Wednesday, June 30, 2010

At least there's catchy music...

Having been reminded that the state protocol updates take effect tomorrow, I realized that I really should waste 30 minutes of my life and view the 'update rollout videos' before I'm taking off riding status. I suppose I should be grateful that they've put it up online so we don't have to go through classes face to face, wasting a whole day.

New in this year's update for BLS providers is the permission to give more than one tube of oral glucose to a diabetic patient who does not respond to the initial tube of glucose (prior, we had to call medical command to give a second tube of glucose), and the clarification that a medical director can allow BLS providers to use glucometers, rather than having the family do it, or wait for an ALS provider to get on scene (thankfully, the medical director for the region I'm in currently has faith that his BLS providers are intelligent enough to use a glucometer). Also new is the removal of the option of intubation for patients with an EMS DNR-A. The belief of The Powers That Be is that this will cause a swing in the number of DNR-B patients to DNR-A patients, as many patients only selected DNR-B because of the intubation issue. My personal belief is that it'll only make a difference to patients who aren't in nursing homes (most of whom do not have DNR's anyway), as those in nursing homes won't get the appropriate information to make the change. Not that it matters anyway...in my experience, ALS turfs all DNR patients to BLS, regardless of the level of DNR, and the hospitals generally disregard the EMS DNR's, and do everything short of intubation and CPR anyway.

Continuing the state's obsession with helicopters, this year's protocol update also included a review of the medevac protocol, with a couple of updates on just who is allowed to fly (though the little provision at the end of the 'trauma decision tree' that states 'paramedic discretion' is used as a catch-all). We were also treated to a safety discussion on creating landing zones and where it is dangerous around the helicopter.

But the most interesting change in the protocols is that BLS units now carry acetominophen, and can administer it to patients for pain control only. Which gives me a huge WTF, personally. While I would like to say "Who the hell doesn't have tylenol in their house?" experience has taught me better. What I will say, is that if tylenol is sufficient to control your pain before I get you to a hospital, did you really need 911? And if you have tylenol in your house, do you really need someone else to tell you to take it? And if your pain is sufficient that you called 911, you should require a paramedic with morphine.

And yes, I know all the arguments about 'they don't know it's not an emergency' and all that, so please, save me your speeches. I know common sense is not so common, but I am really starting to believe that there should be a class in high school on what constitutes an emergency.

*sigh* No wonder I feel as if I am constantly surrounded by the dregs of EMS. Don't get me wrong, there are spectacular people that I've worked with and that I've attempted to model myself after. But when we continue to dumb down our protocols so that we are covering every little tiny issue that may happen, we are removing the ability of the providers to exercise their brains, and making sure that all we really do have are ambulance drivers, not EMT's and paramedics.

At least the protocol rollout has catchy music...

1 comment:

EMS Chick said...

I'm glad they decided BLS providers can use glucometers! There are parts of my state that can't and it always makes me scratch my head. Can serious harm be caused by one? If so I'd like to know how.

On to the Tylenol... wow. I'm really not sure what to say to that. By the time it kicks in I'd imagine you'd be at the hospital anyway (unless your transport times are regularly 45 minutes +?)