---

HI,
I am new memeber
I always had a doubt in my mind,"why are there not any protocals in emergency room in India???".While most of the western countries have such protocals.Especially with large population as ours i think protocals will help us a lot. i want to know your opinion and can we do something about it??

---

Out of the hundreds of specialty hospitals in our country, there are but 4-5 which have independent emergency depts. And these 4-5 HAVE protocols similar to the West. Its only a matter of time before all emergency depts follow.

---

Protocols are very much required for ED.Main advantages of Protocols

1)Make things easier and simple and a structured approach to the patient/illness.
2)Protocols make sure that the proven stucture is followed and there is a least chance for medico-legal disputes.
3)Helps a lot in the training.

Protocols are either consensus/evidence based and depends mostly on the peers who run the department.

I think we need a proper triage system before thinking of protocols on ED in India.I hope it is on place in most of the places if not we need a Indian traige scale which will be harbinger for all protocols in future.

---

Hey guys...
Are we certainly talking about 'protocols' and not 'guidelines'. And remember there are also 'patient care-pathways'. These are entirely different from each other.
I feel that before developing protocols, it is a good idea to have some departmental guidelines. It has to be appreciated that it is extremely difficult to develop protocols (the person responsible for the protocol has to be backed with valid evidence applicable to the local settings and demographics, lest his neck could potentially be on the line!!!)

---

hi mr.maroju
as u said it is difficult to develop a new protocal
but how different is the management of a guy with STEMI in India compared to a guy in western country..not so different isnt it?
so why dont we just follow whats been followed for years in western countries.
MY POINT IS WE NEED TO MAKE OR FOLLOW PROTOCALS SO THAT WITH THE HIGH VOLUME OF PATIENT'S ANYBODY IN THE ER CAN START THE PROTOCAL EVEN WHEN THE DOCTOR IS ON HIS WAY.IN CASE HE IS NOT IN ER.

---

Hello shnmukesh

I couldn't agree with you more that we need some kind of a system to ensure proper patient care.

What I was alluding to earlier was regarding the 'semantics'. A guideline is defined as a statement or other indication of policy or procedure by which to determine a course of action. In contrast, a protocol is a precise and detailed plan for the study of a biomedical problem or for a regimen or therapy.

The effectiveness of a protocol hence would depend on the quality of evidence that it is based on. It also is dependant on the compliance by clinician or health provider. Guideline on the other hand, as understandable guides you as to what you should do in a given situation. It is not rigorous and does not certainly require you to abide by it. In other words, you could still use your clinical judgement based on the guidance.

Even in the 'west', I am sure, they do not have protocols for most conditions. But depending on the local set-up each organisation/institute may choose to develope their 'own' protocol.

Coming back to your example of STEMI, you could certainly use a protocol from any other hospital/ centre provided their service provision facilities and yours match well. Say, if they use PCIs as part of their protocol and your nearest PCI facility is 30 mins away, it may not work quite that well (Just an example... you may well have state of the art Angio suite!!!).

All said, one should certainly strive to put in the energy to create more protocols and improve health care provision. I am sure it would be well worth the effort.