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Home > Topics > EMS Management
June 28, 2012
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EMS News in Focus
by Arthur Hsieh

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 Arthur Hsieh

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:

  1. 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.
  2. 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.

About the author

EMS1 Editor in Chief Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
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