The Ultimate EMS Protocol

I don’t handle the card much anymore. It stays inside a plastic sleeve in my planner. The edges are worn and the words are faded. It wasn’t printed on kind of paper that travels well in a wallet for twenty plus years. But it’s been worth carrying. It is, quite simply, the ultimate EMS protocol.

I don’t read it often. I’ve read it enough times over the past two decades to have it pretty well memorized. It’s my STAR CARE card.

I got it back when I was a paramedic student at Baystar Ambulance in San Mateo California. It was 1992. I always believed the original author was none-other-than EMS guru Mike Taigman. Mike had signed on to be the quality care guy at the fledgling service and I knew the cards had originated in his office.

The idea was simple. We can’t write a policy for eveything you may encounter in the field. Instead, use this guideline. If the decision you’re about to make passes these eight tests, we support you. NO matter what. Come hell or high water … we have your back.

It’s brilliant really. It’s the policy to end all policies. It’s the grand daddy algorithm. It’s the ultimate protocol.

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The Normalization of Deviance

In the span of a generation, NASA has lost two spacecraft and 14 pilots in the collective disasters of the space shuttles Challenger and Columbia. Can you tell me why? Trust me, it’s worth exploring.

The space buffs in the crowed might recall that faulty O-rings in the Challenger’s solid rocket boosters failed and allowed supper heated gasses to escape. The result was a catastrophic explosion and a sullen announcement from my school principal in the middle of sophomore science class. In his quiet monotone, we learned that the mighty Challenger, moments before, had been destroyed and the crew was lost.

Our teacher didn’t know quite what to say, and in the silence that followed, my sixteen year old world got a little smaller.

More of you might recall that Challenger’s sister ship, Columbia, burned up on reentry returning from a mission in 2003. The Columbia’s heat tiles were damaged when a piece of foam insulation dislodged during takeoff and struck the tiles on the wing. Those tiles later failed under the heat of reentry and the craft burned up over the mid-west. Interesting right? But what does all this have to do with EMS? Follow me on this next part.

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Written Protocol vs. Common Sense

Steve Valdez only wanted to cash a check. In retrospect it seems so simple. The check was written to him from his wife’s account at Bank of America. He had two forms of ID, both with photos. The address on the drivers license was the same as the ID on the check (printed by Bank of America.) Bank of America thought differently.

Here’s the rub. B of A has a written policy that states if you don’t have an account at their bank you need to leave a thumbprint. You’ve probably seen those by now. Either you dab your thumb in an ink blotter or you use the fancy thumb scanner. But Steve Valdez doesn’t have any arms. And based on his inability to make a mark with his non-existent thumb, B of A refused to cash the check.

Clearly the bank representative thought that following the rules was the safest option. Instead of considering the needs of the customer, interjecting common sense into the matter, taking on a wee bit of personal risk on behalf of the individual being served and making a simple accommodation, the bank manager stuck to her guns. Rules are rules. And now the story has been picked up by the AP news wire and it’s everywhere.

Don’t laugh. It could happen to you. We all operate under multiple sets of rules and regulations from our written protocols to our national scope of practice to our organizations policy manual. We all are expected to apply a set of pre-established rules to our jobs in EMS. The question is how we perceive those rules. Do they trump basic common sense?

Do the prohibit us from acting in the patients best interest? When are we allowed to forgo the rules? If we decide it’s only in emergencies … well, were bound to encounter a lot of those.

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Five Things Sports Can Teach You About Being A Good EMT

Some of my favorite movies are sports movies. Movies like Bull Durham, The Natural, Hoosiers and Miracle. I love them. There is something about sports that encapsulates our human struggles like few other things do.

Sports can teach us a few lessons about being a good EMT as well. There are good ideas to be gleaned from successful athletes about running a scene and coordinating emergency care well. Here are my top five.

Have A Good Coach

Everyone needs a mentor. At least everyone who wants to be better at what they do needs one. Look around you for the EMT’s, paramedics, nurses and doctors who you respect. People who may have more experience and training in the field (but not necessarily). Find those people who you would like to be more like and talk with them. You’ll be surprised at how willing people are to offer advice and give input on subjects that can help you become a better clinician.

There is an old Buddhist proverb that says, “When the student is ready, the master appears.” There are people all around you that could be mentors and coaches. You’ll find them when you open yourself to the idea of using others to grow and improve yourself. And if you still feel starved for coaching you can always come here.  

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