What do you prefer - LR or NS?

[Hmac]

It depends on the medical director. Some are very very hesitent to allow you to deviate from the written protocols, others allow medics quite a bit of lattitude to use their judgement as long as they can articulate afterwards why they did what they did.

As I said, the laws vary from state to state, but in most states that I'm familiar with, the Medical Director is totally responsible for the way care is rendered by the EMT-P's that he has signed off on, and this is part of his State Board licensing and his liability carrier. The approach is establishing written protocols so that the MD is responsible only for the protocols, not for an individual EMT's deviation from them. Of course, since the MD is legally responsible to ensure Paramedic CME and Quality Assurance, the MD could still be held responsible for adverse outcome on THAT basis. Those are the reasons a Medical Director might be reluctant to allow deviation from protocols.

And besides, the Paramedics' job is tough enough. I have immense respect for the EMT-P's that I supervise, especially the ex-medics, but the last thing I want them doing out in the field on a snowy Minnesota back road in January is worrying about electrolyte balance, post-resuscitation pH problems, or the afterload-reduction merits of adenocard vs amiodorone.

[jklaughrey]

Use what you have on hand. Prefer NS but if all you have left is LR well by all means...

[motorwerks]

Being just an EMT I dont know all our Local EMT-P protocols.... even though I have looked over most of them. But I know I have never seen LR in any of my daily checks between 3 ambulance company's.