As EMS providers we are permitted to practice medicine under the control of a medical physician, using a combination of online direction and more often, offline medical protocols that guide our interventions.
Most of the time these protocols are vetted through a lengthy review process, with input from the medical community. It can be frustratingly slow to adopt new practices, but what might seem so universally beneficial may have its limitations in the local setting.
This is one of the reasons why new paramedics spend the time to memorize these protocols — they represent the standard of care they have to adhere to while on duty.
At the same time, protocols are not rigid. Most EMS practice protocols have a caveat that allows for paramedic discretion — the ability to adapt or even withhold the implementation of a protocol because of the patient’s unique presentation.
This reflects the simple reality that patients do not read the book when it comes to their presentation, and many do not neatly fit a specific protocol. The ability to be flexible and being able to operate in the “sea of gray” that are complex patient conditions is important to the effectiveness of EMS practice.
However that authority comes with responsibility. Contacting medical direction for assistance is also defined by many system protocols. It allows for an external check on the decision-making practice of the EMS provider, and has the added benefit of notifying the receiving facility of an unusual presentation.
Clearly there are times where making base contact may not be possible, but even then there is usually language that guides the paramedic to perform follow up with the physician after the call is complete.
It sounds like the department made the right call in disciplining the paramedics who were involved with these incidents. There’s no telling whether the sedative medication contributed to the morbidity of the patients, but clearly something ran off course for the personnel involved.
The medications that paramedics are allowed to administer are dangerous, and can be downright lethal when inappropriately used. Authority requires responsibility.
