Protocols: Taking the thinking out of everything

Code 3 for shakiness. At the residential drug rehab. Stupid place.

“That fucking place again?”

A male in his 40s is sitting on the couch in the lobby, where apparently most of the patients wait when the facility calls 911. He looks fine, just like most patients we see here.

“Man, I can’t believe I have to go again.”

He does not want to go to the hospital but has no choice because rehab is part of his probation. He does not have any physical complaints.

“Why are we here then?”

He points at the staff, “Ask them.”

“Why did you guys call us?”

“Protocol.”

“Protocol for what?”

“His blood sugar was high. It was 300.”

“Fair enough. What time was that?”

“I don’t know.”

“That’s helpful.”

“We give them their meds at 4:30pm every day. He took his insulin, and we checked his blood sugar. It was high so we called you guys. It’s our protocol.”

It’s 4:50pm.

“So, would it be fair to say that you did his blood sugar sometime between 4:30pm and 4:50pm?”

“Yeah.”

“This particular insulin that he uses isn’t very quick-acting by design. So you basically gave the insulin no time to work, and you called because his blood sugar was high?”

“Well, it’s protocol. His blood sugar is high so we need him to go to the hospital.”

“Then you’re going to be sending him to the hospital every day.”

“It’s protocol.”

“All I’m saying is that you should use some common sense. Can’t you wait an hour or two after the insulin before you check his blood sugar? You’re just wasting everybody’s time. You send so many people to the hospital it’s ridiculous.”

I get it. I understand that these protocols exist because of liability or someone who fucked up, but how does it make sense to reduce liability by dumping on the hospitals people who don’t need to be at hospitals? Why is there no liability for places like this that flood hospitals with stupid cases to the extent that there are no beds for actual cases? How is this any different from the regular drunk who calls 911 himself twice a day?

4 thoughts on “Protocols: Taking the thinking out of everything”

  1. We have a doctor who calls 911 every day for his patients at noon…just before they go to lunch. Sometimes it is for chest pain that started at 9am and the doctor’s office made an appointment for the pt at 11am instead of telling the pt to call 911 then. Sometimes it is for the person with a “change in his ECG” when the doctor doesn’t have an old ECG to compare it to because this is a new patient! The patient was there for a check-up and felt perfectly fine, by the way. Sometimes it is for something serious…but NEVER is the patient on any oxygen when we get there and the patient is ALWAYS ALONE IN THE EXAM ROOM when we get there! Funny, emergent enough to call 911 but not nearly serious enough to put a nurse in there with the patient in the event he gets worse. Idiots.

  2. The sad part is that this is just as applicable to EMS as everyone else. How many patients gets transported because of “liability” or “protocol” after having a beer? How many times is online medical control contacted to try to get rid of “liability?” How many EMS systems have strict cookbook protocols so that they’re providers neither have to think nor incur the associated liability?

    Health care as a whole has an overbearing concern with liability. However, just like any other danger or risk, the best defense is making sure that the providers have the proper education, training, and tools to properly mitigate liability, not shoehorning providers into rigid rules and cookbook protocols.

    Ok, I’m done preaching to the choir.

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