/or education levels of those who see the world through a different prism. The above are just my opinions, and YES, I do understand that opinions are like ###holes... everyone has one and noone is interested in mine.

Maybe I need to apologize, because I apparently don't understand the term "protocol monkey" the same way you do. Where I come from, this is a derogatory term most often used by the "ParaGods" (NO, I am not calling you a ParaGod... I am just using local lingo to describe the context of my comprehension) toward those who are meticulous about their adherence to protocols and complete documentation of patient care. My best medics have always been the ones who fall somewhere between the ParaGods and the Protocol Monkeys because the former so often let their arrogance stand in the way when it comes to detail and following directives that they don't agree with, and the latter often can't get beyond algorithm medicine. My point is simply that if the protocol said to fly them based on specific criteria, then they should be flown if they meet that criteria. If the criteria is out of date or wrong, it should be discussed with the Medical Director and updated when he/she has been educated about the appropriate standard of care. Due to my (different from your) definition of "Protocol Monkey", I took your post to mean that even if the protocol (was neanderthal and) said to fly them, that they shouldn't have been flown if the medic on scene didn't think they needed it. LMAO!!! Two years of English didn't do me any more good than my Master's degree. Apparently, I'm still an idiot. ROTFLMAO!!!! When did Dr. Murray forward you a copy of our protocols??? I guess that doesn't matter... when you get a chance, just forward me the protocol number, section and subsection that I need to review to educate myself. I'll be sure to brush up real fast. Thanks! GD

Ditto!!! The day I let my pride and arrogance start telling me that I am smarter than my Medical Director (the PHYSICIAN under whose license I touch my every patient, and who signed off on my protocols), I'll be out of a job... and rightly so.

NUMBER TWENTY FIVE!!!!!!!!!!!!!!!!!!!!