Advanced Protocols?

[BrandonDrew87]

They can teach you anything in a classroom but the most crucial lessons are often learned in streets. I help teach PMD class sometimes and those green guys can rattle off all of the cranial nerves... Big shit, when they get on the truck with me its a different story.

[DwayneEMTP]

They can teach you anything in a classroom but the most crucial lessons are often learned in streets. I help teach PMD class sometimes and those green guys can rattle off all of the cranial nerves... Big shit, when they get on the truck with me its a different story.

I have no idea what a PMD class is.

Unfortunately brother your post parrots most of what is wrong with EMS. "All that fancy learnin' ain't worth shit next to my heroismness!"

Someday when you leave Florida, and the fire services, and work in a truly progressive EMS system you'll understand the value of all of that 'shit' that others were taught in school.

I'm confident that you've been misled by other forums to believe that all forums hold education in contempt well below heroism and 'street smarts.' You were on track when you said that sometimes the most important lessons are learned on the streets, but then went off into the ditch with the whole macho bullshit "when they get on the truck with me" nonsense.

When they get on the truck with you they should be nurtured and encouraged to be stronger, smarter, and more confident. But that's not really your goal, or the goal of most fire services in general, is it?

I look forward to your thoughts...

Dwayne

[paramedicmike]

I would say it pains me to agree with what Dwayne just said. But it doesn't as I agree 100%.

And I don't know what a PMD class is, either. This page was of little help.

[Kiwiology]

However, you have a well defined scope of practice and adhere to those standards as I understand?

Yes we have an evidence based scope of practice that is defined by the National Ambulance Sector Clinical Working Group and reviewed every two years.

Over the last ten years our scopes of practice have been aggressively widened to ensure the delivery of the most appropriate care to the patient, create a more efficient system of operation and reflect international best practice. A good example is ten years ago only specially selected Paramedics who "[the ambulance service had] absolute faith in" were allowed to be further educated and authorised to carry adrenaline and morphine because it was always to remain "selected" Officers only. Now that the Paramedic Upskilling program has matured and these Officers have proven themselves capable (and with the Bachelors Degree being now required for this level) has led to a substantial upskilling of Paramedic level Officers with a variety of drugs (see my last post)

Rather than "teaching the test" or "teaching the scope" (not saying anybody does this, rather contrasting that methodology) we teach broadly; Ambulance education is more on-par with nursing e.g. anatomy, physiology, health care systems, research and statistics, pathophysiology, risk management etc

I think you missed my point Kiwi...The fact that there is no medical control is often held up by you as a standard of excellence, yet in nearly every instance that I've see it that has not been the case.

You get muppetmedics^TM who are idiots regardless of whatever system you have; it is not that we have a lack of oversight or accountability quite the opposite but rather we do not have to seek permission from an on-line physician to provide treatment.

We're all very proud of your brains and logic, and I mean that with complete sincerity, but I've spent quite a bit of time now working with Aussie, South African, Indian, British, etc medics/nurses/doctors, those with the education and lack of oversight that you speak of, yet have spent almost none of that time thinking, "Holy shit! They are so much smarter, and more confident, and more professional that I am!" as you would seem to lead us to believe that I should.

We do not want to be held up as being "better" or "more intelligent"; we operate differently because the context of our practice is different and that does not mean anybodies is worse than anybody else.

Again, there are muppetmedics^TM regardless of nationality; nobody here thinks they are smarter than anybody else; many of the smartest Paramedics I know come from the US, Canada, South Africa, the UK, all over.

I'm not bagging on you brother, only your oft spoken implication that working autonomously is a a sign of increased competency, as that's not been my experience. No more so than a drug box full of advanced pharmaceuticals indicates an advanced provider. Should it? Sure. Does it? Not in most of my experience, nor according to the comments here, the experience of others.

But it stands to logic that we could reasonably equate increased competency with increased autonomy?

And our Kiwi nurse and doc in Kandahar were such complete douchebags that it was nearly impossible to even get them to comprehend their mistakes. Not to mention a UK and American doctors that weren't any better.

Yes I have heard that Kiwi doctors and nurses can be real douchebags; I see it here and I've heard of it when they go remote as well.

I think NZ/UK doctors/nurses are very good at the biological or theoretical but perhaps not so good at the doing; I've also heard this from colleagues locally who say their American Consultant is much more "hands on" focused than the New Zealander.

This I think comes from that we are perhaps have a bit of so-called "tall flower syndrome" where it's not seen as acceptable to sprout above the rest and take charge I'm not sure.

Lack of oversight doesn't necessarily indicate increased competence, in fact in my limited experience it often seems to signify a lack of quality improvement as the detection of errors and reporting seems substandard.

Again you are confusing the two concepts; professional accountability ("oversight") is very important and something we have a lot of here; locally speaking within Ambulance there are the Clinical Coaches, Clinical Development Team, regular mandatory CCE, audit, QA/QI etc etc; we have a very strong culture of being held accountable.

Having to seek permission to use your scope of practice however what we do not have to do and is fairly common around the world as I have pointed out before. That doesn't mean somebody who has autonomy is not a douchebag, come on mate, you should know, King Douchebag, I mean fuck you ditched me at the casino and went off with some cheap hooker and got wasted on coke and I found you at a cheap motel naked covered in faeces wrapped in a blanket with a vegetable collander on your head to keep the space ships away with your hoe no where to be found; just like your credit cards and identity

The things your ole pal Kiwi does for you ....

Point being that you hold up these standards as accepted benchmarks, which they may be, but in my opinion shouldn't be, as they don't hold true for much of the world, nor, even your part in some, if not many cases.

I don't think having to ask permission to use your parts of your scope of practice should be considered anything other than a benchmark especially when I can name significantly more places where it is the standard than where it is not.

They can teach you anything in a classroom but the most crucial lessons are often learned in streets. I help teach PMD class sometimes and those green guys can rattle off all of the cranial nerves... Big shit, when they get on the truck with me its a different story.

You raise a valid point; one must balance theory with application of said theory.

Edited February 17, 2012 by kiwimedic

[DwayneEMTP]

I've never, nor am I aware of anyone, except second hand, that has to ask permission to act within their scope of practice....

The remainder of this message can be found below... :-)

http://www.emtcity.c...nced-protocols/

[Kiwiology]

I've never, nor am aware of anyone except second hand, that has to ask permission to act within their scope of practice....

Is this not what "online" medical control is?

For example you may have IV adrenaline as part of your scope of practice (not that common in the US I've seen btw) but it may be a "medical control option" only.

And that wasn't feces...We tripped over the chocolate fountain running away from what appeared to be a blurry wedding reception that seemed to start spontaneously while we were humping privately, though creatively, in the fountain a Cesar's...

I was a victim of circumstance..

You lying bastard you should have stayed at the casino man I won up large and could have paid for a better hooker for you but you horny bugger couldn't wait .... what would James say? never mind I think he was at the bar down the street ....

Edited February 17, 2012 by kiwimedic

[JakeEMTP]

Kiwi, I can only speak for the services I have worked for, but I only have to call Medical Control if I want to do something NOT in the protocol.

We have standing orders like everyone else, but if I want to try something "outside the box", that's when I ring the Doc.

[Kiwiology]

The Carolinas seem to have very aggressive standing order based protocols; but in many protocols from across the US it is standard to see something like "contact medical control prior to ... " which ranges from cardioversion to adrenaline to more than x mg of morphine.

For example the Georgia Statewide Protocol has "contact medical control" at damn near every second paragraph; in Los Angeles a whole double sided page of standing orders.

I know there are places where you never or almost never have to contact medical control but it shouldn't be part of practice; I can understand there are numerous co-factors influencing why it is and am not passing judgement on anybody for it but y'know ....

Now Jake I will have to fire up the pick up truck, pop on some contemporary country rock music, pin up the Confederate flag in the rear window and come haulin my ass down your way; we can go fishin' and watch NASCAR (... I don't believe it Bob they're making another left turn!), roast some sort of animal on the BBQ, drink cheap beer, hate on Obama and go to the gun range, perhaps we can do the last two at the same time.

Oh, and we're not bringing Dwayne, he's liable to end up at a rough biker bar and in the county jail

Yeah, I am sort of taking the piss but not really; I am a conservative pro-gun ownership, Christian Republican trapped in a Kiwi's body; know any single chicks who like guys with funny accents? lol

Edited February 17, 2012 by kiwimedic

[DwayneEMTP]

I think that the closest that I've gotten to that are statements like, "Consider med control consult if uncertain or inexperienced with treatment." or the like...

And for the record? This is America...you can do all 6 of those things all at the same time if you want...

[DFIB]

They can teach you anything in a classroom but the most crucial lessons are often learned in streets. I help teach PMD class sometimes and those green guys can rattle off all of the cranial nerves... Big shit, when they get on the truck with me its a different story.

I would have to opine to the contrary. Experienced based knowledge is what is known as empirical knowledge. In EMS empirical knowledge by definition leads to the application of procedures and interventions that are not fully understood in their long reaching effects and interaction with multiple body systems.

Confidence is gained in the knowledge and understanding of the science behind the procedure as opposed to a false sense of security rooted in ignorance of the true implications of a medical procedure.

Experience is important but it definitely is not an end into itself.

I would prefer a schooled partner over an empirical one every day of the week and twice on Sunday.