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Judgment calls: When would you break protocol?
In nearly every set of clinical protocols, there are provisions for EMS personnel to exercise judgment when necessary
By Art Hsieh
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Editor's note: A Minn. prisoner died when a nurse overrode a doctor's orders for an ambulance and denied him emergency care, citing "protocols." |
This is an interesting case in communications, protocols and procedure. Based on the allegations in the lawsuit, it appears that a combination of errors and lapses in judgment likely resulted in the fatality of a prisoner while in the care of state officials.
There are a couple of takeaways that apply to EMS providers:
- Protocols are written to be guidelines, not mandates. In nearly every set of clinical protocols, there are provisions for EMS personnel to exercise judgment when necessary. This allows us to be able to react on the scene to unusual situations that aren't necessarily covered by the protocol.
- Understand your operating policies. While it's not yet clear in this case if organizational policies were violated, we often overlook some of the subtler, more minor aspects that provide structure. Each of us is given a set of P&Ps when we begin work at an agency; take the time to read through them.
Moreover, make sure to ask questions about a directive that doesn't make sense. You want it to be clear. Perhaps it needs to be updated, amended or changed.
Large, glaring mistakes that harm a patient aren't frequent; more often than not, it's a small series of errors that, when taken separately, are usually inconsequential. When they all connect, however, is when potential for disaster occurs.
We can reduce the risk of that happening to us by paying attention to the details.
Jake Stein Thursday, June 28, 2012 7:34:38 PM Hard comparison since in EMS you can call med control at any time for further advice if you feel it is necessary to deviate from the protocols.
There are protocols in place in a prison system to protect the public including the EMTs or Paramedics also.
In this situation the physician should have given the transport order directly the nurse and not the CO. 
Skip Kirkwood Friday, June 29, 2012 3:30:00 AM It's important for a good set of protocols to specify what steps are to be taken when the medic moves in to un-charted territory. For example, an immediate call to the medical director, or some special report - so that others, who may be called upon to explain the deviation, are aware of what happened - and more importantly, why.
Nobody likes surprises, so medics who want to be supported in their exercise of judgment need to make sure that their medical directors and other "highers up" are not taken aback by inquiries. 
