Protocols, as defined in many emergency medicine textbooks, are “a set of policies and procedures for all components of an EMS system.” Thus, the philosophy contained herein is developed for the purpose of providing guidance to prehospital providers, Emergency Physicians, and Emergency Department staff about system performance expectations as established by the Operational Medical Directors. These protocols have been developed to ensure high quality, standard prehospital emergency care. Patient assessment and basic life support (BLS) treatment have been enumerated herein to provide a foundation upon which these protocols are based. It is the assumption that BLS treatment is rendered by the prehospital care provider immediately, without the need for on-line medical direction (with the exception of patient-assisted medications).

These protocols are a guideline that prehospital providers will follow in the treatment of patients who meet the criteria of these protocols. Patients not meeting the clinical signs and symptoms of a protocol are not eliminated from receiving the treatment, but require the provider to contact Medical Control for further direction.

The 2004 revision of the PEMS Patient Care Protocols allows prehospital providers certified as Paramedic much more latitude for treatment of patients. This freedom carries a great responsibility along with them. The philosophy of these protocols IS NOT designed to substitute for on-line medical control, but is an adjunct to the on line Medical Control Physicians. The protocols are to permit prehospital providers the ability to perform certain aspects of advanced prehospital treatment prior to contacting Medical Control.  However, once the prehospital provider begins initiation of a protocol, the protocol should be completed in the manner in which it is written, unless Medical Control is contacted prior to or during its’ initiation. In this event, the provider will follow the orders ff Medical Control. Once Medical Control has been consulted, providers should not return to the use of the protocol, unless the patient’s condition becomes life-threatening and therefore dictates immediate intervention, or unless ordered by Medical Control.  The intent of these protocols is not to exclude provider/physician interaction, but to begin treatment of patients and interact with Medical Control as time permits. At any time prior to, during, or after initiation of a protocol, prehospital providers should contact the appropriate Medical Control Physician. Prehospital providers are encouraged to make contact as early as possible. Waiting to contact until your unit is a few minutes from the receiving facility provides limited benefit to patient care. Prehospital providers are expected to understand and evaluate the appropriateness of orders received from Medical Control. Should an order seem inappropriate (e.g., a nonstandard nose of medication), or if the reasoning is unclear behind an order to deviate from protocol, do not hesitate to express your concern to the Medical Control Physician.  Such activity in no way shall create ill will; but to the contrary, it is expected and necessary to ensure the highest quality of patient care and is a part of your responsibility as a prehospital provider.  Finally, all medical care rendered within the Peninsulas EMS region is done with the expressed written authority of the ALS or BLS services’ Operational Medical Director, and under direct supervision as such. By no means is the philosophy of these protocols intended to prolong the treatment of patients “on scene” and delay transport to the most appropriate receiving facility. These protocols should be implemented if deemed necessary by the clinical presentation of the patient. They exist to provide prompt, quality prehospital medicine to the sick and injured prior to contacting Medical Control.