Something I found in the Iowa State EMS Protocols

I hold licensure in three states as well as my NREMT-P certification. This is partially because I work in both Illinois and Wisconsin but also because I used to work in Iowa and maintain my license as an Iowa EMT-Paramedic Specialist. I keep that license too.†Since Iowaís a National Registry state, itís a simple matter of forwarding them my National recert paperwork to keep it up. Also, because Iím umÖ ďRather OpinionatedĒ and one never knows when Iíll get ran out of a state with pitchforks and torches from the townsfolk, I need a backup plan.

Oh, and I like being called a ďSpecialistĒ in something. Cool, huh? Iím Special, it says so right here on this card I carry. ďEMT-PSĒ

Today, my friend Google landed me on the web link for the new revision of the Iowa State EMS protocols (Revision Aug 2009) and I had the chance to study up on them. Thereís some interesting things in there. You can find the link below.

While they arenít as advanced as the EMS protocols that I function within in Wisconsin, there is something I found in there that I really like and want to bring to the attention of the EMS 2.0 crowd.

- From the Iowa State EMS Protocols Ė August 2009 Revision

APPENDIX D GUIDELINES FOR NEW PROTOCOL DEVELOPMENT A RATIONAL DECISION MAKING PROCESS*

(Also can be used to evaluate existing protocols) Making a decision to develop a new protocol or evaluate an existing one should be based on a rational process. Questions that should be asked and answered when considering a new drug therapy or procedure are as follows:
Key Questions for any New Protocol
1) Is the drug therapy or procedure medically indicated and safe?
2) Is it within the scope of practice for the provider?
3) How specifically will this protocol benefit patient care?
4) What specifically is needed to implement this protocol (education/training, medical director protocol development/authorization, equipment needs, etc.)?
5) How will this protocol impact operations?
6) What is the opinion of providers concerning this protocol?
7) Does the medical community support this protocol change?
8) What are all the costs versus benefits associated with implementation and maintenance?
9) What are the medical-legal implications?
10) What ongoing provider involvement such as skills maintenance and continuous quality improvement is necessary?
11) How will success be measured?

Rational Protocol Development Process to Make the Right Protocol Decision
1) Study the issue thoroughly
2) Identify key questions
3) Compare with goals
4) Assess fit with system
5) Cost benefit analysis
6) Identify measuring tools

Stakeholders in this process are recognized to include, but not be limited to:
2) Medical direction (on-line and off-line)
3) Educators/training programs
4) Regulators of policy and rules
5) Service directors
6) Service providers
7) Consumers
8) Third party payers

*Developed based upon discussion at the October 1998 meeting of the Quality Assurance, Standards, and Protocols subcommittee of the Iowa EMS Advisory Council; and on concepts from the article ĄWhen to Implement Clinical Protocol Change?í From EMS Best Practices September 1998.

My understanding of the Iowa State EMS system is that they have mandatory state EMS protocols that all providers must adhere to. Each service may have a medical director, who may choose to use the state protocols†at their base level, or may choose to add additional protocols†for more advanced treatment.†

HuhÖ A state that says ďThis is the minimum standard weíll hold you to. Now go make them better and report†back to usĒ Then actually†gives each individual paramedic and EMT the†logical framework to evaluate ideas and make revisions and†improvement?†

Also, and this is just HUGE. A state that posts the name and phone number of the State Director of EMS on the protocolsÖ Know what? He actually answers his phone. I know, Iíve called him.

Bravo State of Iowa EMS. Bravo a lot.

  • tclemans

    Asking paramedics on the front lines to explore new ideas is definitively EMS 2.0. Great job Iowa!

  • http://www.lifeunderthelights.com Ckemtp

    Ha! I just realized that WordPress reads “8)” as a smiley face with sunglasses. I'm going to leave it like that… but just thought that you should know that I didn't make it that way on purpose.

  • http://www.medicthree.fireemsblogs.com medicthree

    Now if we could just get them to quit calling Intermediate's paramedics…. I think their new system does that, doesn't it?

    If you're interested in progressive check out Minnesota. I'm sure similar to your WI system. But, when you want another progressive system, have a looks at Ida County, Idaho. Some say it is the most progressive system in the country–if nothing else, their protocol book is pretty.

    • http://twitter.com/Paranemec Devin M Nemec

      There was a proposal to eliminate their “Paramedic” level and combine it with AEMT or upgrade to Paramedic when they switch to the new guidelines.

  • http://www.medicthree.fireemsblogs.com medicthree

    Now if we could just get them to quit calling Intermediate's paramedics…. I think their new system does that, doesn't it?

    If you're interested in progressive check out Minnesota. I'm sure similar to your WI system. But, when you want another progressive system, have a looks at Ida County, Idaho. Some say it is the most progressive system in the country–if nothing else, their protocol book is pretty.

  • http://www.medicthree.fireemsblogs.com medicthree

    Now if we could just get them to quit calling Intermediate's paramedics…. I think their new system does that, doesn't it?

    If you're interested in progressive check out Minnesota. I'm sure similar to your WI system. But, when you want another progressive system, have a looks at Ida County, Idaho. Some say it is the most progressive system in the country–if nothing else, their protocol book is pretty.

  • Chodyb

    In Iowa, the protocols are not mandatory. It is more of a minimum “standard”. Medical Directors have the right to omit or add whatever they see fit.

    • Ckemtp

      Good point, and that’s honestly what I like about them… The state sets the minimum, and expects it to be expanded upon.

  • http://twitter.com/Paranemec Devin M Nemec

    I hold a license in both Iowa (EMT-PS) and wisconsin (EMT-P). I just read the both states scopes for all levels about a week ago and never realized how far ahead WI’s basics and intermediates were. On the flip side, at the paramedic level (or paramedic specialist for iowa) both states had things the other did not. I didn’t even know Iowa had state protocols, I haven’t been on their website since 2005.

    • Ckemtp

      I’m an Iowa PS and a Wisconsin Paramedic as well. It’s facinating (and infuriating at times) that the people in both states have the same anatomy and physiology yet seem to require different treatments… Illinois is even worse, don’t even get me started on us FIBs.

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.
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