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Reinventing the Wheel

How many times have EMS services reinvented the wheel regarding protocols? It's not uncommon to see social media posts asking if anyone is willing to share a protocol on a given subject. Depending on the reach of an individual's social media presence, they may get the answers they're seeking, or they may not. This can be frustrating since thousands of services have the protocol you're looking for but don't see your post. The next step is usually a quick Google search.

Google may or may not provide what you're looking for. There are specific systems that post their protocols publicly. Still, you're often left wondering if they're actually the most up-to-date version, or if this was the actual copy of the protocols the medical director signed off on, or if it's okay to use them. Even if you get your hands on a PDF version, it's still up to you to customize them for your service and re-draft them to meet your needs. Perhaps the most concerning is that the evidence for those protocols is usually missing, leading to a mystery surrounding their actual evidence base. It's worth noting that there are NAEMSO guidelines available that were updated in March of 2022. However, even with the availability of these guidelines, people have not stopped developing their own and customizing them, as they are not all-inclusive or universally applicable.

This problem is compounded by the resources often devoted to creating new guidelines. While some services will have a committee devoted to creating new guidelines, many services have a sole provider tasked with this massive responsibility. This is an antiquated and inefficient way to build protocols or guidelines, and many people are interested in finding a solution to this problem.

Help Needed

I've had multiple people reach out recently and ask if FOAMfrat would be willing to use our reach in the industry to help solve this problem or if we've ever thought of a solution. We need a way for services to share protocols, provide constructive feedback, provide evidence, and build a network to help consolidate information. This is not a small undertaking. We've given this problem quite a bit of thought over the past few months and would like to beta-test a solution called (evolution protocol).

We will host a forum with individual profiles that allows for posting and discussion of all topics involving prehospital medicine. Inside each section, files can be posted, and feedback can be given. If the community would find it useful for a given protocol, a draft combination protocol could be thought up and drafted in an editable format, like a Word (PC) and Pages (Mac) document, so people can customize them for their individual services. This is not meant to be some consensus guideline that rules over all other guidelines, but the community may find it useful for their purposes.

This level of organization will require several different roles. We'll need people who submit their guidelines, give feedback and provide evidence, can be moderators on the forum, and are good with Word and Pages programs to finally make a working protocol for people to edit (creating diagrams and flow charts). Everyone has different talents, so we'll need an assortment of people to make this work.


We have several concerns about this project. We've been talking to a few people about potential problems with a rollout like this. In no particular order, our concerns go like this:

Trolls - Anytime you have a project that involves people signing up online, posting things, and interacting in a group, you get trolls who want to watch the world burn.

Moderation - Everyone maintains a different standard for which they consider online behavior to be either acceptable or unacceptable. It's impossible to please everyone. There will inevitably be complaints about something someone posted. People will want someone removed because they did x, y, or z. We'll be looking for forum moderators with experience in these areas.

Accountability - Who's accountable for the information on this platform? When you think of the span of information available in these numerous protocols, it would be a tall order to fact-check every comment made, and I don't think that's the best way to approach this problem. Still, between forum members, moderators, and the host, we would make every effort to monitor the forum for incorrect information.

Super Users and Bias - If there are some users who are obsessed and believe they have all the correct answers for every situation, they may gain traction within the community. When any one person or small group seems to have authority in a forum, their views (accurate or not) may lead to bias in the information presented.

Copy and Paste - People may copy and paste guidelines without considering how those protocols should be customized to their service. While the alternative might not be any better, it could still be blamed on the platform.

And there are probably others we haven't thought of that will only come to light once the forum is up and running.

Imperfect Solutions

We have some solutions to these problems, but they're not perfect. We're certainly open to suggestions. And, of course, if the following solutions don't sound good to you, there is no obligation for anyone to use the platform.

Trolls - You can never completely eliminate trolls, but you can severely limit their ability to remain anonymous. We would implement a monthly subscription of 99 cents per month to tie a payment method to an email address and ensure the subscriber's identity. We would also require an accurate profile picture and name, the name of the service the person works for, and their job title. This is similar to the information you would place on LinkedIn; a link to that profile would be even better.

Moderation - Acceptable or unacceptable will be judged by the community with up-votes and down-votes. We must develop some community guidelines similar to what you see on a subreddit page. Hopefully, much of this will be negated by keeping the conversations strictly to the relevant medical topics.

Accountability - Each individual will need to perform their due diligence as regards what information they listen to. The community should provide feedback with evidence if something is in question or seems outdated or inaccurate. As the forum host, we would make every effort to assist in the accuracy of the information presented.

Super Users and Bias - This goes along with the accountability noted above. Everyone must research topics, read skeptically, and never take anyone's word for anything. The purpose of this platform will be to share knowledge in the hopes of building better guidelines for everyone.

Copy and Paste - While this will undoubtedly happen, the final decision to implement a protocol rests with the individual service and their medical director.

Beta Testing

We are currently building out the forum for beta testing and will select 25 people to best test. Beta testers will work in one protocol section to reduce the complexity during testing. After testing, if everything works out and the group seems confident that this would be useful to the EMS community, we'll release different sections to monitor the progress and see how everything plays out. We'll likely give it a month after we open it up and then have whichever beta testers are available to hop on a zoom meeting to discuss the project.

We'll close the applications for beta testers at the end of March and then give them the month of April to test (possibly sooner if testers are selected more quickly).

Here is the link to apply to be a beta tester: CLICK HERE


We hope to provide something of benefit to the EMS community with this project. If this subject interests you, please reach out if you have ideas for the project. There is an area for feedback and questions at the end of the application linked above.

We also know there may be a 'failure to launch' on this project, but we believe it's worth a try anyway.

Thanks for reading!

-The FOAMfrat Team


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