Re: Today's Challenge: OB/GYN Scenario

[Guest guest]

I will make one or two comments here about this subject.

One, if you will note, the DOT curriculum makes a point of making the following

statement - " Administer oxytocin per physician's order " I note that this

statement doesn't appear to be commonly used in other sections of the curriculum

with other drugs to be administered, unless I am missing something. I wonder

why they felt it necessary to put that statement in that section specifically

unless some of what I have heard in the past about the use of Pit in the field

is true. That specifically is regarding comments by physicians that Pitocin is

not really a " pre-hospital " type drug. The general concensus so far I have

heard from physicians is that it really should not be used until AFTER the

placenta is delivered anyway. I don't know about most of you folks, but I

typically do not wait on scene for 20 minutes for the placenta to deliver. And,

even though some agencies may have a little longer transport time, most would be

at the receiving facility either before this occurs OR if not, even if the drug

was indicated by this time, they would be at the receiving facility prior to

being able to even get the drug mixed up and hung.

Just being the devil's advocate.... LOL

Jane Hill

Re: Today's Challenge: OB/GYN Scenario

>

> Gene,

>

> I am behind on reading my mail, but I wanted to throw out a guess. I asked

a

> similar question to TDH a while back and waited almost two months for the

> answer.

>

> I believe the crew followed their standard of care and therefore could not

> be held liable for any damages.

>

> The attorney would have to do some really good research to see if the

> medical director had recommended carrying either of the two drugs. If that

> were the case, I believe the service would stand a good chance of being

> successfully sued.

>

> I often wonder if a medical director can be sued for not meeting the

> " standard of care " with the protocols he provides for a service. Who

defines

> standard of care? Is this done at a national, state or local level? When a

> company that I worked for in recent years opened a walk-in clinic we were

> advised by our attorneys not to put a crash cart in the building because

the

> other two clinics did not use them. We would be exceeding the standard of

> care in our area.

>

> You have seen several great responses. Let us know what you think. I do

not

> do well with suspense.

>

>

[Guest guest]

Counterpoint to Jane:

The fact that oxytocin is mentioned in the NSC contemplates that it will be

used. Why else mention it? So it says give it on physician's recommendation.

OK. How can you give it on physician's recommendation if you don't have it?

Why would that be in the NSC if it were not a pre-hospital drug?

LOCALITY RULE.

BTW, some are still laboring under the misapprehension that there's such a

thing as a " locality rule " in malpractice cases. That rule has disappeared

except where a procedure requires equipment that can't realistically be

provided.

Example: A small rural hospital would not be expected to have an MRI

available, nor would it be expected that there would be neurosurgery available.

But where you're talking about a cheap, old drug with proven results, which

is a part of the NSC for Paramedics, there's no reason in the world why it

would be carried in one part of the country and not in another. There's no more

difficulty in training prehospital folks to use it than there is in

administering dopamine, an epi drip, or procainamide. Much less in fact.

So, it's difficult to argue against it unless there is uncontrovertible

research data against it. Once again, the expert who attempts to justify

failure

to provide it as an available drug will have to show why his judgment is

better than the national committee that adopted the NSC as the approved

curriculum

for paramedics.

Not saying it can't be argued successfully, but the cards are stacked against

you.

Evidence based medicine is a double edged sword. While it's easy to say,

there's no evidence for it, it's also easy to say, where's the evidence against

it?

Doctor, what published studies do you rely upon in advising against carrying

oxytocin on ambulances? Doctor, what independent research have you conducted

which showed that oxytocin has bad results when used in the pre-hospital

setting? Doctor, were you aware that a national committee of experts was

considering adoption of a new curriculum for paramedics? Doctor, did you make

your

views known to that committee? Doctor do you disagree with the inclusion of

oxytocin in the NSC for paramedics? What is your disagreement based upon other

than your personal feelings? What medical evidence do you rely upon?

Doctor, have you published any articles in peer reviewed journals stating your

opposition to having oxytocin available on ambulances? Doctor, I show you this

book which was the textbook used in the obstetric course you took in medical

school. Please refer to page 1165 and read the part I have highlighted to the

jury. Et Cetera. That's how it goes.

When you're going against national guidelines, better be prepared to defend

your position with something more than your own personal preference.

Again, not saying it can't be done. I can just as easily demonstrate the

other point of view. But I want all to be aware of the facts of life when

evidence is presented in court.

We'll all make up our own minds about what to carry and what not to. Just be

ready to defend your point of view.

Best,

GG

In a message dated 6/4/2003 1:57:10 PM Central Daylight Time,

je.hill@... writes:

> I will make one or two comments here about this subject.

>

> One, if you will note, the DOT curriculum makes a point of making the

> following statement - " Administer oxytocin per physician's order " I note that

this

> statement doesn't appear to be commonly used in other sections of the

> curriculum with other drugs to be administered, unless I am missing something.

I

> wonder why they felt it necessary to put that statement in that section

> specifically unless some of what I have heard in the past about the use of Pit

in

> the field is true. That specifically is regarding comments by physicians that

> Pitocin is not really a " pre-hospital " type drug. The general consensus so

> far I have heard from physicians is that it really should not be used until

> AFTER the placenta is delivered anyway. I don't know about most of you folks,

> but I typically do not wait on scene for 20 minutes for the placenta to

> deliver. And, even though some agencies may have a little longer transport

time,

> most would be at the receiving facility either before this occurs OR if not,

> even if the drug was indicated by this time, they would be at the receiving

> facility prior to being able to even get the drug mixed up and hung.

>

> Just being the devil's advocate.... LOL

>

>