I have made my list of the 16 biggest EMS treatment changes over my twenty-year career as a paramedic. I will be posting my list in reverse order over the coming weeks.
16. Increased Standing Orders
When I started as a paramedic 20 years ago, we had to call medical control for permission to give medications far more than we do today, including anytime we wanted to give controlled substances. If a patient was in status epilepticus or had bones sticking out of their leg, we had to call to talk to a doctor for permission to give Valium for the seizure or morphine for the broken leg. What doctor would say no? We did this because at the time in Connecticut there was a law requiring “simultaneous communication” with a physician for a paramedic to give controlled substances.
We had also had to call in many other situations. often whether you got permission or not depended on which doctor answered the phone. Some moonlighters or new doctors didn’t even know our guidelines or would tell us to give drugs we didn’t carry. Recently we had torodol as a medical control option. The problem was some doctors said no to torodol no matter the scenario, while others thought ti was a great drug and always said yes. There was little consistency. In the end, we decided to remove the drug altogether and just up the amount of fentanyl and morphine would could give instead.
We hardly ever have to call for anything now. Our region has decided that if our guidelines are reasonable, we ought to be able to lay out situations where paramedics can do what they need to do on standing orders. For instance, if a medic needs to call in for permission to give a drug like dopamine, he likely has a patient sick enough to demand his full attention and requiring him to get on the phone to talk a doctor, who likely is busy himself, is not an ideal situation. While medics are always encouraged to call if they have any question, as long as they are within our general guidelines they are free to follow them on their own. The only two major situations we call for now are for STEMI alerts to get the doctor to activate the cath lab and on cardiac arrests if we want permission to cease a resuscitation on scene. Overall, the standing order system works great and is a vast improvement over the old “Mother, May I?” days.