Statewide Protocols: Effect on Standardization of Rural EMS Care

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Statewide Protocols Effect on Standardization of
Rural EMS Care
Douglas F. Kupas, MD
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Statewide Protocols Effect on Standardization
of EMS Care

• Douglas F. Kupas, MD
• Geisinger Health System
• Danville, PA

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Objectives

• Describe the potential advantages to statewide
  protocols
• Discuss how statewide protocols can address both
  rural and urban issues
• Describe the current state of statewide protocols
  in the U.S.

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Outline

• Current Statewide Protocol Use
• Rural vs Urban Issues
• Five Advantages of Statewide Protocols
• Translation of Knowledge
• Advantages
• Effect of Statewide Protocols

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State of Statewide Protocols

• The Pennsylvania Story
• 2000 (16 EMS regions with regional protocols)
• Statewide stakeholder conference (over 80
  providers)
• Protocol Template Standardized
• Protocols Developed
• Protocol Roll-out (training)
• 11/1/04 Statewide BLS Protocols Effective
• 7/1/07 Statewide ALS Protocols Effective
• Biannual updates and training

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Rural vs. Urban

• Should a patient with chest pain be treated
  differently by EMS between Philadelphia and Elk
  County, PA?

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Five Advantages to Statewide Protocols

• EMS Responder, July 8, 2008
• Uniformity
• Evidence-based
• Up-to-date
• Standardization
• Disaster preparedness

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Five Advantages to Statewide Protocols

• Uniformity
• Guideline-based care Quality
• Pay-for-performance
• Patient safety/ reduction of errors
• Performance parameters/ indicators
• Benchmarking
• Consistent quality improvement
• Providers work multiple jobs

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Five Advantages to Statewide Protocols

• Evidence-based
• FICEMS evidence-based EMS summit/ grant
• Nova Scotia EBM protocols

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Five Advantages to Statewide Protocols

• Up-to-date
• Ability to update all protocols when major
  guidelines change
• 2005 ILCOR/AHA BCLS/ACLS guidelines
• Ability to emergently update protocols
• Pennsylvania H1N1 protocol implemented within 36
  hours of posting of CDC guidance document
• Knowledge Translation
• Gap between knowledge and practice

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Knowledge Translation

• IOM report recommendation
• Evidence-to-Practice Pipeline

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Knowledge Translation

• Any process that contributes to the effective
  and timely incorporation of evidence-based
  information into the practices of health
  professionals in such a way as to effect optimal
  health care outcomes and maximize the potential
  of the health care system.

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Five Advantages to Statewide Protocols

• Standardization beyond protocols
• Curriculum
• Skills assessment
• Scope of practice
• Complaint investigation
• Drug list/ equipment list

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Five Advantages to Statewide Protocols

• Disaster preparedness
• Multiregional strike teams
• H1N1 example
• Blast/ explosive injuries example

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Effect of Statewide Protocols

• Patient Care Reports compared
• 7/1/06 12/31/06
• 7/1/07 12/31/07
• Electronic data (NHTSA data elements)
• 1.8 million PCRs/year
• Compared ALS protocol indicators for calls with
• ALS provider on crew
• Transport to hospital

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Conclusion

• States have variable adoption of statewide
  protocols
• Patients in rural and urban settings deserve the
  same high quality and consistent EMS care
• Reducing variability provides a higher quality
  and less expensive EMS care
• Statewide Protocol Advantages
• Uniformity
• Evidence-based
• Up-to-date
• Standardization beyond protocols
• Disaster preparedness

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? dkupas_at_geisinger.edu
Douglas F. Kupas, MD