How a Proposal For Change Becomes a Protocol
The Academy maintains a single Unified Protocol, with no variants, that introduces changes to the standards in an orderly manner which is then provided to all users of the protocols throughout the world. Because all communication centers everywhere use the same protocol, the valuable experience, useful ideas, and specific research from each center can then be shared with all protocol users around the world via the submission of Proposals for Change (PFC).
PFCs are first reviewed by a group of experts known as the Raters. The Raters is a subcommittee of the Council of Standards that gives an initial rating to each PFC. The rating system helps the council arrive at effective decisions and provides early identification of PFCs that require further research.
The rated PFCs are then passed on to the Readers Group of the Council of Standards. We affectionately call the Readers the “worker bees”, because they research, evaluate, discuss, and debate each PFC to determine its clinical and functional soundness, dispatch relevance, and potential for logical implementation in to the MPDS, PPDS, FPDS, and ECNS. The Readers Group is responsible for accepting, modifying, rejecting, or referring to the Research Council each of the hundreds of PFCs received between protocol versions. These volunteers meet once or twice between protocol versions for the duration of a week or more each time. The Academy also has several specialty councils (resuscitation, obstetrics, and special rescue to name a few) that may meet separately when their specific expertise is needed.
After the Readers have completed their work, the Research and Standards team begin the production cycle for the new protocols. Each approved PFC is converted into an internal proof sheet which gives detailed instructions for the precise changes required by the PFC and provides area for each specialist in the production cycle to implement, test, and sign off.
Carrying out the changes from the proof sheets inevitably involves tackling unforeseen problems, especially while implementing the changes into the complex logic structure of the automated protocol system, ProQA. These challenges are resolved through continual communication with the Readers Group. When special intricacies must be addressed on things basically approved by the Readers, another group, the Rules Committee, is given the task of finalizing these details for final inclusion. When the full Council of Standards votes on the new protocol version, any issues, concerns, or no votes received from this broad group of international experts are considered and worked out by Rules.
Eventually, as proof sheets are finalized and production on the manual cardset protocols continue, the Academy opens up the software protocol to beta sites for testing. Beta testing provides a very important check and balance system.
Meanwhile, the Curriculum Boards are making updates to their course materials including instructor slides, course manuals, certification exams, recertification exams, and case entry pads to name a few. Concurrently, translators busily adapt all of these materials into multiple languages and dialects.
Once the protocols have been thoroughly tested and determined to be complete, the entire protocol is then sent to full Council of Standards for formal voting. A 75% or greater approval must be obtained for the protocols to be ratified. Only after final approval can the manual cardsets and all related materials be sent to the printer. These final steps can take up to three months.
After council approval, the IAED then calls for the International Cultural Committees of the Council of Standards to formally review the new protocol for all language and cultural-based nuances before the protocols are officially released in 21 languages throughout 45 countries.
Because we process hundreds of PFCs for each protocol version, it may be some time before notification is received from the Academy regarding the status of Proposals For Change or see the results in the MPDS, FPDS, PPDS, or ECNS. This timeframe depends on many factors including when PFCs are received in relation to our continuous method for protocol evolution.
Keep in mind, however, that the Raters Groups of each discipline reviews all PFCs as they are received and if an urgent need is detected, a special process may be utilized to effect a change in software as soon as possible.