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Kentucky plans to offer modular pre-approved protocols
By JOHN
HULTGREN
Kentucky EMS Connection
LOUISVILLE — Do you want to update or change your ALS medical protocols?
OK, here is the process you need to follow. First, do some research to identify the most current recommendations, and then type it all up in an approved format. Then, submit it to the Kentucky EMS Council at least 30-days before their next quarterly meeting. Then, if the council doesn't have any questions about what you want to do, you can wait while the council sends it along to the Kentucky Board of Medical Licensure, which meets the following month, for final approval. Then wait for notification, which should come anywhere from three to seven months after you start the process.
Oh, you want to do it all today?
Because of some innovative thinking, that may soon be possible.
The current system can be frustrating. Providers face a difficult and time-consuming task researching new protocols -- and many end-up reinventing the wheel. Before each EMS Council meeting, the members of the Medical Standards / Delegated Practice Committee must spend many hours reviewing the protocols submitted for approval. Many times, these protocols must be returned to the provider for modification.
And protocols approved years ago are probably out-of-date and long overdue for a review.
The Medical Standards / Delegated Practice Committee of the Kentucky EMS Council has a plan to improve the entire protocol approval process.
Picture this: you go to the internet and review pre-approved protocol modules. For some topics, you might have multiple choices to pick from (maybe an urban and a rural version). You can download one protocol -- or create an entire set -- and then notify the EMS Branch electronically that you are going to begin using them today.
Do you need or want to do something a little different? Then load a pre-existing module for editing in your computer -- or write a new module from scratch -- and submit just those changes for approval the old way.
And when the EMS office updates an approved protocol module, you'll be notified that a revision has been approved and is available for your immediate use.
You can't do this yet -- the whole project, the first of its type in the nation, is in its development stage.
The committee, lead by Daniel J. O'Brien, M.D., has begun work and has created a list of protocol modules. "This is for discussion purposes," O'Brien said, and the working list will change as the project develops.
O'Brien envisions protocol modules falling into three classifications: modules that are required by all ALS providers, optional modules included at the providers discretion, and restricted protocols that will come with a curriculum and special requirements.
The committee is seeking exemplary protocols that have already been approved by the KBML. "If your service has a really good trauma protocol, we'd like you to submit it" electronically for consideration as a module choice, O'Brien said.
O'Brien explains the project in a recent letter:
There have been several discussions at the MAC meetings regarding the development of a web-based statewide medical protocol.
The intent is to be more efficient and proactive, to limit reviewer variability and to provide up to date medical protocols in a fashion that still allows for local variability and content. There are no state resources for this project. It will have to be a group effort and will require the resources of paramedics, EMT's, physicians and providers alike.
The process:
1. Develop a list of protocol categories. For purposes of discussion, I've created the attached list.
2. Categorize these into essential, optional and restricted.
3. Services who would like to provide their protocols would submit them electronically for review and approval to each specific category. These approved protocols from rural suburban and urban systems will be available for downloading under each protocol category. They would be periodically reviewed and updated.
4. Restricted protocols would include the necessary curriculum and system requirements. A service interested would have to provide documentation in this regard prior to utilization of the protocol.The payback:
1. A service may use any of the approved protocols immediately by downloading them and notifying the EMS Branch electronically. Follow-up written notification and documentation will go to the MAC quarterly. If they are altered in any way they will need prior approval.
2. A service may still submit their own protocol, but it would take a quarterly cycle and perhaps additional "resources".
3. In theory, the EMS Branch would know what service was using which protocol. If a protocol was updated, the affected services could be notified.Longer Range:
Develop a statewide BLS protocol utilizing the same format.
Fold the category III protocols and curricula into a "critical care paramedic" curricula.
This will take a while and won't happen without your help. I may be about to discover why no other state has pulled this off. However, if you see the advantages and are willing to donate your time and intellectual property, please forward to me you comments, suggestions and protocols.
Dan O'Brien, MD
OBrien@pol.net
View the Modular Protocol Project Internet Page
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