Tuesday, May 23, 2006

Protocol VS. Scope of Practice

Here is something for you to wrap your head around.

You are called to transport Joe a 67 year old cancer pt to his radiation appointment.
The skinny on Joe is.

Throat Cancer
120 lbs
6' 3"
BP 110/70
Pulse 100
SP02 93% with trach o2 mask set at 4 lpm.
Non-communicative, has trach, requires frequent suctioning.

The catch to this senerio is your a basic crew and according to your company protocol you are not allowed to trach suction. Your "state" guidelines say you can, but your company protocol does not have a provision for it.

You are 20 minutes into your transport and Joe starts to grab at his trach site and he appears to be turning blue. You immediately contact your dispatcher and ask for an ALS intercept and head for the closest facility that can handle Joe.

Joe is breathing on his own, but it's very noisy and you can hear obvious obstructions with his airway. A yankur suction device is not doing the trick. Joe's SPO2 drops into the 80's, you are 15 minutes out of a hospital and your intercept is at least 10 minutes away.

The question I have for you is. Do you suction Joe as you have been trained by your state? This would go completely against your companies policy. Do you wait for your intercept and hope for the best?

You decide.



Anonymous said...

I have run into situations like this regularly at an EMT. EMT's are trained things in school but not allowed to practice to their level of training due to their company policies.
What would your decision have been if the outcome would have been the death of this patient if you did not perform something a simple as suctioning his airway?
There are many times that you run into circumstances where you have to make a split second decision about how to treat a patient. You basically hold the life of this person in the palm of your hand. He called you because he needed help and is assuming that you are going to do your very best to make him better.
I personally feel that your patient comes FIRST! There are times when everyone of us have to deviate a little from protocols to "err on the side of good judgement".
Do you think it is fair that you either suction this patient to keep their airway clear so they can continue breathing or possibly let them die?
I surely don't want to have to tell the patient or his family "I'm so sorry, I could not suction his airway due to my company protocals and therefore he died". Who do you think that family is going to balme for his death?

Zer0 said...

How true you are, however in the case of Joe. If the EMT-B suctioned his airway going directly against his/her companies wishes, and the company dismissed them from their duties who is going to pay to feed that Emt-B while they look for another Job? The state might not yank their card (ok the state WOULD NOT yank their card) but that doesnt change the fact that it might have been a firable offense.

Kelsey said...

Call a doc- ask them what to do... Company policy can't overrule a doc's orders. Or can it?

tdmason said...

First off, are you talking about policy and procedures or protocols? I am in Texas so I don't know if things here would be different than where you are. At my company we only run MICU so obviously this isn't an issue for me as a medic. However, we view our protocols as a set of guidelines because there will be times that you have a chief complaint that isn't covered in your protocols. We do have standards we go by such as the state's, ACLS, BTLS, etc. We can treat up to our scope of practice but not beyond. Of course if there is any question about what to do you should contact your medical control for direction.