Miss. Code. tit. 15, pt. 12, subpt. 32, ch. 7, app 15-12-32-7-2
General Provisions
Protocols are designed by the off-line (system) medical control system to provide a standardized approach to each commonly encountered patient problem. This provides a consistently defined level of pre-hospital care. When treatment is based on such protocols, the on-line physician assists the pre-hospital personnel in their interpretation of the patient's complaint, the findings of their evaluation, and the application of the appropriate treatment protocol. The process should be reviewed periodically in order to consider changing medical standards, new therapies, and data generated from audits of patient care.
In the realm of pre-hospital emergency medicine, there are a limited number of interventions to cover the myriad of problems that may be present. Although advanced life support may be skilled in many maneuvers, there are limitations on what they can accomplish in the pre-hospital setting. Basic life support personnel can do even less. The goal of pre-hospital care is to respond correctly and consistently.
Because the types of illnesses and inquiries commonly encountered in a given EMS system may be grouped into broad categories, protocols and standing orders may be established to help accomplish this goal. There are three major advantages to using protocols:
Pre-hospital personnel may be trained to respond to a given medical problem in a defined manner. Regardless of the weather, the hostility of the crowd, the immediate danger of any other outside stress, the pre-hospital personnel can consistently treat the problem in a defined manner with minimal chance of omission.
The EMS system will have a set standard by which care may be audited. The system and its successes or failures may be measured against consistent standards allowing for necessary change and improvement based on documented evidence, and not on the notion of this year's medical director or any other outside influence not based in fact and logic.
Protocols provide a standard of medical treatment for each patient problem so that individual variations necessary for non-routine patient problems may have a context to aid the on-line physician in a complex treatment regimen.
Protocol Development
The development of protocols may include the following steps:
List the common illnesses and injuries that are currently encountered by the local EMS system. A chart review on a random basis for all months of the preceding year should suffice. All months are important, for there may be significant seasonal variations with particular illnesses or injuries.
This list must also include any life-threatening problems that can be affected positively in the pre-hospital setting, but that are not seen routinely (e.g., anaphylaxis, snake bite).
This list may be divided into two general categories-pediatric problems and adult problems-even though there will be duplication within these two lists. Asthma, seizures, trauma, and other illnesses and injuries are common to both groups, but the physical interventions and medications are sufficiently different to justify this separation.
Similar problems (e.g., cardiopulmonary, trauma, poisons/overdose, etc.) may be combined into groups.
Some problems that will not fit easily into groupings (e.g., hypothermia) may be listed separately or included in a miscellaneous group called "other."
In each of these groups, there will be common parameters, such as the ABCs, vital signs, history of the current illness/injury, medical history, and medications, allergy history.
For each of the problems within the group, additional parameters or interventions may be added to further reduce the patient's morbidity or mortality.
Additional treatments for special cases may be added to create a more specifically detailed protocol.
For a given region, the level of training of the pre-hospital personnel involved, the capabilities of the EMS response system as a whole, the capabilities of the receiving hospital and the medical opinion in the region must be considered before applying protocols synthesized outside the EMS system.
Protocol Implementation
Protocols are the responsibility of the medical director, who often delegates their development to a committee consisting of emergency physicians and other appropriate physicians. This committee implements the protocols, which reflect the currently optimal method for pre-hospital treatment of the defined problems. All levels of controllers, the medical director and off-line and on-line physicians, must be cognizant of the adopted protocols, and must agree to function "by the book."
Discrepancies of disagreements that evolve should be brought back to the committee for consideration.
Pre-hospital personnel are then trained in the use of the protocols and held accountable through the audit and review process. Variance from protocol must be clearly documented and justified.
Consistently occurring variances, whether or not justified and documented, should induce review of that protocol. Even when no problems emerge, the committee should review all protocols at least annually in light of past experience and new medical insight.
Miss. Code. tit. 15, pt. 12, subpt. 32, ch. 7, app 15-12-32-7-2