Mississippi Administrative Code › Title 15 - Mississippi Department of Health › Part 12 - Bureau of Emergency Medical Services › Subpart 32 - Trauma System › Chapter 7 - Burn Centers › Appendix 15-12-32-7-2 - PROTOCOLS

Current through June 25, 2024
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.