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Who writes your EMS protocols?
Do your paramedics get input on writing your protocols, or does someone else write them and you just have to comply?
The reason I'm asking is that the "Nasal Cannula for Cardiac" thread got me thinking.
It is obvious that protocols are seen as absolutes in some places and as guidelines in others.
There are at least four different systems for writing protocols...
1) State or Regional protocols. These are legislated or adopted, and everyone in that geographic area has to follow them. This system is fairly common in the northeast.
2) System protocols written by the Medical Director/Medical Control Physician. This is the most common way to do it. Versions of this system are in use all over the country.
3) System protocols written by a Protocol Committee that includes the Medical Director, paramedics, and possibly hospital representation. This is the way my department does it. Our Protocol Committee includes our Medical Director, and Assistant Medical Director who also represents the local hospital E.D., the two Training officers (both are paramedics), and at least two paramedics from each shift. Most of our protocols were written by paramedics, then approved by the committee and signed off by the Medical Director.
4) Someone else's protocols, adopted by reference. Some places have model state protocols. These protocols can be adopted by individual EMS systems without having to write their own. Other systems adopt ACLS, ITLS/PHTLS, and other medical specialty class standards by reference, even though those classes all teach the "follow local protocol" caveat.
We really like our system. It gives the street providers a lot of input, lets us write protocols in a format and language that are easily understood by our providers, and gives the paramedics an opprotunity to engage in research, professional writing, and improving standards.
Our protocols follow the principle that medical care should be based on scientific evidence. We closely follow the ECC 2005 ACLS standards, with some differences.
Our paramedics have also researched several new drugs, written proposals, and had the new drugs added to our State EMS Formulary.
Our Medical Director is a very knowledgeable emergency physician, he understands the street, and he respects us enough to work cooperatively to write protocols that are both evidence-based and practical.
The reason I'm asking is that the "Nasal Cannula for Cardiac" thread got me thinking.
It is obvious that protocols are seen as absolutes in some places and as guidelines in others.
There are at least four different systems for writing protocols...
1) State or Regional protocols. These are legislated or adopted, and everyone in that geographic area has to follow them. This system is fairly common in the northeast.
2) System protocols written by the Medical Director/Medical Control Physician. This is the most common way to do it. Versions of this system are in use all over the country.
3) System protocols written by a Protocol Committee that includes the Medical Director, paramedics, and possibly hospital representation. This is the way my department does it. Our Protocol Committee includes our Medical Director, and Assistant Medical Director who also represents the local hospital E.D., the two Training officers (both are paramedics), and at least two paramedics from each shift. Most of our protocols were written by paramedics, then approved by the committee and signed off by the Medical Director.
4) Someone else's protocols, adopted by reference. Some places have model state protocols. These protocols can be adopted by individual EMS systems without having to write their own. Other systems adopt ACLS, ITLS/PHTLS, and other medical specialty class standards by reference, even though those classes all teach the "follow local protocol" caveat.
We really like our system. It gives the street providers a lot of input, lets us write protocols in a format and language that are easily understood by our providers, and gives the paramedics an opprotunity to engage in research, professional writing, and improving standards.
Our protocols follow the principle that medical care should be based on scientific evidence. We closely follow the ECC 2005 ACLS standards, with some differences.
Our paramedics have also researched several new drugs, written proposals, and had the new drugs added to our State EMS Formulary.
Our Medical Director is a very knowledgeable emergency physician, he understands the street, and he respects us enough to work cooperatively to write protocols that are both evidence-based and practical.
Replies to This Discussion
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Permalink Reply by David Zarker on
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Our protocols are a combination of two types. First they are a regional type protocol that the various agencies vol. join into. And secondly they are written by a committee with the medical directors from all the agencies and paramedics representives from all agencies. We have been using this for about 4 years and it works well. The hardest thing is getting all of the different medical directors to agree on treatments.
Dave
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Permalink Reply by T.J. on
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Our protocals are pretty much written by the doctor who we work under for our ems liscence.
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Permalink Reply by Russell Stine on
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Ours are based on a state wide model, but are altered by our medical director with input from our run reports as well as medics on the street. It helps out that our medical director is also the chair of the committee that writes the state wide model protocol.
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Permalink Reply by Chris Harris on
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NYSDOH and REMO provide our protocols and they are always changing them....
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