Clinical Judgment and Protocols

[emtannie]

If you people can't find a procedure that has been going on since 2008, then you all need some help.. The problem

Here is we have a person here that can't face the fact that he was wrong. Hopefully you are not around myself or my loved ones....maybe someone should buy you a holster so you can wear that EZ io gun all day long...people like you are the reason why procedures like RSI are not available to educated paramedics...

I think I am going to ask admin to check your IP address.... your actions are very similar to another member here who tends to throw out supposed facts and then cannot support them with actual references. Your continued attacks on Dwayne are childish and unprofessional. Did Dwayne act outside of protocol? Probably.... did he have justification for it? Absolutely. Did he do more harm to the patient? Absolutely not. Did he get fired? Yup. Was the firing justified? Not in my opinion, as he had valid reasons for his actions. He didn't use the IO to be a cowboy... he did it because it was the right thing to do for that patient. If I or a member of my family were sick or injured, I would want a practitioner like Dwayne to respond, because he is NOT a cookbook medic who can't think outside the box, and who puts the care of his patient first. Dwayne has been very open about the fact that his care was aggressive.

I would like you to explain how his actions were "wrong." Did he do more harm to the patient?

Your comments of "you people" and "people like you" are emotionally based, not factually based, and show that you cannot support your claims with more than emotion.

If you continue to post on this site, you will continue to be asked to back your claims with something factual.

Twice I have asked you to provide references, and twice you have ignored my request and responded with replies that are completely opinion, not fact. I cannot treat your posts with the respect you think they should earn, when you cannot provide information to back up your claims.

Based on your posts thus far, until I see an intelligent post from you, backed with actual evidence, I will assume you are a troll here for the sole purpose of annoying others. I am open-minded enough to change my opinion if I am shown evidence to prove me wrong.

[usalsfyre]

Sounds very much like your hung up on one services protocol, because from what it seems like most of the research behind it was done well before 2008 (meaning it's been going on much longer).

The reason RSI isn't available to even "educated" paramedics is 1) most of them aren't that educated 2) too many paramedics think in terms if absolutes, not clinical possibilities 3) the places that need RSI rarely do enough intubations to remain proficient. I work for a service where all of our medics can RSI. Frankly I've seen some really scary stuff, even among "educated" medics.

[Johnboy]

Again, ass clown, you were terminated for this wonderous action that you saved the day with..OBVIOUSLY you were right all along!! I am pretty sure it happend for good reason, yea- your former boss had a brain!! Kudos to your former boss buddy, tell him I said thanks, he did that town a favor. Do yourself a favor, put the gun away and get the books back out jackass..

[paramedicmike]

Aaaaaaannnnddddd... the troll comes out.

Oh well. It was bound to happen. Better it happened sooner rather than later, eh?

Moving on...

[Just Plain Ruff]

Again, ass clown, you were terminated for this wonderous action that you saved the day with..OBVIOUSLY you were right all along!! I am pretty sure it happend for good reason, yea- your former boss had a brain!! Kudos to your former boss buddy, tell him I said thanks, he did that town a favor. Do yourself a favor, put the gun away and get the books back out jackass..

WOW WOW, it seems as if Johnboy's true colors come out and he has to insult and curse in a post towards Dwayne.

Let's examine this

He cites that the standard of care for Glucophage is Intranasal

He hasn't give us any of the background information on how it's standard even though he has been shown that the literature is many years old.

He calls Dwayne and Ass clown - that's original

He seems to fear the IO device - I wonder what his opinion of the FAST1 Device is or the BIG Gun is?

Like Mike said in his response to the RSI comment and Mike is spot on - is Johnboy even able to RSI? If he's not able to then I think that speaks volumes if true

When someone starts to curse in a thread in response to someone also on the thread it usually means the person is threatened by what is posted by that member and the person swearing at the other usually has nothing left to give except for cursewords and insults.

So Johnboy, where are your sources, where is your background proof that Glucagon is standard or do you just have insults and calling others names. Come on, you seem more intelligent than this, you aren't in 6th grade on the schoolyard.

But if you insist on acting like a 6th grader who doesn't have anything more to give than insults and cuss words but I'll bite - "my daddy can beat up your daddy"

I think I am going to ask admin to check your IP address.... your actions are very similar to another member here who tends to throw out supposed facts and then cannot support them with actual references. Your continued attacks on Dwayne are childish and unprofessional. Did Dwayne act outside of protocol? Probably.... did he have justification for it? Absolutely. Did he do more harm to the patient? Absolutely not. Did he get fired? Yup. Was the firing justified? Not in my opinion, as he had valid reasons for his actions. He didn't use the IO to be a cowboy... he did it because it was the right thing to do for that patient. If I or a member of my family were sick or injured, I would want a practitioner like Dwayne to respond, because he is NOT a cookbook medic who can't think outside the box, and who puts the care of his patient first. Dwayne has been very open about the fact that his care was aggressive.

I would like you to explain how his actions were "wrong." Did he do more harm to the patient?

Your comments of "you people" and "people like you" are emotionally based, not factually based, and show that you cannot support your claims with more than emotion.

If you continue to post on this site, you will continue to be asked to back your claims with something factual.

Twice I have asked you to provide references, and twice you have ignored my request and responded with replies that are completely opinion, not fact. I cannot treat your posts with the respect you think they should earn, when you cannot provide information to back up your claims.

Based on your posts thus far, until I see an intelligent post from you, backed with actual evidence, I will assume you are a troll here for the sole purpose of annoying others. I am open-minded enough to change my opinion if I am shown evidence to prove me wrong.

Annie, listen to the voice of reason, when someone comes out swinging with an emotional response and cursing people then that's all they have to give to the conversation. Insults come with the turf of someone who has nothing else to provide to the discussion.

I'm betting my next paycheck that Johnboy will not provide any responses to the questions that have been asked for proof and him citing his source that IN glucophage is the standard - It just won't happen.

[Bieber]

D- back to the matter- you were apparently fired over this, and now a complete stranger agrees with the outcome. Wake up.... It is this attitude, that gets paramedics in hot water and you are living proof.....

John, tell me about your paramedic school. What were you taught from day one of paramedic school? Were you taught that the goal of paramedics was to follow their protocols faithfully, unquestioningly, and without ever thinking outside of the box? Was that the moral at the end of the story? Or were you told that paramedics exist to provide competent, safe, and appropriate medical care to patients? I challenge you to find in any paramedic textbook any quote that says that our mission is to follow our protocols. You won't. That's because that's not the mission of EMS. The mission of EMS is to provide emergency medical care to patients and to help them in their time of desperation.

You may not agree with Dwayne, and that's okay. But why did you get into this profession? Were you bursting at the seams when you got your acceptance letter, so full of exuberance and jubilation, at the idea of being able to follow your protocols to the letter? Or were you excited to be able to provide medical care to people when they were at their worst; ecstatic to be able to HELP people?

We didn't get into this job to follow protocols, we got into it to help people. That is our primary goal, that is our mission. Protocols exist to facilitate that mission, but at the end of the day, you have somebody's life in your hands and you better learn to respect the fact that it is up to YOU to protect that at any cost. Are you going to have the same courage Dwayne has shown when that day comes?

EDIT: (Addition) I'll say this. Someday I am going to be dying. I am going to be sick or injured and I am going to know all too well the kind of men and women who will be taking care of me. And there, in the back of my mind, I am going to be crying out desperately for someone to save me. I am going to be begging for someone to do whatever it takes to keep me alive--not to do whatever it takes to follow their protocols. And I hope that the person who cares for me in my time of need is as selfless as Dwayne and as willing to give up everything for my life, because while it's easy for us to take a step back and not really see the value, the preciousness, and the gravity of our patient's lives through their eyes, we need only become as helpless as they to realize just how desperately we all want to live and be saved by that one person who is willing to do whatever it takes for us. Dwayne has proven himself as that man. I haven't, not yet. And I'm willing to bet many of us here haven't yet proven that yet, yeah, even you.

So Dwayne, by all means, drill into my bones. Act outside of your protocols if you feel you must. Do whatever it takes. Because when my time comes I am going to ask you to do one thing and one thing only, the same thing every one of our patients ask us, the same thing we will all eventually ask of someone else in the hopes that they will have your same courage and conviction:

Save me.

Edited April 5, 2011 by Bieber

[Richard B the EMT]

Most of this string has been above my pay grade.

I'll only mention, during my stint at one of the IFT services, I got into trouble for doing my job. Call reports were required, but certain facility charge nurses took exception that I, a lowly EMT, would take a BP before loading the patient, as whatever result they had obtained could be taken to the bank, my reading was not needed, no matter how long after they took it and wrote it down on the transfer papers. The boss wouldn't go to bat for us, but suggested we wait until we had the patient aboard the ambulance. We ended up having to roll at least around the corner, out of sight of the facility staff, as at least one of them complained that we didn't immediately start towards the ER after loading. She actually came out to the parking lot, and banged on the doors!

[DwayneEMTP]

...He calls Dwayne and Ass clown - that's original...

Good God! That is like....80% of the people on this site, and 100% of the people in this thread!! And it's also why I love the City. It keeps me from believing that I'm a hotshot, when I'm just a dorky medic trying not to do foolish things any more than necessary.

Thanks to all here, including the goofy kid that hates me and my medicine, for making me think today, and hopefully making me a better provider.

Dwayne

[Johnboy]

D. You gave Lidocaine to an UNCONSCIOUS pt. That is NOT indicated. This right here proves my beliefs about your judgements. That is for concious people. What don't you understand? You or nobody else on this site knew if she had addequate glycogen stores. YOU or nobody else did not know if it would have worked. It might have. I am glad you were fired , you deserved to be. You know everything, right? Your boss is a saint. What you did , you did outside the box alright, so outside, it was stupid. You need to read more about Lidocaine buddy. I am finished waisting my time with you. You were wrong in placing the IO prior to Glucagon, and you were wrong in giving a bolus of Lidocaine to an unconscious person... Again, what don't you understand?

JB

[Just Plain Ruff]

D. You gave Lidocaine to an UNCONSCIOUS pt. That is NOT indicated. This right here proves my beliefs about your judgements. That is for concious people. What don't you understand? You or nobody else on this site knew if she had addequate glycogen stores. YOU or nobody else did not know if it would have worked. It might have. I am glad you were fired , you deserved to be. You know everything, right? Your boss is a saint. What you did , you did outside the box alright, so outside, it was stupid. You need to read more about Lidocaine buddy. I am finished waisting my time with you. You were wrong in placing the IO prior to Glucagon, and you were wrong in giving a bolus of Lidocaine to an unconscious person... Again, what don't you understand?

JB

Wow, now you are just talking stupid.

In the last three services I've worked for and my current service, Lidocaine is given via the IO (EZIO especially) to limit the painful response. It makes no difference in my protocols that the patient is conscious or unconscious. Are you saying that we should not give lidocaine for pain relief in an IO just because they are unconscious?

Or are you saying in the bigger picture that your problem with Dwayne is that he gave lidocaine under any route to an unconscious patient? I hope you are not saying that.

You are right in saying none of us knew what the glycogen stores were but the IO wasn't wrong. What if the patient was having a stroke and needed TPA or venous access? An IO was not inappropriate.

I think that maybe you are unfamiliar with the EZIO and therefore you do not know or understand that this is a very good alternative access routes. I have placed 30 EZIO's in patients over the past several years and I have never had a adverse reaction. Are you sure that your resistance to the IO is that it's often considered the IV of last resort and maybe you don't have the experience with it that others on this site have.

There are many times that you will be called on to do something outside the box, consider field amputation, in field C-section(yes it has happened),Field Trach, pushing drugs that are not in your protocols, transporting the patient who clearly is refusing and is competent yet you are ordered by medical control to transport. If you go by field protocols then none of the above will fit and you won't be able to do any of the above so by your logic, if you do any of the above then you should be fired. So let's hope that you don't have to do any of the above because you WILL be fired and your boss will be considered a Saint, by your own logic.

You still haven't given the references that Glucagon IN is the standard. PUt up or shut up. But you won't provide those references because you are focused on Dwayne and not listening or reading anything else. That is what we call tunnel vision and it seems like you have gone into the tunnel.

Edited April 5, 2011 by Ruffems