Protocols and procedures are there for a reason and this is to protect me (health care provider) and institution (receiving facility). Usually they are created by people who never had to implement them on the scene or in the environment that can't be controlled. EMS personnel knows what works best and knows which corners can be cut and which order of things can be changed in order to benefit the pt or without hurting them. But there is other side to this... lets say you saved someone’s life during cardiac arrest and instead of doing what you should by the numbers you mixed things up a bit (since it worked in the past). Person you save is ok except he/she has a minor speech deficit secondary to oxygen depravation during down time. Now both you (rescuer) and md knows that there was a great chance of anything going wrong and it is a miracle that this person is even alive. Now family finds out that you didn’t cross all the Ts and dotted all the Is and went AWOL on the prescribed procedure. How long do you think before fancy lawyer steps in? How long before your organization settles out of court because not following a medical protocol is a big no-no...

Having said that I think that because there is a possibility of getting sued a lot of EMS providers keep their mouth closed about what works that is slightly out of protocol.

Here in NYC our seizure protocol states to start an IV and give pt sugar just in case seizure activity was induced by hypoglycemia and than if that doesn’t help go with sedatives. Now I don’t know if you ever saw a bad seizure but trying to start an iv on a pt who’s movements are unpredictable is dangerous not only to the patient but also to a medic. Can it be done? Hell yeah but why risk it. Have I done it? Yes many times but more for skills than for anything else. What we do in the field is we give valium thru muscle and when they come down start IV and follow with more sedatives and sugar. Is valium faster thru IV? Yes it is but again there is a risk of accidental needle stick. This protocol was develop in cooperation with top NYC seizure experts based on the condition in the ER. Docs who spoke their mind and chose combination of drugs for us to use already had an IV put in by the nurse. So all they did was show up and do their stuff. None of them docs had to put an IV into patient that is flopping on the floor like a tuna on the deck of the boat. And it sucks because new medics are getting hurt and confused trying to figure out why stuff is done certain way.

It is great to work in the community which is highly tolerant of new stuff and open minded to improvement. Unfortunately many large systems are run by ER docs who cant start ivs ,intubate or read an EKGs since all of it is done by nurses and medics in the field.