The PROTOCOL PROCESS

As a field provider, do you have the opportunity to participate in the protocol change and development process at your agency? Do you exercise that option, or would you if it existed? We're asking a few simple questions about the issue. Please take a moment to share your thoughts, and help us get a better picture of how providers help shape the protocol process across the U.S. Click here for a quick survey. For more on this topic, see January's issue of EMS Magazine, available on January 9, 2007. It is illuminating to talk about how EMS systems typically integrate new developments and technologies in the fast-changing world of prehospital emergency medicine.

The prospect of delivering continuous positive airway pressure in the field excites a lot of people in EMS. It's fast, simple and works well against serious matters like congestive heart failure, chronic obstructive pulmonary disease and asthma. A number of jurisdictions already use it.

     The prospect of delivering continuous positive airway pressure in the field excites a lot of people in EMS. It's fast, simple and works well against serious matters like congestive heart failure, chronic obstructive pulmonary disease and asthma. A number of jurisdictions already use it.

     Problem was, three years ago, when a pair of providers in Maine wanted to introduce it in their state, there wasn't a huge body of evidence attesting to its efficacy outside hospital walls. What data there was came largely from hospitals, and while those findings might have translated to the field, they also might not have. Prehospital care, as we all know, often poses challenges and variables that the safe, controlled environment of the hospital does not.

     So what was a progressive EMS type who wanted to try field CPAP to do?

     "We probably could have just gone ahead and made it a protocol, but we really are trying to transition to an evidence-based approach," recalls Dan Batsie, who, along with a colleague, first broached the notion to relevant EMS authorities in Maine. "So we designed a pilot project approach, and what's evolved out of it is a process that we're trying to model into a method for delivering new protocols in the state."

     What Batsie and Co. did, with support from Maine's EMS Medical Directions and Practice Board, was initiate a new way of pilot-testing new or not-as-proven-as-we-might-like interventions. It allows sytems to voluntarily implement emerging capabilities like CPAP-under a test protocol and close scrutiny designed to protect patients-while generating important data that could aid other systems wrestling with the decision down the line. It's not the only way to develop a new protocol, but it's one with significant benefits.

     "A pilot project basically allows us to handle it in small portions," says Batsie, education coordinator for the Northeastern Maine EMS Council, the governing body for a four-county region in the northeastern part of the state. "If services want to have CPAP, great. If they don't, they don't have to spend any money or do anything. But it enables services to prepare: They can join the pilot project and begin operating under the requirements and parameters that will likely come with a new CPAP protocol if and when it's implemented statewide."

The Benefits of Statewide Protocols
     Five benefits to having statewide EMS protocols, according to Pennsylvania medical director Doug Kupas, MD, whose commonwealth recently implemented them: